394500676-9-14-2022-53-CC-SWIS-CJ9PJ9-20220914112111

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 394500676
Report Date: 09/14/2022
Date Signed: 09/14/2022 11:21:22 AM

Document Has Been Signed on 09/14/2022 11:21 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:	AMERICO, GABRIELA		FACILITY NUMBER:	394500676
ADMINISTRATOR:	AMERICO, GABRIELA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(408) 449-7116
CITY:	RIPON	STATE: CA	ZIP CODE:	95366
CAPACITY: 14	TOTAL ENROLLED CHILDREN: 14	CENSUS: 0	DATE:	09/14/2022
TYPE OF VISIT:	Prelicensing	ANNOUNCED	TIME BEGAN:	09:30 AM
MET WITH:	Gabriela Americo		TIME COMPLETED:	11:40 AM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	On September 14, 2022, at 9:30AM, Licensing Program Analyst (LPA) Stacey Williams met with Applicant Gabriela Americo for the purpose of a pre-licensing inspection. Thre is a secondary Applicant, Maria Carmen Lopez associated to the facility; however, was not present during the inspection. Criminal record clearances were verified. Fire clearance has been granted by Ripon Fire Department on July 27, 2022. LPA and Applicant toured the single-story home. The facility consists of 3 bedrooms, 3.5 bathrooms, living room, dining room area, laundry room, kitchen, and a 2-car garage. The home has an in-law suite that has a conjoining kitchenette and bathroom. This will be the primary childcare are for the children. The kitchenette has secured covers for the stove/oven control. Off limit areas: master bedroom, laundry room, and the garage. Applicant is renting the home. A copy of the lease agreement is on file. Applicant has completed the required Preventative Health and Safety course which includes 1 hour of nutrition and lead prevention training. LPA provided blank forms required for staff records as well as for children's records including LIC 9227- Individual Infant Sleeping Plan. Applicant has a designated Licensing Area where required forms such as Parent's Rights Notification, Emergency Disaster Plan, Earthquake Preparedness Checklist and the Facility Sketch is posted. This area is where Licensing forms/posters will be placed for parental review. LPA and Applicant toured the outside facility. The backyard is fenced. There is also a separate fenced area on the left side of the house where the Applicant’s dog will reside during childcare hours. Applicant understands that it recommended to have increased supervision by the fenced area designated for the dog due to the fencing structure. There are no bodies of water on the property. Continued on subsequent page, LIC 809C

SUPERVISORS NAME: Bettina Engelman
LICENSING EVALUATOR NAME: Stacey Williams
LICENSING EVALUATOR SIGNATURE:	DATE: 09/14/2022

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/14/2022

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: AMERICO, GABRIELA	FACILITY NUMBER: 394500676
	VISIT DATE: 09/14/2022

NARRATIVE

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Applicant stated there are no weapons in the home. Applicant understands the smoking prohibition for childcare.

LPA observed the kitchen cabinets are properly secured. All medications and knives are stored and inaccessible.

LPA observed a 2A10BC fire extinguisher. LPA observed an operational smoke detector and carbon monoxide detector in the home that meet regulatory standards. Applicant understands that if any structural changes are made to the home; licensing must be notified prior to construction.

LPA and Applicant discussed Safe Sleep Regulations and Covid-19 Guidance for Childcare Providers.

LPA discussed the safe sleep regulations with Applicant 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 Applicant 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.

Applicant was reminded that all adults 18 and over living in the home, persons who provide care and supervision to children, and staff who have contact with children, 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.

This facility plans to provide Incidental Medical Services – IMS. For IMS information , see PIN 22-02-CCP. 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

** Continued on subsequent page LIC 809 C **

SUPERVISORS NAME: Bettina Engelman
LICENSING EVALUATOR NAME: Stacey Williams
LICENSING EVALUATOR SIGNATURE:	DATE: 09/14/2022

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/14/2022

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: AMERICO, GABRIELA	FACILITY NUMBER: 394500676
	VISIT DATE: 09/14/2022

NARRATIVE

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Applicant has completed the required AB1207 Mandated Reporter training. Applicant understands that the training must be completed once every two years, training is accessible at www.mandatedreporterca.com. CPR/First Aid certification is current and expires 7/2023.

Applicant understands that a current roster must be maintained and that a fire drills must be conducted and documented once every six months. Applicant understands that licenses are not transferable, and once licensed, licensee must live in the home and be present for 80% of the operating hours. LPA explained to applicant that if she relocates and wants to continue to provide care, she must submit a change of location application and have the new home inspected.

Applicant understands that if an unusual incident occurs; licensing is to be notified via phone call, e-mail or fax within 24 hours and the Unusual Incident Report LIC 624 shall be submitted within seven days to remain in compliance.

LPA reviewed with Applicant the LIC 311D, Forms/Records To Keep In Your Family Child Care Homes, children’s forms/records, facility forms/records, and information to be posted.

Entrance Checklist was provided to the applicant.

Community Care Licensing Division (CCLD) regularly sends information to licensed facilities, providers, and stakeholders by way of Provider Information Notices (PIN), Program Quarterly Update Newsletters and other important information communication platform.

To receive important licensed-related information to licensed facilities, visit the CCLD Important Information website at https://www.cdss.ca.gov/inforesources/community-care-licensing/subscribe and select the Child Care option to receive email communication.

This facility evaluation report was reviewed and discussed with the Applicant.

As of today, 9/14/2022 the facility is approved for a large Family Child Care Home license for a capacity to serve up to either 14 children, two (2) of which must be at least 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 years old.

SUPERVISORS NAME: Bettina Engelman
LICENSING EVALUATOR NAME: Stacey Williams
LICENSING EVALUATOR SIGNATURE:	DATE: 09/14/2022

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/14/2022

LIC809 (FAS) - (06/04)

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