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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 394500873
Report Date: 09/21/2023
Date Signed: 09/21/2023 11:54:17 AM

Document Has Been Signed on 09/21/2023 11:54 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
SACRAMENTO S. CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME:FERREYRA, VERONICAFACILITY NUMBER:
394500873
ADMINISTRATOR:FERREYRA, VERONICAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(209) 507-5088
CITY:LODISTATE: CAZIP CODE:
95242
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 0DATE:
09/21/2023
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Applicant, Veronica FerreyraTIME COMPLETED:
12:00 PM
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LPA Tobias Lake met with Licensee, Veronica Ferreyra, for the purpose of conducting a change of location inspection. Licensee is requesting a change of location from old facility with license (#393610448) to current location. The facility is a two-story home that consists of 4 bedrooms, and 3 bathrooms. LPA and Licensee toured the entire home inside and outside. Off limit areas consists of the garage and the entire upstairs which include master bed/bath, 3 bedrooms, and a bathroom. Licensee acknowledged that children are never allowed in the off limit areas. Off limit areas will remain inaccessible by door handle covers, locked closed doors and supervision. All adults living and working in the facility have a criminal record clearances. Home has a backyard that is fenced. Licensee understands that 100% supervision is required when children play in any unfenced areas.

LPA discussed licensing requirements with Licensee including the posting of licensing inspection notices and reports, as well as injury and incident reporting. Fire extinguisher and first aid kit is located in the kitchen. Smoke alarm and carbon monoxide detectors were observed to be in operational order. Licensee stated there are no weapons in the home. There are no bodies of water on the property. LPA observed a gas fireplace with a metal screen and a glass panel covering. Licensee stated the fireplace is not used. LPA discussed supervision with Licensee regarding the use of the fireplace while children are in care. Hazardous items and personal hygiene items are made inaccessible to children. Sharp utensils are stored in an upper cabinet in the kitchen. Licensee has a current Mandated Reporter Training Certificate that expires 08/11/2025. Current pediatric CPR and first aid training was verified and expires 08/2025. LPA discussed new safe sleep regulations.

Continue 809-C.
SUPERVISORS NAME: Karyn Guerra
LICENSING EVALUATOR NAME: Tobias Lake
LICENSING EVALUATOR SIGNATURE: DATE: 09/21/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/21/2023
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: FERREYRA, VERONICA
FACILITY NUMBER: 394500873
VISIT DATE: 09/21/2023
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Licensee currently does not have any children enrolled that require IMS. LPA discussed IMS services and the requirement to create a plan of operation. 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.

Licensee understands that anyone living or working in the home, eighteen years of age or older must obtain fingerprint clearance PRIOR to living or working in the home. Licensee understands that licenses are not transferable, and once licensed, licensee must live in the home and be present for 80% of the operating hours. Licensee 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 7 days to remain in compliance. Licensee understands that if any structural changes are made to the home; licensing must be notified prior to construction. Licensee understands that if they want to make any off-limit area an ON-limits area, they must notify licensing and LPA must do an inspection BEFORE children are allowed in the area. Licensee understands that children’s records are to be maintained according to Title 22 regulations and be accessible to licensing for up to three years.

This facility evaluation report was reviewed and discussed with the Licensee. Records, postings and reporting requirements were discussed. LIC311D was provided and discussed. Licensee was encouraged to visit the department website at WWW.CCLD.CA.GOV for information regarding child care updates, forms, regulations and legislation pertaining to family child care homes.

Prior to the issuance of a large Family Child Care Home license, Applicant will need to make the following corrections and submit proof to LPA: TB tests for all adult residents.
SUPERVISORS NAME: Karyn Guerra
LICENSING EVALUATOR NAME: Tobias Lake
LICENSING EVALUATOR SIGNATURE:

DATE: 09/21/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/21/2023
LIC809 (FAS) - (06/04)
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