274416068-10-12-2023-07-CC-FCJO-CWK2S3-20231012173825

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 274416068
Report Date: 10/12/2023
Date Signed: 10/12/2023 05:38:37 PM

Document Has Been Signed on 10/12/2023 05:38 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
SAN JOSE CC RO, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME:	POMPA, DIOSELINA		FACILITY NUMBER:	274416068
ADMINISTRATOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY: 8	TOTAL ENROLLED CHILDREN: 4	CENSUS: 1	DATE:	10/12/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	08:38 AM
MET WITH:	Dioselina Pompa		TIME COMPLETED:	12:05 PM

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	Licensing Program Analysts (LPA) Fermin Campos-Jaramillo conducted an unannounced annual inspection to the home today. LPA met with licensee Dioselina Pompa, and explained the nature of today's inspection to her. Licensee has submitted also to this Licensing Program an application for increase of capacity. Days and hours of operation are Monday to Friday from 5:00 AM to 6:000 PM. The adults that reside in the home are the Licensee, her adult children Yuritzi and Michael, her in law Carmen, and her nephew Jose. Also in the home resides licensee's minor children 16 and 10 years old, and grandchild 2 years old. Licensee was not providing child care today. Licensee's grandson child was in care of the licensee daughter in law. Licensees' certifications for CPR and First Aid card is current and will expire on 3/19/24. Licensee has obtained a fire inspection clearance by the City of Salinas Fire Department on 10/05/23. LPA toured the indoor and outdoor areas of the single story home during today's inspection. LPA obtained a copy of the Child Care Facility Roster and it is current. Licensee has documented fire drill at least one every six months, last fire drill was documented on 7/07/23. The Licensee has a working telephone in the home. LPA observed sufficient materials, toys, and play equipment for the day care children. LPA observed there are not wall heaters in the home. Off limit areas in the home are: 4 bedrooms, one bathroom, and the attached garage. LPA observed there are no stairs in the home. Licensee understands that the use of the garage is not permitted for childcare according with the fire inspection clearance document. Off limits outside areas: The right side yard and front yard. LPA observed the home has a back yard and it is fenced. Licensee uses the back yard as playground. LPA observed a fully charged 2A10BC fire extinguisher last time serviced on 7/14/23, working smoke detectors and no bodies of water. LPA observed a working carbon monoxide detector in the home. Licensee states that she does not have any weapons in the home. All detergents, cleaning compounds, medications, and other similar items are stored inaccessible to children. LPA observed the laundry area is located within the off limits garage. LPA observed Licensee has previously submitted proof of immunization for pertussis, measles and influenza according with the SB792. ***********************************Report dated 10/12/23 continues in page 2.

SUPERVISORS NAME: Susy Cervantes
LICENSING EVALUATOR NAME: Fermin Campos-Jaramillo
LICENSING EVALUATOR SIGNATURE:	DATE: 10/12/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/12/2023

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

FACILITY NAME: POMPA, DIOSELINA	FACILITY NUMBER: 274416068
	VISIT DATE: 10/12/2023

NARRATIVE

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Report dated 10/12/23 continues from page 1.

Supervision of children was discussed with the Licensee and she understands that she must be present in the home during day care hours and ensure that the children are supervised at all times. Licensee was informed that if eventually a large license is granted, the maximum capacity is 14 and a helper is required to be present whenever there are more than 8 children in care and ratio (age of the children) must be observed. Licensee understands that in absence of a qualified helper, her license capacity automatically returns to capacity 8 and ratio must be observed as well. Licensee understands that the children residing in her home count as part of the capacity of the license. The Licensee states that she transports children via vehicle and she understands that children cannot be left in parked vehicles unattended at any time.

Department website: www.ccld.ca.gov provided to Licensee.

LPA discussed the requirements of AB 633 with the Licensee. LPA also discussed "zero tolerance" related regulations with the Licensee. LPA observed that licensee has completed the required "mandated reporter" training on 3/09/22. Licensee understands the training must be renewed every two years.
LPA referred the licensee to the training website www.mandatedreporterca.com for additional information.
A review of staff records on 10/10/23 indicates that all Facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions.
Licensee was reminded that all the adults 18 and over living or working in the home, 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.
LPA discussed the safe sleep regulations with licensee and discussed the Child Care Licensing Safe Sleep web page at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-andresources/safe-sleep as an additional resource.

Report dated 10/12/23 continues in page 3

SUPERVISORS NAME: Susy Cervantes
LICENSING EVALUATOR NAME: Fermin Campos-Jaramillo
LICENSING EVALUATOR SIGNATURE:	DATE: 10/12/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/12/2023

LIC809 (FAS) - (06/04)

Page: 2 of 3

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN JOSE CC RO, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME: POMPA, DIOSELINA	FACILITY NUMBER: 274416068
	VISIT DATE: 10/12/2023

NARRATIVE

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******************Report dated 10/12/23 continues from page 2.

LPA also informed licensee 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.

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)/ (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: https://www.ada.gov/resources/child-care-centers/.

To improve the quality and value of the new inspection process, a survey may be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or CARE tools, please send email inquiries to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/inspection-process.

Licensee was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain child care by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.

During the exit interview, the LICENSEE Dioselina Pompa confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS.

Exit interview conducted and report was reviewed with the licensee Dioselina Pompa.
No deficiencies were cited today.
A notice of site visit was handed to licensee and must remain posted for 30 days.
Licensee Dioselina Pompa was informed that a large Family Child Care Home license would be approved pending on the following: 1) Approval from a manager of the Licensing Program.

SUPERVISORS NAME: Susy Cervantes
LICENSING EVALUATOR NAME: Fermin Campos-Jaramillo
LICENSING EVALUATOR SIGNATURE:	DATE: 10/12/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/12/2023

LIC809 (FAS) - (06/04)

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