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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 384004346
Report Date: 11/09/2022
Date Signed: 11/09/2022 10:50:38 AM

Document Has Been Signed on 11/09/2022 10:50 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, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME:ACEVES, ROSAURAFACILITY NUMBER:
384004346
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 2DATE:
11/09/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Rosaura AcevesTIME COMPLETED:
11:00 AM
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Licensing Program Analyst (LPA) Yee conducted an unannounced, Required - 1 year inspection today. The purpose of the inspection was explained. Present at the facility are the licensee, Rosaura Aceves, her daughter,Viri and 2 children. Current residents are The licensee, Rosaura Aceves , her boyfriend and her 17 years old son. The facility personnel summary report was reviewed with Viri and she said it is current. Hours of operation are Monday to Friday from 7:30 am to 2:30 pm; 3:00 pm to 10:00pm.

DAY CARE AREAS:living room, dining room, hallway bathroom, and back yard. The remaining areas are off limit.

LPA observed the home to be in good repair with proper temperature and ventilation. There are a variety of age-appropriate toys and equipment in the home which were in good condition. All cleaning supplies, poisons, and other chemicals were stored inaccessible to children behind child-safety locked cabinets. The facility has a small dog and kept in the off limit areas.

The facility has a working smoke detector, carbon monoxide detector, and a fully charged fire extinguisher that meets the fire department standard. Per Licensee, there are no weapons or guns in the home.

LPA reviewed all 2 children's records and is in order.

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SUPERVISORS NAME: Ali Zebila
LICENSING EVALUATOR NAME: Jennifer Yee
LICENSING EVALUATOR SIGNATURE: DATE: 11/09/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/09/2022
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, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME: ACEVES, ROSAURA
FACILITY NUMBER: 384004346
VISIT DATE: 11/09/2022
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LPA reviewed Licensee's Pediatric First Aid/CPR which is current and will expire 2/2024. Earthquake drill and fire drill were practiced on 10-26-2022. Annual fee is due the end of this month. A copy of the fee statement was provided.

Licensee 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. LPA reminded the licensee that when her son turns 18 years of age, he would need a fingerprint clearance. She said she understands.

Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Family Child Care Homes Sections 102417. When any IMS is provided, an updated Plan of Operation that includes 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

LPA review AB 1207 with the Licensee. As of January 1, 2018, all staff members are required to complete Mandated Reporter Training every two years. The training can be obtained online at www.mandatedreporterca.com. Helper AB1207 certificate was completed on 2/24/22, the licensee AB1207 was completed on 3/3/22.

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. A blank form LIC 9227 was provided. A sample infant sleep chart was provided.

A notice of site visit was given and must remain posted for 30 days.
SUPERVISORS NAME: Ali Zebila
LICENSING EVALUATOR NAME: Jennifer Yee
LICENSING EVALUATOR SIGNATURE:

DATE: 11/09/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/09/2022
LIC809 (FAS) - (06/04)
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