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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 393620520
Report Date: 03/25/2022
Date Signed: 03/25/2022 10:56:03 AM

Document Has Been Signed on 03/25/2022 10:56 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, 2525 NATOMAS PARK DR. STE 250
SACRAMENTO, CA 95833
FACILITY NAME:CARMONA, LILLIANNAFACILITY NUMBER:
393620520
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 0DATE:
03/25/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Lillianna CarmonaTIME COMPLETED:
11:00 AM
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Licensing Program Analysts (LPAs) Christopher Jackson and Lauren Scott met with licensee Lillianna Carmona for the purpose an Increase of Capacity inspection. LPAs and Licensee toured the single story three bedroom home. Off-limit areas include: Mater Bedroom, Laundry Room, Office, and Garage. During today's inspection licensee requested to add the shed to the off-limit areas. Licensee acknowledged that children may never enter these off-limit areas. Licensee has requested a capacity increase to 14 children. Fire clearance has been approved by the Stockton Fire Department on 03/18/22. Licensee stated there are no new residents in the home since licensure. All Adult residents have criminal record clearances. The Department received the Fire Safety Inspection Clearance, and home has been cleared for up to 14 children. Large family child care home capacity limitations were reviewed during today's inspection.

LPAs observed cleaning supplies properly stored out of reach of children. LPAs observed medications out of reach of children, LPAs observed the weapon in the home stored according to title 22 regulations. Fire extinguisher (2A10BC), smoke detector, and carbon monoxide meet regulation. Toys appear to be clean and safe. The backyard is fenced, but the side yards connect to the front of the home. The front is completely gated in. LPAs discussed and advised 100% supervision if using the backyard area, due to the access to the front of the home. Licensee understands that prior to making alterations or additions to the home or grounds, the licensee shall notify the Department of the proposed changes.

LPAs observed a current CPR/First Aid certificate Exp 09/2023. LPAs reviewed a child's file during today's inspection. LPAs observed the file contained emergency contact information and signed Notifications of Parents’ Rights. LPAs discussed changes in sleep regulations and advised licensee to visit the licensing website at http://www.ccld.ca.gov for current forms, laws, regulations and legislation. LPAs provided updated information for children's files to the licensee during today's inspection.

Report Continues on 809-C
SUPERVISORS NAME: Justin L Denton
LICENSING EVALUATOR NAME: Christopher Jackson
LICENSING EVALUATOR SIGNATURE: DATE: 03/25/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/25/2022
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, 2525 NATOMAS PARK DR. STE 250
SACRAMENTO, CA 95833
FACILITY NAME: CARMONA, LILLIANNA
FACILITY NUMBER: 393620520
VISIT DATE: 03/25/2022
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All adults subject to criminal background review have obtained criminal record clearance. 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.

LPAs discussed the safe sleep regulations with licensee and discussed the Child Care Licensing Safe Sleep web page at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPAs 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. LPAs discussed the requirement to check and log infant napping every 15 minutes, for infants under 24 months and under 24 months. LPAs provided a copy of LIC 9227 Individual Sleeping Plan, for infants under 12 months.

This provider is not currently providing Incidental Medical Services (IMS) services to children in care. 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

Effective today's date, 03/25/22, LPAs will approve the capacity increase to serve up to either 14 children, one (1) of which must be enrolled in Kindergarten and at least one (1) 6 years of age and no more than three (3) may be infants; or 12 children, four (4) of which may be infants. Infants are children under the age of 2.

In the areas that were evaluated, no deficiencies were observed at the time of the inspection.
Exit interview conducted. Notice of site visit posted.
SUPERVISORS NAME: Justin L Denton
LICENSING EVALUATOR NAME: Christopher Jackson
LICENSING EVALUATOR SIGNATURE:

DATE: 03/25/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/25/2022
LIC809 (FAS) - (06/04)
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