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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 393621199
Report Date: 07/06/2023
Date Signed: 07/06/2023 11:14:58 AM

Document Has Been Signed on 07/06/2023 11:14 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
SACRAMENTO S. CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME:JARA, SANDRAFACILITY NUMBER:
393621199
ADMINISTRATOR:JARA, SANDRAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(209) 331-6384
CITY:STOCKTONSTATE: CAZIP CODE:
95209
CAPACITY: 14TOTAL ENROLLED CHILDREN: 4CENSUS: 1DATE:
07/06/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Sandra JaraTIME COMPLETED:
11:30 AM
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On 07/06/23, Licensing Program Analyst (LPA) Elvira Sierra met with the licensee, Sandra Jara for the purpose of an unannounced annual inspection. All individuals subject to criminal background review have obtained a criminal record clearance. Per Licensee hours of operation are 7 days a weeks 24 hours a day. Licensee was reminded never to exceed 24 hours of consecutive care. Present in the facility was Licensee, her 3 children and one daycare child.

A health and safety inspection was conducted in all areas accessible to children. Off-limits areas include;All bedrooms, garage, laundry room. Licensee was reminded that day care children may never enter these off-limit areas. Home is clean and appropriately ventilated. Age-appropriate toys and reading material were observed. There were no hazardous materials or chemicals observed accessible to children. Medications and knives are inaccessible to children. Per Licensee there are no weapons in the home and no bodies of water were observed. Facility maintains a working phone, a functioning carbon/monoxide detector and a 2A10BC fire extinguisher that meets Fire Marshall standards. LPA reminded Licensee that any changes to the home or any new construction must be reported to Licensing. Backyard is fence for supervision and is free of any dangerous conditions. Facility provide meals.
One child file was reviewed. Current EMSA CPR and First Aid certification was verified (exp 06/11/25). Fire drill was conducted on 01/13/23 and is properly documented. Mandated Reporter Training expires 05/18/25.

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.
Report continues on subsequent page 809C--
SUPERVISORS NAME: Bettina Engelman
LICENSING EVALUATOR NAME: Elvira Sierra
LICENSING EVALUATOR SIGNATURE: DATE: 07/06/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/06/2023
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
SACRAMENTO S. CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME: JARA, SANDRA
FACILITY NUMBER: 393621199
VISIT DATE: 07/06/2023
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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.

LPA discussed the safe sleep regulations 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.

To improve the quality and value of the new inspection process, a survey will be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or tools, please send them by email to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/process.



LPA verified the annual fees are current. LPA provided the Child Care Advocates Program email address: childcareadvocatesprogram@dss.ca.gov, so the licensee can request to be added to the distribution list to receive Quarterly Updates. Licensee was encouraged to visit the Department website at WWW.CDSS.CA.GOV for child care updates, current forms, legislation and regulation information.

Exit interview conducted. This facility evaluation report was reviewed and discussed with the licensee, Sandra Jara. A Notice of Site Visit was posted and should remain posted for 30 days for parental review.

SUPERVISORS NAME: Bettina Engelman
LICENSING EVALUATOR NAME: Elvira Sierra
LICENSING EVALUATOR SIGNATURE:

DATE: 07/06/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/06/2023
LIC809 (FAS) - (06/04)
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