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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376100906
Report Date: 12/01/2021
Date Signed: 12/01/2021 03:08:15 PM

Document Has Been Signed on 12/01/2021 03:08 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, 7575 METROPOLITAN DR STE 110
SAN DIEGO, CA 92108
FACILITY NAME:VASQUEZ, OLIVIA FAMILY CHILD CAREFACILITY NUMBER:
376100906
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: DATE:
12/01/2021
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
01:31 PM
MET WITH:Olivia VazquezTIME COMPLETED:
03:10 PM
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Licensing Program Analyst (LPA), Tyra Block, conducted an announced Pre-Licensing inspection for relocation with Olivia Vazquez. The first floor apartment home was toured and inspected to ensure an environment safe for the care and supervision of children. The fire extinguisher (2A10BC) and smoke detector meet requirements and are operational. The carbon monoxide detector was not operational. All hazardous items were latched/locked and secured out of reach of children. There are no bodies of water in the home, however, there is a nearby gated pool located on the premises that requires a key for entry. Applicant states that there are no weapons in the home. CPR and First Aid expire on 4/22. A review of staff records on this date indicates that all facility staff or other individuals who require caregiver background checks have received criminal record and child abuse clearances or exemptions. Mandated reporter certification expires 11/23. Staff immunization requirements were met. Applicant rents the home and has provided landlord notification.

Applicant will be using the following rooms for childcare: All rooms and bathrooms are accessible to children, there are no off-limit areas. The applicant has sufficient toys and equipment available and the home has a fenced patio available for outdoor activities.

Applicant was reminded of requirements for children’s records, child abuse, and unusual incident reporting, immunizations, adults living or working in the home and associated civil penalties, applicant was also reminded that corporal punishment, smoking, walkers, exersaucers, bouncy seats and jumpers are not allowed in day care. All equipment that is used should be used only as intended by the manufacturer. LPA provided information regarding Safe Sleep /SIDS and Shaken Baby Syndrome. LPA and Licensee discussed California Megan's Law and LPA provided: www.meganslaw.ca.gov. LPA observed COVID posters, hand hygiene, and disposable face masks. LPA and applicant discussed current COVID guidance and face covering mandate in child care.
SUPERVISORS NAME: Tashima Daniel
LICENSING EVALUATOR NAME: Tyra Block
LICENSING EVALUATOR SIGNATURE: DATE: 12/01/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/01/2021
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, 7575 METROPOLITAN DR STE 110
SAN DIEGO, CA 92108
FACILITY NAME: VASQUEZ, OLIVIA FAMILY CHILD CARE
FACILITY NUMBER: 376100906
VISIT DATE: 12/01/2021
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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.

Applicant is advised to regularly visit the Community Care Licensing WEB SITE: http://www.ccld.ca.gov/ for quarterly updates and updated regulation information. Duty Line was provided: (619) 767-2248.Southern California Child Care Advocate information was provided and applicant was encouraged to subscribe through the CCLD website in order to be placed on an email list for updated regulation information. Advocate information was provided: (714) 703-2800 or childcareadvocatesprogram@dss.ca.gov.

The following corrections are needed prior to the issuance of the license: operable carbon monoxide detector

Once all corrections are made and proof is sent to licensing a license for 8 children will be granted.

LPA discussed the following with Applicant: maximum capacity for a small family child care home: 4 infants only (infants mean any children under 24 months); or 6 children with no more than 3 infants; or (with landlord consent) 8 children with no more than 2 infants, 1 child in kindergarten or elementary school and 1 child at least age 6 including children under age 10 who live in the licensee's home.
SUPERVISORS NAME: Tashima Daniel
LICENSING EVALUATOR NAME: Tyra Block
LICENSING EVALUATOR SIGNATURE:

DATE: 12/01/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/01/2021
LIC809 (FAS) - (06/04)
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