304313930-9-8-2021-06-CC-KDEI-C6NQLX-20210908121640

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 304313930
Report Date: 09/08/2021
Date Signed: 09/08/2021 12:17:12 PM

Document Has Been Signed on 09/08/2021 12:17 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, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868

FACILITY NAME:	RAGSDALE-VAZQUEZ, RACHEL		FACILITY NUMBER:	304313930
ADMINISTRATOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY: 8	TOTAL ENROLLED CHILDREN: 0	CENSUS: 0	DATE:	09/08/2021
TYPE OF VISIT:	Prelicensing	ANNOUNCED	TIME BEGAN:	10:00 AM
MET WITH:	Applicant Ms. Ragsdale-Vazquez Rachel		TIME COMPLETED:	12:40 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 Analyst (LPA) Ketki Desai, conducted an announced in-person Pre-Licensing inspection for a new Small Family Child Care home. LPA met with applicant Ms. Ragsdale-Vazquez Rachel who provided a tour of the new home. LPA observed Applicant wearing face mask, and following CDC and Dept of Public Health Guidelines. A review of the Facility Personnel Report Summary indicates adult resident, who require caregiver background check clearances exemptions is received and is cleared. Applicant stated, she is not currently registered with any Resource Foster Care agency or holds a Resource foster parent license. Applicant was reminded if changes to notify the licensing office. Per Applicant, operation hours will be Monday to Friday, 7.00 AM to 6.00 PM and care and supervision shall be provided to children ages 2 years to 10 years of age (Pre-school to School age) All areas identified on the facility sketch were inspected, including but not limited to, off limit areas. This is a two story single family home with three bedrooms and two and half bathrooms/ Living room / Kitchen with dining area / an attached garage / Side and back yard. Currently there are no children receiving care and supervision. Areas that will be used by children were inspected for safety, comfort, cleanliness, telephone service (cell phone), ventilation and heating. The home has central air and heating system. A/C unit is placed on the right side yard . Not accessible or visible to children. Detergents, cleaning compounds, medicines, sharp objects and hazardous items that can pose a danger to children are inaccessible in areas designated for children. Applicant states (that there are no poisons on the premises). Applicant was advised that any poisons must be locked with a key or combination lock. (1)

SUPERVISORS NAME: Thuy Ho
LICENSING EVALUATOR NAME: Ketki Desai
LICENSING EVALUATOR SIGNATURE:	DATE: 09/08/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/08/2021

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, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868

FACILITY NAME: RAGSDALE-VAZQUEZ, RACHEL	FACILITY NUMBER: 304313930
	VISIT DATE: 09/08/2021

NARRATIVE

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Based on the Facility Sketch submitted, areas off limits to children and parents are: Upstairs : Three bedrooms, two full bathrooms / kitchen / Right side yard and the attached garage.

There is a stairway in the home, leading to the second level of the home, it has a child safety gate installed making the second level (3 bedrooms, two bathrooms ) inaccessible to children. Garage is accessible through the door next to the bathroom and it has a bolt lock installed, as well as a top latch stopper making it inaccessible. Kitchen has a safety gate and all the cabinets have child safety locks installed. There is a fire place in the living area, Applicant has installed a safety latch on the glass door making it safe. There is also an Adult size Trampoline in the backyard it is made inaccessible by installing several zip ties. There is also a second Fire place in the backyard but needs a safe barrier across it. Laundry room is in the garage. All chemicals/ detergents are stored in the garage.

Applicant understands that licensing staff may have access to off-limit areas during inspection visit if necessary.

Areas Designated for Day care activities: Children shall enter the home through the front gate of the home into the designated Day care area the living area. Applicant has a set up an area for temperature check and hand sanitizing station upon entrance into the living area. Child masks shall be offered if needed.

Applicant has designated the living room/ dining area and one bathroom in the small passage area on the left side with garage door next to it , open back yard and the left side yard as the designated for Day Care activities.

The designated Day Care activity area( Living room) was observed to be spacious and applicant has set up the room with toys and educational items for the children. The designated bathroom is located on the left side of the passage and it was observed to be safe and free of hazardous items. There is a cabinet under the sink, which was empty and bathroom was clean.

Applicant shall to use mats with linens during nap time, all blankets shall be provided by the parent and sent home on a weekly basis. Children shall nap in the living area. Day care area is safe and appropriate set up was observed

OUTDOOR PLAY AREA: Per Applicant, children shall use the back & left side yard for outdoor activities, it is shaded and completely fenced with concrete and grass flooring. Applicant has set up the outdoor activity area for enrolled children. It has several outdoor toys with water table/ climbing structure. (Page-2)

SUPERVISORS NAME: Thuy Ho
LICENSING EVALUATOR NAME: Ketki Desai
LICENSING EVALUATOR SIGNATURE:	DATE: 09/08/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/08/2021

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, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868

FACILITY NAME: RAGSDALE-VAZQUEZ, RACHEL	FACILITY NUMBER: 304313930
	VISIT DATE: 09/08/2021

NARRATIVE

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Trampoline in the back yard is for their personal use only. Applicant has installed zip ties to prevent access to Day care children.
Applicant has a Fire Extinguisher along with Smoke and Carbon Monoxide detector.

Applicant plans to provide the Breakfast/ AM/PM snacks with Lunch to the enrolled children and is also in process of enrolling in the Food Program. Till the enrollment is completed, children shall bring their own lunch on a labeled container.

Applicants have completed the required Health and Safety with Nutrition and Lead Poisoning component Training and Pediatric First Aid and CPR which expires on 9/2023.
There are first aid supplies available. Applicant has one pet cat in the home.

Per applicant there are no weapons or bodies of water in the home. The home was clean, orderly, and at a comfortable temperature.

The following was discussed with the applicant:
Individuals who are 18 years of age or older living in the home must obtain a criminal record clearance. Individuals within one month of their 18th birthday must be fingerprinted immediately. Civil Penalties will be assessed if not in compliance.
·In the absence of the licensee a qualified adult must be present supervising the children; a qualified adult is an individual who has a valid and current Pediatric First Aid and CPR certification and a valid criminal record clearance associated to the facility license, along with TB clearance.

·Annual fees must be paid promptly and by the due date or a late fee shall be assessed and/or the License may be terminated. ·The fire extinguisher type 2A-10BC must be serviced annually or as often as necessary. Smoke and carbon monoxide detectors should be checked, and batteries replaced as needed.

Licensee was also made aware of the Child Advocacy program so she could receive the updated Quarterly reports and other information in a timely manner. ChildCareAdvocatesProgram@dss.ca.gov

Reporting Requirements: Changes should be reported to the Department as soon as they occur such as construction, remodeling, telephone number changes and/or if you move from your home. (Page-3)

SUPERVISORS NAME: Thuy Ho
LICENSING EVALUATOR NAME: Ketki Desai
LICENSING EVALUATOR SIGNATURE:	DATE: 09/08/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/08/2021

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, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868

FACILITY NAME: RAGSDALE-VAZQUEZ, RACHEL	FACILITY NUMBER: 304313930
	VISIT DATE: 09/08/2021

NARRATIVE

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Reporting Requirements: Any unusual incidents or injuries must be reported to the Department within 24 hours via telephone and within seven (7) days in writing.

Fire and safety drills must be performed every six months and documented for review by the Department.
Children and Staff records must be maintained and updated as needed and must be available for review by the Department.

No smoking, No infant walkers, No Johnny jumpers, No saucer chairs, No trampolines and any other item that falls into that category are not permitted in the facility.

All adults living and working in the home shall be made of aware of the Departments right to inspection authority, which includes but not limited to the right to enter the home when children are being cared for, interview children and adults and review documentation.

Licensees shall reveal each facility license number in all advertisements, publications or announcements with the intent to attract clients.

LPA advised the applicant how to access forms, regulations and quarterly updates on the Child Care Licensing website at: www.ccld.ca.gov. LPA reviewed and issued the Forms/Records to Keep in Your Family Child Care Home (LIC 311D) and provided the following forms: All the forms were provided to the Applicant during the Pre-Licensing inspection today.

A Packet with following forms were provided and discussed with the applicant during the Pre-Inspection today.

CHILDREN FORMS/RECORDS - Children’s files must contain the following documents/information:
Identification and Emergency Information (LIC 700), Consent for Emergency Medical Treatment (LIC 627), Notification of Parent’s Rights (LIC 995A), Caregiver Background Check Process (LIC 995E), Family Child Care Consumer Awareness Information (LIC 9212), Consent/Verification for Nebulizer Care (LIC 9166), California School Immunization Record, Parent Notification for Additional Children in Care (LIC 9150), Affidavit Regarding Liability Insurance (LIC 282), Acknowledgment of Receipt of Licensing Reports (LIC 9224). (Pg 4)

SUPERVISORS NAME: Thuy Ho
LICENSING EVALUATOR NAME: Ketki Desai
LICENSING EVALUATOR SIGNATURE:	DATE: 09/08/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/08/2021

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, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868

FACILITY NAME: RAGSDALE-VAZQUEZ, RACHEL	FACILITY NUMBER: 304313930
	VISIT DATE: 09/08/2021

NARRATIVE

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FACILITY FORMS/RECORDS - Facility files must contain the following documents/information:
Personnel Records: As required in Title 22 Regulations 102416.1, Unusual incident/Injury Report (LIC 624B): Child Care Facility Roster (LIC 9040), Notice of Employee Rights (LIC 9052), Statement Acknowledging Requirement to Report Suspected Child Abuse (LIC 9108), Property Owner/Landlord Consent (LIC 9149), Property Owner/Landlord Notification Form (LIC 9149).

INFORMATION TO BE POSTED IN YOU FAMILY CHILD CARE HOME – You are required by Law to post the following: Facility License (LIC 203), Emergency Disaster Plan (LIC 610A), Earthquake Preparedness Checklist (LIC 9148), Notification of Parent’s Rights (PUB 394). A Notice of Site Visit (LIC 9213): Must be posted for 30 days after each site inspection by a Licensing Representative. Any Licensing Report documenting a Type “A” deficiency must be posted for 30 days during the hours that children are in care. Any Licensing Report or other document verifying compliance or non-compliance with the Department’s order to correct a Type “A” deficiency must be posted for 30 days during the hours that children are in care.

OTHER INFORMATION AND FORMS PROVIDED: Capacity Handout for a Small Family Child Care Home

COVID Posters and additional guidelines were also provided to the Applicant.

LPA provided Guardian Information and website info: https://www.cdss.ca.gov/inforesources/cdss-programs/community-care-licensing/caregiver-background-check/guardian

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.

COVID 19 Self Assessment guide was reviewed and received from the applicant. (Page-5)

SUPERVISORS NAME: Thuy Ho
LICENSING EVALUATOR NAME: Ketki Desai
LICENSING EVALUATOR SIGNATURE:	DATE: 09/08/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/08/2021

LIC809 (FAS) - (06/04)

Page: 5 of 6

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868

FACILITY NAME: RAGSDALE-VAZQUEZ, RACHEL	FACILITY NUMBER: 304313930
	VISIT DATE: 09/08/2021

NARRATIVE

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Per applicant, there are no dual licenses at this address. Applicant’s email address was obtained during this inspection. The applicant was advised that email may be public information. Once licensed, the applicant is required to adhere to the terms and limitations stated on the license. A copy of this report and all other Licensing reports must be made available to the public for 3 years.

The facility at the time of Pre-licensing, is not in compliance for a (Small Family Child Care Home) with Title 22 Regulations.
Following corrections are needed before the final approval of the License.

1) Fire place in the back yard needs to have a safe barrier making it inaccessible to children.
2) Spike plants in the back yard needs to have a safe barrier across it to prevent any injury to children.
Applicant needs an additional one week to place the needed barriers across the fire place and spiked plants.
Proof of correction shall be submitted via email to the LPA.

A license for Small Family Child care home, with a capacity of 8 children (2-10 years) old shall be issued upon receiving the above corrections and pending management approval.

Appeal rights were presented and Exit interview was conducted with the applicant Ms. Ragsdale-Vazquez, Rachel.

SUPERVISORS NAME: Thuy Ho
LICENSING EVALUATOR NAME: Ketki Desai
LICENSING EVALUATOR SIGNATURE:	DATE: 09/08/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/08/2021

LIC809 (FAS) - (06/04)

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