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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376100964
Report Date: 12/17/2021
Date Signed: 12/17/2021 10:01:28 AM

Document Has Been Signed on 12/17/2021 10:01 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, 7575 METROPOLITAN DR STE 110
SAN DIEGO, CA 92108
FACILITY NAME:BAUTISTA, TERESA FAMILY CHILD CAREFACILITY NUMBER:
376100964
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 1DATE:
12/17/2021
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
08:26 AM
MET WITH:Teresa Bautista TIME COMPLETED:
10:15 AM
NARRATIVE
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On 12/17/21 at 8:26 am Licensing Program Analyst (LPA) Annette Sutherland, conducted an announced Pre-Licensing inspection for relocation with the applicant. Upon arrival, LPA met with applicant Teresa Bautista. Also present was one minor childcare child. The one-story home was toured and inspected to ensure an environment safe for the care and supervision of children. The fire extinguisher, carbon monoxide detector, and smoke detector meet requirements and are operational. All hazardous items were latched/locked and secured out of reach of children. Home has a pool in the backyard with access from both the front and backyard. The pool is not properly fenced or covered (fence is 4ft, climbable and there is access from the living room window). Photos were taken. Applicant states that there are no weapons in the home. CPR and First Aid expire in March July 17, 2023. Preventative health practices course was completed on 10/2/21. Lead Poison prevention training was completed on 12/16/21. Mandated reporter training was completed on 12/7/21. 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. Staff immunization requirements were met. Required documents have been posted. Child’s records were reviewed and were complete. Applicant rents the home. The applicant has toys and equipment available.

Applicant will be using the following rooms for childcare Living room, Family room, Dining room, Kitchen, Playroom, Master bedroom, Bathroom #1 and Backyard. Off limits areas include, Laundry room, Bedroom #2 and master bathroom. The home has a fully fenced backyard available for outdoor activities. Front yard is off-limits. (continued on LIC809-C...)

SUPERVISORS NAME: Monica Cuddy
LICENSING EVALUATOR NAME: Annette Sutherland
LICENSING EVALUATOR SIGNATURE: DATE: 12/17/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/17/2021
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: BAUTISTA, TERESA FAMILY CHILD CARE
FACILITY NUMBER: 376100964
VISIT DATE: 12/17/2021
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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 Regulations/SIDS and Shaken Baby Syndrome. LPA and Licensee discussed California Megan's Law and LPA provided: www.meganslaw.ca.gov. LPA Sutherland reviewed COVID-19 guidelines with Applicant and provided COVID-19 resources. LPA Sutherland directed Applicant to website: https://www.cdss.ca.gov/inforesources/community-care-licensing to receive important updates and information.

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.


The following corrections are needed prior to the issuance of the license:

1. Pool has to be properly fenced or covered according to the criteria below.


Please refer to regulation 102417(g)(5) for pool fencing requirements.
Continued on LIC 809 c

SUPERVISORS NAME: Monica Cuddy
LICENSING EVALUATOR NAME: Annette Sutherland
LICENSING EVALUATOR SIGNATURE:

DATE: 12/17/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/17/2021
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, 7575 METROPOLITAN DR STE 110
SAN DIEGO, CA 92108
FACILITY NAME: BAUTISTA, TERESA FAMILY CHILD CARE
FACILITY NUMBER: 376100964
VISIT DATE: 12/17/2021
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If there is a fence, it has to meet the following criteria:

· At least 5 ft high
· The gate has to be self-closing and self-latching & should not be locked
· The latch has to be within 6” of the top of the gate
· There can’t be any gaps between posts, or between the fence and the ground that could fit anything larger than a golf ball
· It cannot be climbable
· You have to be able to see through it into the pool area
· There cannot be any direct access to the pool from any windows or doors.

If there is a cover, it needs to meet the following criteria:
· Support the weight of an adult
· Secured and locked down
· No gaps between locks that would allow a child to crawl under it.


Once all corrections are made and proof is sent to licensing a license for 8 children may be granted. Applicant understands that proof of corrections must be submitted to Licensing within 30 days or the application may be denied. Applicant agreed to comply with all regulation and laws governing family childcare homes. An exit interview was conducted with applicant. Applicant was provided a copy of their Appeal Rights (LIC9058) along with a copy of the report (LIC809) and their signature on this form acknowledges receipt of these rights.
SUPERVISORS NAME: Monica Cuddy
LICENSING EVALUATOR NAME: Annette Sutherland
LICENSING EVALUATOR SIGNATURE:

DATE: 12/17/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/17/2021
LIC809 (FAS) - (06/04)
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