343623996-11-10-2021-03-CC-BMOS-C8MQ2R-20211110104734

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 343623996
Report Date: 11/10/2021
Date Signed: 11/10/2021 10:47:42 AM

Document Has Been Signed on 11/10/2021 10:47 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, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833

FACILITY NAME:	HERRERA, KATHERINE		FACILITY NUMBER:	343623996
ADMINISTRATOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY: 8	TOTAL ENROLLED CHILDREN: 8	CENSUS: 0	DATE:	11/10/2021
TYPE OF VISIT:	Prelicensing	UNANNOUNCED	TIME BEGAN:	08:55 AM
MET WITH:	Katherine Herrera - Applicant		TIME COMPLETED:	11:05 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 Wednesday, November 10th, 2021, 9:00am, Licensing Program Analyst (LPA) Blake Morillas met with the Applicant, Katherine Herrera, for a Prelicensing inspection. This is a two story, 4 bedroom, 2 and a half bathroom home. The anticipated operating hours are 7:00am to 4:30pm, Monday through Friday, year around. At 9:10am, LPA initiated a health and safety inspection of all areas of the home as well as the outdoor area that will be used by the children in care. Off-limits areas will include the Garage, all of Upstairs. Applicant acknowledged that children may never enter these off-limit areas. Fire extinguisher, carbon monoxide and smoke detectors meet regulation. Hazardous cleaning compounds and medications are stored inaccessible and or out of children reach. Stairs in the home are gated to prevent access by children in care. The outdoor area used by children is fenced and age appropriate toys were observed. Applicant understands that 100% supervision is required in any unfenced areas. There are no bodies of water on the premises. Applicant stated there are no weapons in the home. At 9:26am, LPA began to review Children’s files and other documentation that is required for operation of a day care. Applicant owns the home and provided the appropriate forms. LPA reviewed the fire drill requirements. Continued on LIC 809-C Page 1 of 3*

SUPERVISORS NAME: Keven Peters
LICENSING EVALUATOR NAME: Blake Morillas
LICENSING EVALUATOR SIGNATURE:	DATE: 11/10/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/10/2021

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

LIC809 (FAS) - (06/04)

Page: 1 of 3

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833

FACILITY NAME: HERRERA, KATHERINE	FACILITY NUMBER: 343623996
	VISIT DATE: 11/10/2021

NARRATIVE

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*Continuation of LIC 809

At this time, the Applicant does not carry liability insurance. LPA explained about obtaining a $300,000 annual aggregate/$100,000 per occurrence liability insurance policy. Applicant understands that until a policy is obtained, they must use the affidavit.

The Applicant was reminded that all adults 18 and over living or working in the home, including employees and volunteers, 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 up to $500.00 maximum per day/per person will be assessed if this regulation is violated.

The Applicant has completed CPR/First Aid (expires: 4/2023) and Mandated Reporter Training.

LPA provided and discussed the Lead Testing brochure and current Covid-19 guidelines.

LPA discussed the safe sleep regulations with licensee 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 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.

*Continued on LIC 809-C

Page 2 of 3

SUPERVISORS NAME: Keven Peters
LICENSING EVALUATOR NAME: Blake Morillas
LICENSING EVALUATOR SIGNATURE:	DATE: 11/10/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/10/2021

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
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833

FACILITY NAME: HERRERA, KATHERINE	FACILITY NUMBER: 343623996
	VISIT DATE: 11/10/2021

NARRATIVE

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*Continuation of LIC 809

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

At 10:36am, LPA reviewed and discussed this facility evaluation report with the Applicant.

Effective today (11-10-2021) the facility is LICENSED to serve a MAX. CAP: 6 - NO MORE THAN 3 INFANTS OR 4 INFANTS ONLY. CAP 8 - NO MORE THAN 2 INFANTS, 1 CHILD IN KINDERGARTEN OR ELEMENTARY SCHOOL AND 1 CHILD AT LEAST AGE 6.

A notice of site visit was given and must remain posted for 30 days.

Exit interview conducted and report was reviewed with the licensee, Katherine Herrera.

Page 3 of 3

SUPERVISORS NAME: Keven Peters
LICENSING EVALUATOR NAME: Blake Morillas
LICENSING EVALUATOR SIGNATURE:	DATE: 11/10/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/10/2021

LIC809 (FAS) - (06/04)

Page: 3 of 3