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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 394500764
Report Date: 09/05/2024
Date Signed: 09/05/2024 01:57:03 PM

Document Has Been Signed on 09/05/2024 01:57 PM - 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:USECHE DEMEDINA, EMIZABETHFACILITY NUMBER:
394500764
ADMINISTRATOR/
DIRECTOR:		FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 6DATE:
09/05/2024
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:20 PM
MET WITH:Licensee Emizabeth Useche De MedinaTIME VISIT/
INSPECTION COMPLETED:
02:30 PM
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On 9/5/24, Licensing Program Analyst (LPA) Carla Polanco Rivera conducted a Case Management visit for the purpose of increasing an FCCH licensed capacity from 8 to 14 children. LPA met with Licensee Emizabeth Useche De Medina. Fire safety Inspection Clearance was granted on 8/26/24 for a total capacity of (14) children. Facility hours of operation are Monday through Friday, from 7:30 AM to 5:30 PM. LPA verified that individuals subject to criminal background review have obtained a criminal record clearance. At the time of the inspection there were six children being supervised by Licensee and a qualified assistant.

A health and safety inspection was conducted in all areas accessible to children. Off-limits areas include the entire upstairs, downstairs bedroom, kitchen/dining room area, garage, laundry room, family room and left side of the backyard. LPA observed that hazardous items were inaccessible to children in care. LPA observed age-appropriate toys and napping equipment. Licensee stated there are no weapons in the home. No bodies of water were observed by LPA. Home has a working telephone, 2A10BC fire extinguisher and functioning smoke and carbon monoxide detectors. Licensee understands that prior to making alterations or additions to the home or grounds, the licensee shall notify the Department of the proposed changes. Licensee and her husband are the home owners, control of property was verified prior to inspection. Licensee’s CPR/First Aid certification was verified and expires 04/2026. Mandated Reporter Training certification was verified and expires 09/2025. During the inspection LPA reviewed large family childcare home capacity limitations with licensee. The childcare roster form was provided to Licensee.



Report continued on LIC809C............
SUPERVISORS NAME: Karyn Guerra
LICENSING EVALUATOR NAME: Carla Polanco Rivera
LICENSING EVALUATOR SIGNATURE: DATE: 09/05/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/05/2024
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: USECHE DEMEDINA, EMIZABETH
FACILITY NUMBER: 394500764
VISIT DATE: 09/05/2024
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Licensee 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.

Incidental Medical Services (LMS) were discussed. Licensee states that she has no children needing medications at this time. 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

Safe sleep regulations were discussed. For additional information on Licensing Safe Sleep Regulations, please visit 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.

Effective today, 9/5/24, Licensee is approved for a Large Family Child Care Home, with a maximum capacity of 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.

Licensee understands that when there is no assistant present, facility shall revert to that of a small family child care home.

An exit interview was conducted, and the report was reviewed with the licensee. A notice of site visit was provided and posted by LPA and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.
SUPERVISORS NAME: Karyn Guerra
LICENSING EVALUATOR NAME: Carla Polanco Rivera
LICENSING EVALUATOR SIGNATURE:

DATE: 09/05/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/05/2024
LIC809 (FAS) - (06/04)
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