394500946-9-13-2023-53-CC-DNGN-CVMPXN-20230913114237

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 394500946
Report Date: 09/13/2023
Date Signed: 09/13/2023 11:42:48 AM

Document Has Been Signed on 09/13/2023 11:42 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:	RIVERA, LESLIE IRENE		FACILITY NUMBER:	394500946
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	ANNOUNCED	TIME BEGAN:	09:10 AM
MET WITH:	Leslie Irene Rivera		TIME COMPLETED:	12:00 PM

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 13th, 2023, at 9:10 AM, Licensing Program Analyst (LPA) David Nguyen met with Applicant, Leslie Irene Rivera for the purpose of a pre-licensing evaluation. The purpose of pre-licensing inspection was explained. LPA was granted for entry into the facility by Applicant. All individuals subject to criminal background review have obtained a criminal record clearance. Applicant's tentative hours are Monday to Friday from 7:30 am to 5:00 pm. Meals—breakfast, lunch, and PM snack—are provided to children in care. Purified water from water dispenser is provided to children in care for drinking water. A health and safety inspection was conducted inside and out. The detached one-story single family home has 3 bedrooms and 2 bathrooms. The off-limits area in the home include all bedrooms, master bathroom, laundry room, and attached 2-car garage. Off-limits areas will remain inaccessible to day care children by doorknob covers, baby gate, closed locked doors, and SUPERVISION. On-limits areas in the home include the living room, the kitchen, dining area, the bathroom in the hallway, the front yard, and the backyard. Outdoor play area was toured. There are no bodies of water on the premises. LPA toured the bathroom and verified toxic and hazardous items were inaccessible to children in care. Functioning smoke and carbon monoxide detectors were observed in the hallway. LPA observed cleaners are inaccessible to children in care. There is a fireplace in the home, and it is barricaded with a baby gate. 2A10BC fire extinguisher and first aid kit were observed in the kitchen. Applicant stated there are no weapons in the home. Applicant stated that she will utilize the front yard for outside play and water play in the Summer. Applicant understands that 100% supervision is required at the front yard while the daycare children have water play and outdoor play at the front yard. Applicant stated that her FCCH houses 1 indoor cat. Report continues 809-C....(Page 2)

SUPERVISORS NAME: Chayntel Hunter
LICENSING EVALUATOR NAME: David Nguyen
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: RIVERA, LESLIE IRENE	FACILITY NUMBER: 394500946
	VISIT DATE: 09/13/2023

NARRATIVE

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LPA discussed the new Mandated Reporter Training with applicant. Beginning January 1, 2018, 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. Applicant has a current Mandated Reporter Training Certificate that expires 7/19/2025. Current pediatric CPR and first aid training was verified and expires 07/15/2025.

Incidental Medical Services (IMS) policy was discussed. 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

LPA discussed the safe sleep regulations with licensee and discussed the Child Care Licensing Safe Sleep webpage at www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPA also informed licensee 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. LPA discussed the requirement to check and log infant napping every 15 minutes, for infants under 24 months. LPA provided Licensee a copy of LIC 9227—Individual Infant Sleeping Plan. LPA discussed the requirement to complete the LIC 9227--Individual Infant Sleeping Plan for infants under twelve (12) months of age.

Report continues on LIC809-C....(Page 3)

SUPERVISORS NAME: Chayntel Hunter
LICENSING EVALUATOR NAME: David Nguyen
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)

Page: 2 of 3

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: RIVERA, LESLIE IRENE	FACILITY NUMBER: 394500946
	VISIT DATE: 09/13/2023

NARRATIVE

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This facility evaluation report was reviewed and discussed with the applicant. Records, postings and reporting requirements were discussed. LIC311D was provided and discussed. Applicant 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. LPA also provided the e-mail address for the advocates in order to be added to the quarterly newsletter mailing list. childcareadvocatesprogram@dss.ca.gov

Applicant 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. 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. 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 7 days to remain in compliance. Applicant understands that if any structural changes are made to the home; licensing must be notified prior to construction.

Applicant 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. Applicant understands that children’s records are to be maintained according to Title 22 regulations and be accessible to licensing for up to three years.

As of today, Applicant will be approved for a Small Family Child Care Home license for a capacity of 6 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.

SUPERVISORS NAME: Chayntel Hunter
LICENSING EVALUATOR NAME: David Nguyen
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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