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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 394500452
Report Date: 07/30/2021
Date Signed: 08/12/2021 09:10:01 AM

Document Has Been Signed on 08/12/2021 09:10 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:CANTU, CERITAFACILITY NUMBER:
394500452
ADMINISTRATOR:CANTU, CERITAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(650) 455-9433
CITY:STOCKTONSTATE: CAZIP CODE:
95212
CAPACITY: 14TOTAL ENROLLED CHILDREN: 0CENSUS: 0DATE:
07/30/2021
TYPE OF VISIT:Case Management - Licensee InitiatedANNOUNCEDTIME BEGAN:
10:29 AM
MET WITH:Cerita CantuTIME COMPLETED:
12:30 PM
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On 30th July 2021 at 10:40am Licensing Program Analyst (LPA) Aruna Sridharan met with licensee Cerita Cantu for an announced case management inspection for change of location per licensee's request. Licensee moved from previous licensed(393622135) address: 1313 Quad Court, Stockton CA 95210 to current home at 8231 Shay Circle, Stockton, CA 95212. The hours of operation are Monday-Friday from 7:00am to 6:30pm. The fire clearance was received on 07/26/2021. All adults are fingerprint cleared.
LPA toured the home inside and out. The licensee owns the home which is a two storey home with four bedrooms and two bathrooms upstairs and living, dinning, kitchen, laundry room, half bathroom, garage in the first floor. OFF LIMIT areas include: entire upstairs, garage, and laundry room. Licensee acknowledges that children may never enter these off-limit areas. Licensee provided copy of deed and insurance which is $300,000 for every occurrence.
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 dinning area. The stairs are barricaded, no fireplace in the house. Licensee stated there are firearms and LPA observed them stored in lock and key separately. Cleaning compounds are stored in cabinet under the kitchen sink with child safety latch. Sharp utensils like knives are stored in the kitchen drawer with child safety latch. The medications are stored in upper cabinet in the kitchen and out of reach of children. The home contains appropriate toys for the children.
The Licensee has certificates of completion for 15 hours of health and safety training and has shown proof of enrolment for Lead Poisoning Prevention module on 8/10/21. Licensee has CPR and First Aid (exp:03/2023) and Mandated Reporter (exp: 03/2023).
Licensee is following COVID guidelines and precautions to provide care for children at this time.
LPA reviewed all children's files and provided 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 has approved for a Provisional license for 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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