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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 343625041
Report Date: 06/13/2023
Date Signed: 06/13/2023 10:19:04 AM

Document Has Been Signed on 06/13/2023 10:19 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
RIVER CITY (SACTO)CC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME:CORTEZ, LEYLANE & CRUZ, GUSTAVOFACILITY NUMBER:
343625041
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 0DATE:
06/13/2023
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
08:45 AM
MET WITH:Leylane CortezTIME COMPLETED:
10:20 AM
NARRATIVE
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On June 13, 2023, at approximately 08:45 AM, Licensing Program Analyst (LPA) Michelle Pascual met with licensee Leylane Cortez for the purpose of a pre-licensing inspection due to a change of location. There were no other adults or children in the home during the inspection. All individuals subject to criminal background review have obtained a criminal record clearance. Applicant plans to operate Monday through Friday from 7AM to 5:30 PM.

A health and safety inspection was conducted inside and out. This facility is a single story home. The house consists of a kitchen, living room, dining room, bathroom, Master room and bedroom with a playroom (that will also house the laundry area). There is no garage. The off-limit areas are: Master room, bedroom and shed. Off-limits areas will remain inaccessible to children by closed doors and/or supervision. There is a seasonal creek, located behind the property, but the backyard is fenced in. Licensee will not allow children to go beyond the fence towards the creek.

Toxic and hazardous items are inaccessible to children and are stored in the latched kitchen cabinets. Functioning smoke and carbon monoxide detectors and fire extinguisher were observed in the home. LPA received EMSA certified certificate for Preventative Health and Safety training, Applicant's pediatric CPR and First Aid training is valid until 08/2023. Mandated Reporter expires 09/2023.

SUPERVISORS NAME: Keven Peters
LICENSING EVALUATOR NAME: Michelle Pascual
LICENSING EVALUATOR SIGNATURE: DATE: 06/13/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/13/2023
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
RIVER CITY (SACTO)CC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME: CORTEZ, LEYLANE & CRUZ, GUSTAVO
FACILITY NUMBER: 343625041
VISIT DATE: 06/13/2023
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Applicant stated that there are no weapons in the home. Immediate Civil Penalty regulation and deficiencies were reviewed.

LPA consulted applicant regarding the following topics; new upcoming regulations, Type A vs. Type B deficiencies, complaints, LPA’s right to interview children without parental consent, civil penalties, incidental medical services, placement of detergents, placement of poisons, placement of medicines, announced vs. unannounced inspections, posting requirements, unusual incident reports, On-limits vs. Off-limit areas, licensing file management, fire drills, 80% supervision, 100% supervision, fingerprint clearances, advertising, mandated reporting and best practices.



LPA consulted the applicant regarding personal rights. Applicant understands that corporal, physical and/or unusual forms of punishment is never allowed toward day care children or their own children during day care hours.

LPA provided the Community Care Licensing website www.ccld.ca.gov, so the Applicant can obtain updated licensing information, new regulations and access forms. LPA advised licensee of their responsibility to stay current regarding new regulations.
SUPERVISORS NAME: Keven Peters
LICENSING EVALUATOR NAME: Michelle Pascual
LICENSING EVALUATOR SIGNATURE:

DATE: 06/13/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/13/2023
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
RIVER CITY (SACTO)CC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME: CORTEZ, LEYLANE & CRUZ, GUSTAVO
FACILITY NUMBER: 343625041
VISIT DATE: 06/13/2023
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This facility currently does not provide Incidental Medical Services (IMS). 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

Applicant was reminded that all adults 18 and over living in the home, persons who provide care and supervision to children, and staff who have contact with children, 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.



Effective today June 13, 2023, the change of location is is licensed.
Facility is approved for a small family childcare home license to serve a capacity of 6 children with no more than 3 infants or 4 infants only. Or with a capacity of 8 children: no more than 2 infants, 1 child in kindergarten or elementary school and 1 child at least age 6.

Exit interview conducted.

SUPERVISORS NAME: Keven Peters
LICENSING EVALUATOR NAME: Michelle Pascual
LICENSING EVALUATOR SIGNATURE:

DATE: 06/13/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/13/2023
LIC809 (FAS) - (06/04)
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