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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 394500444
Report Date: 07/30/2021
Date Signed: 08/12/2021 08:54:22 AM

Document Has Been Signed on 08/12/2021 08:54 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:LUNA, YESENIAFACILITY NUMBER:
394500444
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 0CENSUS: 0DATE:
07/30/2021
TYPE OF VISIT:Case Management - Licensee InitiatedANNOUNCEDTIME BEGAN:
01:15 PM
MET WITH:Yesenia LunaTIME COMPLETED:
03:30 PM
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On 30th July 2021 at 12:54pm Licensing Program Analyst (LPA) Aruna Sridharan met with licensee Yesenia Luna for an announced case management inspection for change of location per licensee's request. Licensee moved from previous licensed(394500075) address: 5605 Tamworth Way, Stockton CA 95207 to current home at 8111 N Eldorado Street, Stockton, CA 95210. The hours of operation are Monday-Friday from 6:00am to 6:00pm. Licensee was by herself during the inspection. All adults are fingerprint cleared.
LPA toured the home inside and out. The licensee rents the home which is a single storey home with three bedrooms and two bathrooms. OFF LIMIT areas include: masterbedroom and bath, bathroom at the end of hallway and garage. Licensee acknowledges that children may never enter these off-limit areas. Licensee provided the lease and will use the affidavit regarding liability insurance in children's files.
The entire outside area was toured and no bodies of water were found. The front yard is unfenced and the backyard area is fenced. The licensee understands that 100% supervision is needed when children are in an unfenced area. Licensee understands that prior to making altercations or additions to the home or grounds the licensee shall notify Licensing Agency per regulation 102416.3
Home has working fire extinguisher, carbon monoxide and smoke detectors that meet regulations. The first aid kit is in the entry closet. The fireplace in dinning area is inoperable. Licensee stated there are no firearms in the house. Cleaning compounds are stored in upper shelf in kitchen and in cabinet in the garage.the kitchen sink with child safety latch. Sharp utensils like knives are stored in the upper cabinet in kitchen. The medications are stored in the garage. The home contains appropriate toys for the children.
The Licensee has certificates of completion for 15 hours of health and safety training and has Lead Poisoning Prevention module on 7/17/21. Licensee provided proof of enrollment in CPR and First Aid course on 9/11/21 and has Mandated Reporter certification(exp: 09/2021).
LPA advised licensee to follow COVID guidelines and precautions to provide care for children at this time.
LPA reviewed all children's files and regulations on Safe Sleep.
LPA has provided the licensee with the web site www.ccld.ca.gov to enable access to all updated forms, requirements and changes. LPA advised the licensee of their responsibility to stay current in the requirements of the Department. LPA reviewed the fire drill requirements. LPA reviewed postings.
LPA will recommend for Provisional license for a change of location as of today.
Notice of Site Visit was posted.
SUPERVISORS NAME: Sharon Ogbodo
LICENSING EVALUATOR NAME: Aruna Sridharan
LICENSING EVALUATOR SIGNATURE: DATE: 07/30/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/30/2021
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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