376629170-8-23-2021-20-CC-JARL-C66PCF-20210823111149

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 376629170
Report Date: 08/23/2021
Date Signed: 08/23/2021 11:12:10 AM

Document Has Been Signed on 08/23/2021 11:12 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:	PEREZ, ADELE FAMILY CHILD CARE		FACILITY NUMBER:	376629170
ADMINISTRATOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY: 8	TOTAL ENROLLED CHILDREN: 0	CENSUS: 1	DATE:	08/23/2021
TYPE OF VISIT:	Prelicensing	UNANNOUNCED	TIME BEGAN:	08:30 AM
MET WITH:	Adele Perez		TIME COMPLETED:	10:15 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 August 23^rd, 2021 at 8:30 AM, Licensing Program Analysts (LPA) Jo Ann Legaspi and David Miller conducted a pre-licensing inspection with Applicant Adele Perez. The inspection’s purpose is to ensure that the home follows standards established in CCR, Title 22, Division 12, Chapter 3, for Family Child Care Homes. The Applicant provided LPAs with entry into her home. Present in the home was the Applicant, and one (1) related child. This three (3) bedroom, three (3) bathroom, two (2) story home was toured and inspected. The daycare operational schedule will be weekdays 6 AM to 6 PM. Applicant will use the following areas for childcare: the bottom floor, specifically living room 1, one (1) bathroom and the dining room. The off limits areas include the living room 2, kitchen and second floor. The kitchen, living room 2 and stairs to the second floor are made inaccessible to day care children by use of safety gates. There are no bodies of water observed during time of visit. The fire extinguisher is rated 2A 10B: C. and located in the kitchen. The smoke and carbon monoxide detectors meet requirements and are operational. Poisons, detergents, and cleaning compounds are secured inaccessible to children in care by high placement in the bathroom closet which is beyond children’s access. Medicines are in an upstairs room; stairs to the upstairs room are barred with a safety gate. Children’s toys and play equipment are available. The Applicant has a working telephone/cell phone. The Applicant agreed to notify licensing should her telephone number or email address ever change. The Applicant indicated there are no firearms or other weapons in the home. The Applicant intends to conduct outdoor activities in the fenced backyard. The Applicant acknowledges continuous, visual supervision shall be given whenever children are engaged in outdoor activities. The Applicant intends to occasionally transport the children in their own vehicle. The Applicant shall transport children in rear seats in appropriate child passenger restraint systems which meet applicable federal motor vehicle safety standards. The Applicant acknowledges children shall never be left unattended in the daycare vehicle. The Applicant further confirms maintenance of the daycare vehicle shall be upheld to ensure safety.

SUPERVISORS NAME: Tulam Vu
LICENSING EVALUATOR NAME: JoAnn R Legaspi
LICENSING EVALUATOR SIGNATURE:	DATE: 08/23/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/23/2021

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: PEREZ, ADELE FAMILY CHILD CARE	FACILITY NUMBER: 376629170
	VISIT DATE: 08/23/2021

NARRATIVE

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Applicant maintains documentation of proof of control of property for review by the Department. Applicant has completed the preventative health and lead poisoning prevention courses. The Mandated Reporter training was completed on 06/01/2021. Pediatric CPR and First Aid certifications expire in June 2023. The Applicant and adult residents in the home have criminal record clearances and/or exemptions on file. The Applicant was advised that any new/additional adults must be cleared prior to working or residing in home. Any minor upon their 18th birthday must be fingerprinted within 30 days. Immunization records per SB792 were reviewed and comply. Applicant reported only she will care for daycare children. LPA advised that prior to making alterations or additions to the home or grounds, the Applicant shall notify the Department of the proposed change. The Applicant states they are financially secure to operate a family childcare home for children and will comply with all regulations and laws governing family childcare homes.

The Applicant does not plan on providing Incidental Medical Services (IMS) to clients currently. 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 New Provider Resource Packet was reviewed with the applicant including information on the following: Provider Information Notice (PIN) 20-24-CCP/Safe Sleep, Lead Exposure, SIDS, shaken baby, child abuse reporting, children’s records, facility records, required postings, immunizations, unusual incident report, contact information for local public health, facility roster, car seat law, visual for ratio/capacity, and the fire/disaster drill log. The Applicant was also informed the following items are prohibited during day care operating hours: walkers, exersaucers, jumpers, inclined sleepers and bouncy seats. Corporal punishment and smoking are not allowed in the day care.

LPA discussed the maximum capacity for a small family child care home: four infants only (infants mean any children under 24 months); or six children with no more than three infants; or, with landlord consent, eight children with no more than two infants, one child in kindergarten or elementary school and one child at least age six, including children under age 10 who live in the home. Landlord consent is on file.

SUPERVISORS NAME: Tulam Vu
LICENSING EVALUATOR NAME: JoAnn R Legaspi
LICENSING EVALUATOR SIGNATURE:	DATE: 08/23/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/23/2021

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: PEREZ, ADELE FAMILY CHILD CARE	FACILITY NUMBER: 376629170
	VISIT DATE: 08/23/2021

NARRATIVE

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The Applicant agrees to comply with all regulations and laws governing family childcare homes. The Applicant is advised to regularly visit the Community Care Licensing WEB SITE: http://www.ccld.ca.gov/ for quarterly updates and updated regulation information. The Licensing Duty Line was provided: (619) 767-2248. The Southern California Child Care Advocate (SCCCA) information was provided. LPA enrolled Applicant onto the SCCA email list through the CCLD website so she may receive updated regulation information. Advocate information was provided: (916) 654-1541 or childcareadvocatesprogram@dss.ca.gov.

No corrections are needed. A small license is issued effective today 08/23/2021. The new license will be mailed to the Applicant.

An exit interview was conducted with the Applicant. Licensee Rights (LIC 9098 01/16) along with a copy of this report was provided to the Applicant and their signature on this form confirms receipt of these rights.

SUPERVISORS NAME: Tulam Vu
LICENSING EVALUATOR NAME: JoAnn R Legaspi
LICENSING EVALUATOR SIGNATURE:	DATE: 08/23/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/23/2021

LIC809 (FAS) - (06/04)

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