274416024-9-15-2021-07-CC-SCES-C6VNTC-20210915104432

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 274416024
Report Date: 09/15/2021
Date Signed: 09/15/2021 10:44:42 AM

Document Has Been Signed on 09/15/2021 10:44 AM - 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, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME:	GODINEZ, ALMA		FACILITY NUMBER:	274416024
ADMINISTRATOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY: 8	TOTAL ENROLLED CHILDREN: 0	CENSUS: 0	DATE:	09/15/2021
TYPE OF VISIT:	Prelicensing	ANNOUNCED	TIME BEGAN:	09:30 AM
MET WITH:	Alma Godinez		TIME COMPLETED:	10:50 AM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	On 09/15/2021 at 9:30 AM, Licensing Program Analyst, LPA, Susy Cervantes met with applicant, Alma Godinez and conducted a pre-licensing visit for location change and in this facility. Applicant's current license is #274416013 which is located at 617 Fremont St., Salinas, CA 93905. Applicant stated that adult living in the home are applicant, their spouse Julian and daughter Mytzy with two children ages 17 and 11. Applicant owns the house. Applicant has liability insurance and they understand that if they decide not to carry liability insurance in the future, they will have parent/authorized representative sign the Affidavit Regarding Liability Insurance for FCCH form (LIC 282). The days and hours of operation will be Monday - Friday from 5:30 am to 6:00 pm. A listing of staff criminal record clearances associated to previous facility in the CCL Licensing Information System (LIS) on 09/15/2021 was reviewed; and it indicates that all Facility staff or other individuals who require caregiver background clearances have received criminal record and child abuse index clearances or exemptions. LPA reminded Applicant of the applicable civil penalties for those adults who have not received fingerprint clearances, are not associated to the license and who come in contact with or provide care and supervision to the children. Penalty amounts: $100.00 per person per day, minimum of $100.00 to a maximum of $500.00 per person for an initial violation and a minimum of $100.00 to a maximum of $3000.00 per person for any subsequent violation within a 12 month period. The entire home was inspected inside and outside. The home had a working smoke detector and carbon monoxide detector, a working telephone and a 3A40BC fire extinguisher that was last serviced on 05/24/21. Certifications for CPR and First Aid expire on 07/18/22. Preventative Health Practices training and the lead component is on file. Mandated Reporter training for Child Care Workers AB 1207 was completed on 01/05/21. Applicant has on file Immunization's for Measles Pertussis and Influenza. *Continues on report dated 09/15/2021*

SUPERVISORS NAME: Mary Segura
LICENSING EVALUATOR NAME: Susy Cervantes
LICENSING EVALUATOR SIGNATURE:	DATE: 09/15/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/15/2021

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, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME: GODINEZ, ALMA	FACILITY NUMBER: 274416024
	VISIT DATE: 09/15/2021

NARRATIVE

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Continuation of report dated 09/15/2021

LPA observed no stairs, no bodies of water, no wall heaters, and covered fireplace. Licensee stated there is a dog and is vaccinated. Applicant stated there are no firearms/weapons in the home. Off limit areas inside: three bedrooms and one bathroom. The backyard is fenced. There were age appropriate toys in the day care areas. Bathroom was clean. Medication, cleaning products, hazardous and sharp objects were inaccessible to children and stored in the top cabinets in the kitchen and child care room. Discipline policy was discussed with applicant and she understood that the children's personal rights should not be violated and corporal punishment is not allowed. Applicant stated their discipline method will be speaking to children and redirection. Applicant will not transport children but understood the safety seat belt/car seat requirements.

A Family Child Care Home packet was reviewed with applicant. Department's website: www.ccld.ca.gov to obtain forms and regulations CCR, Title 22 was provided. Applicant was advised on the regulations that smoking, baby walkers, bouncers, excersaucers and other similar items are not allowed. The following was discussed, safe sleep and LIC 9227, isolation of sick children; supervision of children; capacity options; requirements for reporting suspected child abuse; unusual incident/injuries; fire drills practiced at least twice a year and documented. LPA also discussed the requirements of AB 633 to applicant and provided applicant the fact sheet and a copy of Acknowledgement of receipt of Licensing Reports (LIC 9224). Zero Tolerance with $500 civil penalty also explained to applicant.
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Incident 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) 415-0301 (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.

LPA conducted an exit interview with the Applicant in Spanish. LPA advised applicant that Licensure for a large family child care home is granted pending:
- Fire Department Clearance
- Management's approval.

SUPERVISORS NAME: Mary Segura
LICENSING EVALUATOR NAME: Susy Cervantes
LICENSING EVALUATOR SIGNATURE:	DATE: 09/15/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/15/2021

LIC809 (FAS) - (06/04)

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