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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 015700372
Report Date: 08/02/2022
Date Signed: 08/02/2022 12:12:37 PM

Document Has Been Signed on 08/02/2022 12:12 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
CCLD Regional Office, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
FACILITY NAME:RUVALCABA, SUSANAFACILITY NUMBER:
015700372
ADMINISTRATOR:RUVALCABA, SUSANAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(408) 981-4017
CITY:NEWARKSTATE: CAZIP CODE:
94560
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 1DATE:
08/02/2022
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
11:31 AM
MET WITH:Susana Ruvalcaba- LicenseeTIME COMPLETED:
12:25 PM
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On 8/2/22 at 11:31am, Licensing Program Analyst (LPA) Briana Plumboy conducted an announced Relocation/Prelicensing Site Inspection with Licensee Susana Ruvalcaba for an ANNOUNCED RELOCATION INSPECTION as well as an increase in capacilty. Present for the inspection was licensees minor age son whom is included in her ratio at this time. Licensees husband also resides in the home. The home was toured with the licensee to conduct a health and safety inspection. Hours of operation for day care are Monday through Friday, 24 hours a day. Licensee is aware a child in care may not stay at her home for a 24 hour or more period.

The home is single story. The home consists of the following rooms: living room, kitchen, 2 bedrooms, a master bedroom with master bathroom, hallway bathroom, and garage. The home is neat and clean with heating and ventilation for safety and comfort. The licensee has requested the OFF LIMIT AREAS BE: the first bedroom on the left side of the hallway, the master bedroom with master bathroom, the kitchen, and the garage . There is a child gate located across the entrance to the kitchen to prevent access to children in care. The licensee has requested the following rooms be ON LIMITS - the hallway bathroom, the first bedroom located on the right side of the hallway, and the living room. The ISOLATION AREA will be the hallway. BACKYARD play area is completely fenced. The licensee will only use the left side of the backyard for children in care. There is a fence to prevent access to the right side of the backyard. On the left side of the backyard there is a shed which is used as storage and has a child safety knob cover to prevent access to children in care. There is also a sandbox located in the on limit area in the backyard and licensee is aware to maintain it and keep it free from outside debris. There are no play structures present today which are required to be anchored. There are toys and learning materials present at the facility during today's inspection. There are no pools, hot tubs or any other bodies of water on the premises during today's inspection.

The home has a fully charged 3A40BC fire extinguisher, pull down fire alarm, working smoke detector, working carbon monoxide detector, and working telephone. The licensee’s Health and Safety training is completed and CPR and First Aid certificate is current and expires 8/28/23. The licensee's mandated reporter training is complete and she received a certificate of completion on 6/16/21. The licensee is in compliance with the immunization law which pertains to day care providers. There is a water heater located in the garage which is an off limits area to children in care. Per licensee, there are no firearms in the home. A copy of the lease was reviewed and shows control of property.

See 809-C for continuance
SUPERVISORS NAME: Wynn Norona
LICENSING EVALUATOR NAME: Briana Plumboy
LICENSING EVALUATOR SIGNATURE: DATE: 08/02/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/02/2022
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
CCLD Regional Office, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
FACILITY NAME: RUVALCABA, SUSANA
FACILITY NUMBER: 015700372
VISIT DATE: 08/02/2022
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Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Family Child Care Homes Section 102417. 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)/ (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

Licensee is reminded that ALL assistants, volunteers, frequent visitors, or adults living in the home, that are 18 years of age or older must be fingerprint cleared and associated to this facility prior to being in the presence of children in care or an immediate civil penalty will be assessed from $100 to $3000 per person, per incident. Licensee was reminded of the responsibility as a mandated reporter. All forms can be downloaded at www.ccld.ca.gov

For licensing updates email childcareadvocatesprogram@dss.ca.gov and ask to be added to the email list.

The licensee is reminded any structural changes to the home or additions to the child care facility must be reported to Community Care Licensing. Also, any adults moving into the home must be reported to Community Care Licensing prior to them moving in and all requirements must be met before the person lives in the facility. Licensee was reminded of Departments inspection authority, with our without any notice.

California Law requires Family Child Care Home licensees to report unusual incidents or injuries to children in care to child's parents and to the Department of Social Services using the Unusual Incident/Injury form (LIC 624). Incidents must be reported within 24 hours by phone, fax, or electronic mail. Roster of the children must be properly maintained and fire/disaster drill every six months must be documented.

On 7/26/22, a fire clearance was granted to facility #015700372 by Newark Fire Prevention. All documents have been received for the increase of capacity/relocation application. The Licensee was reminded that an assistant is needed with a large family child care home license, and whenever an assistant is not present, the licensee will comply with the capacity requirements for a small family child care home.



This home is recommended for licensing as of 8/2/22. There are no deficiencies cited. This entire report has been read to the Licensee by LPA Plumboy. The licensee is aware the signature on this report confirm receipt of these documents. LPA asked the licensee if the licensee had any questions pertaining to any aspects including, but not limited to, any part of this report and of the documents given to the licensee, and per licensee, there are no further questions at this time. Licensee is aware at anytime she can reach out to LPA Plumboy or CCLD. This report shall remain on file for 3 years. Exit interview conducted.
SUPERVISORS NAME: Wynn Norona
LICENSING EVALUATOR NAME: Briana Plumboy
LICENSING EVALUATOR SIGNATURE:

DATE: 08/02/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/02/2022
LIC809 (FAS) - (06/04)
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