394500858-9-13-2023-53-CC-CPRA-CVMQUB-20230913122827

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 394500858
Report Date: 09/13/2023
Date Signed: 09/13/2023 12:28:35 PM

Document Has Been Signed on 09/13/2023 12:28 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:	TAVARA, JIMMY & MEJIA, EVELIN		FACILITY NUMBER:	394500858
ADMINISTRATOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY: 8	TOTAL ENROLLED CHILDREN: 8	CENSUS: 0	DATE:	09/13/2023
TYPE OF VISIT:	Prelicensing	UNANNOUNCED	TIME BEGAN:	09:30 AM
MET WITH:	Jimmy Tavara & Evelyn Mejia		TIME COMPLETED:	12:45 PM

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On 9/13/23, Licensing Program Analyst Carla Polanco (LPA) met with Applicant's Jimmy Tavara & Evelyn Mejia, (A1 & A2) for the purpose of a pre-licensing inspection. LPA disclosed the purpose of the inspection and was granted entrance into the Family Childcare Home (FCCH). LPA provided the Entrance Checklist to A. All individuals subject to criminal background review have obtained a criminal record clearance verified by LPA accessing Guardian. A1 &A2’s tentative hours of care are Monday through Friday, from 6:00 AM until 6:00 PM. A1 & A2 do not intend on providing overnight or weekend care at this time.

A health and safety inspection was conducted inside and outside of the FCCH. A1 & A2 accompanied LPA for the entirety of the tour. The FCCH is a one-story house with a living room, kitchen, laundry room, 2 bathrooms, 3 bedrooms, and a converted bedroom/garage. LPA verified that toxic and hazardous items were inaccessible to children in care. LPA did not observe any stairs. LPA observed a fireplace in the living room with a screen cover; LPA suggested not using the fireplace during business hours or barricading the fireplace with a baby-gate. The outdoor play area was toured which includes the backyard which is both cemented and grass. LPA verified that the entirety of the backyard is fenced-in and walked the perimeter to ensure the safety of the fence and gate. A1 & A2 stated they will be making minor adjustments to the backyard. The backyard will be off-limits until minor repairs are complete. The covered patio area has steep steps that are accessible and might pose a risk of falling to children, A1 & A2 stated that they will be fencing the area, to prevent falls. A1 & A2 state that they will notify LPA once the fence is put up, so that the yard can be added to the daycare.

LPA did not observe any pool, spa nor water feature in the FCCH. LPA observed a locked shed in the backyard.
A1 & A2 understand that 100% supervision is required for children in the front yard. A1 & A2 stated that they do not own any pets.

Continued on LIC809-C..........

SUPERVISORS NAME: Jeanne Smith
LICENSING EVALUATOR NAME: Carla Polanco Rivera
LICENSING EVALUATOR SIGNATURE:	DATE: 09/13/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/13/2023

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: TAVARA, JIMMY & MEJIA, EVELIN	FACILITY NUMBER: 394500858
	VISIT DATE: 09/13/2023

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The OFF-limits areas of the FCCH are the bedrooms, converted garage/bedroom, bathroom near the laundry room, laundry room and the entire backyard. A1 understands that OFF-limits areas must remain inaccessible to children in care.

A functioning smoke detector and a functioning carbon monoxide detector was tested in the main hallway. LPA observed cleaners stored in the kitchen, bathroom and laundry room in cabinets that are behind child safety locks. A H06386940 fire extinguisher was observed in the kitchen, and a first aid kit was observed in the laudry room. A1 stated there are no firearms nor weapons in the home.

LPA discussed Mandated Reporter Training with both A1 & A2. Health and Safety Code 1596.8662 requires all licensed providers, applicants, directors and employees to complete training as specified on their Mandated Reporter duties and to renew their training every two years. Volunteers are encouraged but not required to take the training. This training requirement may be met by using the Department’s Office of Child Abuse Prevention (OCAP) online training modules. The OCAP modules are free of cost and available at: http://www.mandatedreporterca.com/. The training is currently provided in English and Spanish. Jimmy Tavara has a current Mandated Reporter Training Certificate which will expire on 04/2025 & Evelyn Majia's expires 4/2025. Current Pediatric CPR and First Aid training for Jimmy Tavara was verified and expires on 11/2025 & Evelyn Majia's 1/2025. Completion of Preventative Health and Safety training including nutrition and lead exposure was verified before the inspection. Proof of required immunization's for A1 & A2 was also verified before the inspection.

LPA discussed the Safe Sleep Regulations with A1 & A2 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.

Incidental Medical Services (IMS) policy was discussed with A1 & A2. For IMS information, see PIN 22-02-CCP. 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.

Continued on LIC809-C.................

SUPERVISORS NAME: Jeanne Smith
LICENSING EVALUATOR NAME: Carla Polanco Rivera
LICENSING EVALUATOR SIGNATURE:	DATE: 09/13/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/13/2023

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: TAVARA, JIMMY & MEJIA, EVELIN	FACILITY NUMBER: 394500858
	VISIT DATE: 09/13/2023

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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 communications.

Applicant's were 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.

A1 & A2 understand that licenses are not transferable, and once licensed, Licensee must live in the home and be present for 80% of the operating hours. A1 & A2 understand 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 7 days to remain in compliance. A1 & A2 understand that if any structural changes are made to the FCCH; Licensing must be notified PRIOR to construction.

A1 & A2 understand that if they want to make any Off-limits area an ON-limits area, They must notify Licensing and LPA must do an inspection BEFORE children are allowed in said area. A1 & A2 understand that children’s and staff’s records are to be maintained according to Title 22 regulations and be accessible to Licensing for up to 3 years. LPA reviewed with Licensee 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. A1 & A2 understand that fire drills must be conducted and documented once every 6 months.

Continued on LIC809-C.................

SUPERVISORS NAME: Jeanne Smith
LICENSING EVALUATOR NAME: Carla Polanco Rivera
LICENSING EVALUATOR SIGNATURE:	DATE: 09/13/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/13/2023

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: TAVARA, JIMMY & MEJIA, EVELIN	FACILITY NUMBER: 394500858
	VISIT DATE: 09/13/2023

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As of today, 9/13/23, Jimmy Tavara & Evelyn Mejia are approved for a Small Family Child Care Home license for a capacity of 8 children with no more than 3 infants, or 4 infants only, or up to 8 children with no more than 2 infants, 1 child in Transitional Kindergarten or above and 1 child at least age 6. Infants are children under the age of 2.

An exit interview was conducted, and the report was reviewed with A1 & A2. Licensee Appeal Rights were provided. A Notice of Site visit was 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: Jeanne Smith
LICENSING EVALUATOR NAME: Carla Polanco Rivera
LICENSING EVALUATOR SIGNATURE:	DATE: 09/13/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/13/2023

LIC809 (FAS) - (06/04)

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