073409493-5-9-2024-02-CC-BGOY-D54QUR-20240509122911

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 073409493
Report Date: 05/09/2024
Date Signed: 05/09/2024 12:30:01 PM

Document Has Been Signed on 05/09/2024 12:30 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
OAKLAND CC RO, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612

FACILITY NAME:	NOGUERA, ANA		FACILITY NUMBER:	073409493
ADMINISTRATOR/ DIRECTOR:	ANA NOGUERA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(415) 632-2638
CITY:	PITTSBURG	STATE: CA	ZIP CODE:	94565
CAPACITY: 14	TOTAL ENROLLED CHILDREN: 0	CENSUS: 0	DATE:	05/09/2024
TYPE OF VISIT:	Prelicensing	ANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	08:30 AM
MET WITH:	Ana Noguera		TIME VISIT/ INSPECTION COMPLETED:	12:30 PM

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On 5/9/24, Licensing Program Analysts (LPAs) Brindha Govindasamy and Diana Campos conducted an announced Pre-licensing inspection for a Large Family Childcare home and met with applicant Ana Noguera. LPA's disclosed the purpose of the inspection and was granted entry into the facility by the applicant. Applicant resides in the home with her fingerprinted spouse and 3 minor children. Applicant was reminded that when her minor child under 10 years is present during day care hours, applicant will comply within the ratio. The facility was toured to conduct a health and safety inspection. Applicant plans to operate Monday through Friday from 6:30am to 6:00pm.

This home is double story house consisting of 4 bedrooms, 2 1/2 bathrooms, a living room, kitchen, 2 garage and fenced backyard. The home was observed to be neat and clean with heating and ventilation for safety and comfort of the children.

Indoor (Level 1) :

On-limit-areas are: Bedroom 1 ( Classroom 1), Closet, 1/2 Bathroom, Living room (Classroom 2 ), Additional Converted Room (Classroom 3 - Playroom/ Activities) and Hallway outside bathroom.

Isolation area: Couch Classroom 2

Off-limit-areas are: Kitchen/ Dining area (gated),Garage 1 and Laundry Area.

(Level 2) :
Entire Second Floor is Off Limits. Master Bedroom, Master Bathroom, Closet,
Hallway, Hallway Cabinet, Bathroom 2, Bedroom 2, Bedroom 3.

Outdoor play area: Backyard, Garage 2.
Outdoor Off limits : Planters, Left Side Yard

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SUPERVISORS NAME: Sherelle Johnson
LICENSING EVALUATOR NAME: Brindha Govindasamy
LICENSING EVALUATOR SIGNATURE:	DATE: 05/09/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/09/2024

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)

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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
OAKLAND CC RO, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612

FACILITY NAME: NOGUERA, ANA	FACILITY NUMBER: 073409493
	VISIT DATE: 05/09/2024

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There are age-appropriate toys which are observed to be safe, clean and in good repair. There are no bodies of water observed. LPA did not observe any toxins accessible to children during today’s inspection. Per Applicant there are no firearms in the home. The house has centralized heating, barricaded fire place and gated stairs to prevent access by children. Off limits areas are made inaccessible by closed and/or locked doors, gates, and visual supervision.

The home has a fully charged 3A40BC fire extinguisher that meet the state standards. There is a working smoke detector and a plug-in carbon monoxide detector and a working telephone. The applicant’s CPR certificate expires on 12/2025 and the Mandated Reporter Certificate expires on 3/17/2026.

Applicant was reminded that all adults 18 and over living in the home, persons who provide care and supervision to children, and staff who have contact with children, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a licensed Family Child Care Home. A civil penalty of $100.00 minimum/day for a maximum of 5-days or, if the penalty is for a repeat violation, for a maximum of 30-days per person will be assessed if this regulation is violated.

Applicant provided proof of control of property.

Fire Clearance was granted 1/25/2024.

Applicant was reminded that an assistant is needed with a large family childcare home license and whenever an assistant is not present, the licensee will comply with the capacity requirements for a small family childcare home. Parent Notification LIC 9150

must be provided to parents when caring for more than 12 children.

Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02-CCP. When any IMS is provided, a Plan for Providing IMS must be submitted to the Department. The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice) or (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: http://www.ada.gov/childqanda.htm.
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SUPERVISORS NAME: Sherelle Johnson
LICENSING EVALUATOR NAME: Brindha Govindasamy
LICENSING EVALUATOR SIGNATURE:	DATE: 05/09/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/09/2024

LIC809 (FAS) - (06/04)

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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
OAKLAND CC RO, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612

FACILITY NAME: NOGUERA, ANA	FACILITY NUMBER: 073409493
	VISIT DATE: 05/09/2024

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LPA reviewed with applicant the LIC 311D, Forms/Records to Keep in Your Family Child Care Homes, children’s forms/records, facility forms/records, and information to be posted. Entrance Checklist was provided to the applicant.

Applicant was reminded to inform CCLD before making any changes to ON LIMIT or OFF-LIMITS areas. LPA reviewed fingerprint, TB and flu requirement once child is 18 years old with applicant..

LPA discussed the safe sleep regulations with applicant and discussed the Child Care Licensing Safe Sleep webpage at: https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep, as an additional resource. LPA also informed of the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at: https://www.cpsc.gov/,and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment.

On this date, 05/6/2024, the California Attorney General - Megan’s Law website was searched for information on sex offenders required to register with local law enforcement under California's Megan's Law. No registered sex offenders were found at the facility addresses. Under state law, some registered sex offenders are not subject to public disclosure; therefore, they may not have been included in this search. However, the Department conducts a monthly cross reference of each address on record for all registered sex offenders against all CCLD facility addresses pursuant to information shared by California DOJ.

Applicant was informed of the MyChildCarePlan.org site, a consumer education website that helps families obtain childcare by connecting them to childcare providers and Resource and Referral Agencies (R&Rs) throughout California.

Website links for provider resources:

Licensing forms, Title 22 regulations, can be obtained through the internet at www.ccld.ca.gov.
Guardian Background Check: www.guardian.dss.ca.gov
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SUPERVISORS NAME: Sherelle Johnson
LICENSING EVALUATOR NAME: Brindha Govindasamy
LICENSING EVALUATOR SIGNATURE:	DATE: 05/09/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/09/2024

LIC809 (FAS) - (06/04)

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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
OAKLAND CC RO, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612

FACILITY NAME: NOGUERA, ANA	FACILITY NUMBER: 073409493
	VISIT DATE: 05/09/2024

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Community Care Licensing Division (CCLD) regularly sends information to licensed facilities, providers, and stakeholders by way of Provider Information Notices (PIN), Program Quarterly Update Newsletters and other important information communication platform. To receive important licensed-related information to licensed facilities, visit the CCLD Important Information website at https://www.cdss.ca.gov/inforesources/community-care-licensing/subscribe and select the Child Care option to receive email communication.

Applicant agreed to make the following corrections before license can be granted: Submit corrections no later than 05/30/24.

1. Cover the Electricity outlet and Rod
2. Sprinkler
3. Trim low tree branch with thorns.
4. Fix backyard unstable fence slate .

Licensure for LARGE FAMILY CHILDCARE HOME upto 14 is contingent upon a final review and manager’s approval / plan of corrections. Exit interview conducted and report was reviewed with the Applicant Ana Noguera.

SUPERVISORS NAME: Sherelle Johnson
LICENSING EVALUATOR NAME: Brindha Govindasamy
LICENSING EVALUATOR SIGNATURE:	DATE: 05/09/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/09/2024

LIC809 (FAS) - (06/04)

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