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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 394500946
Report Date: 10/17/2024
Date Signed: 10/17/2024 04:29:31 PM

Document Has Been Signed on 10/17/2024 04:29 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:RIVERA, LESLIE IRENEFACILITY NUMBER:
394500946
ADMINISTRATOR/
DIRECTOR:		FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 9CENSUS: 7DATE:
10/17/2024
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
02:15 PM
MET WITH:Rivera, Leslie IreneTIME VISIT/
INSPECTION COMPLETED:
04:45 PM
NARRATIVE
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On October 17th, 2024, at 2:15 PM, Licensing Program Analysts (LPAs) David Nguyen and Deborah Khashe met with licensee, Leslie Irene Rivera for the purpose of an unannounced annual inspection. The purpose of the unannounced annual inspection was explained. LPAs were granted entrance by licensee. There were seven (7) children present at the time of inspection. Licensee’s spouse arrived home about forty (40) minutes later with her six-year-old daughter. Licensee’s operating hours are Monday through Friday from 7:30 AM. to 5:00 PM. Meals—breakfast, lunch, and PM snack—were provided to daycare children. Purified water from water service was provided to daycare children for drinking water. LPA Nguyen verified licensee’s annual license fees were current.

All adults subject to criminal background review have obtained criminal record clearance. Licensee was reminded that all adults 18 and over living or working in the home, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, 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 for a maximum of 5 days or, if the penalty is for a repeat violation, for a maximum of 30 days per person will be assessed if this regulation is violated.

A health and safety inspection was conducted in all areas accessible to children. The detached one-story and single-family home consists of three (3) bedrooms, two (2) bathrooms, and an attached 2-car garage. The off-limits area in the home include all bedrooms, master bathroom, laundry room, and an attached 2-car garage. Off-limits areas will remain inaccessible to day care children by doorknob covers, baby gate, 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.

Upon arrival, LPAs observed a bag full of soiled diapers with flies surrounding the bag at the entry door. Outdoor play area was toured. LPAs observed multiple piles of dog fecal matter. LPAs also observed one (1) box spring and two (2) mattresses propped up on fences in the side yard as well as other discarded household items, such as chairs, bar stools, and scraping BBQ tool on gas BBQ grill. There are no bodies of water on the premises. Licensee stated that none of her direct neighbors has in-the-ground pool or above-the-ground pool.

Report continues on LIC809-C...(Page 2)
SUPERVISORS NAME: Chayntel Hunter
LICENSING EVALUATOR NAME: David Nguyen
LICENSING EVALUATOR SIGNATURE: DATE: 10/17/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/17/2024
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: RIVERA, LESLIE IRENE
FACILITY NUMBER: 394500946
VISIT DATE: 10/17/2024
NARRATIVE
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(Page 2)
LPAs toured the bathroom and verified toxic and hazardous items were inaccessible to children in care. LPAs observed a stack of dirty dishes in the kitchen sink and flies throughout the kitchen area. Functioning smoke and carbon monoxide detectors were observed in the hallway. LPAs 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. Licensee stated there are no weapons in the home. Licensee stated that she will utilize the front yard for outside play and water play in the Summer. Licensee understands that 100% supervision is required at the front yard while the daycare children have water play and outdoor play at the front yard. Licensee stated that her FCCH houses 1 indoor cat and one (1) outdoor dog.

Children's files were reviewed. Emergency information and required immunization records were on file. LPA observed a current roster and documentation that a fire drill is conducted at least once every six months. The last fire drill was conducted and logged on 4/1/2024. Licensee's immunization records are available in the facility file. Current EMSA pediatric CPR and First Aid certification was verified and expires on 7/15/2025 and Child Care Provider Mandated Reporter certification was verified and expires on 7/19/2025.

LPA discussed the safe sleep regulations with licensee 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 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 a copy of LIC 9227 Individual Infant Sleeping Plan, for infants under 12 months.

This provider is not currently providing Incidental Medical Services (IMS) services to children in care. 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
Report continues on LIC809-C...(Page 3)
SUPERVISORS NAME: Chayntel Hunter
LICENSING EVALUATOR NAME: David Nguyen
LICENSING EVALUATOR SIGNATURE:

DATE: 10/17/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/17/2024
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: 10/17/2024
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Community Care Licensing Division (CCLD) regularly sends information to licensed facilities, providers, and stakeholders by way of Provider Information Notices (PINs), 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.

LPA discussed the Year-Round/Daily Reminder of Water Safety Requirements and Measures with licensee. LPA provided licensee the PIN 23-17-CCLD, the Year-Round and Daily Reminder of Water Safety Requirements and Measures. LPA stressed the importance of checking the premises for bodies of water daily prior to children's arrival for children's safety.

Licensee was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain child care by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.

During the exit interview, the LICENSEE, Leslie Irene Rivera confirmed that there are no Registered Sex Offenders living in the facility, and LPA completed the RSO profile in FAS.

To improve the quality and value of the new inspection process, a survey will be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or tools, please send them by email to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/inspection-process

Licensee was encouraged to visit the Department website at WWW.CCLD.CA.GOV for childcare updates, current forms, legislation, and regulation information.

Exit interview conducted and report was reviewed with licensee, Leslie Irene Rivera. Appeal rights and a notice of site visit were provided. A notice of site visit was posted and must remain posted for 30 days. A copy of this report will remain on file for a period of three years for public review upon request. Licensee's signature on this form acknowledges receipt of this form. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

Report continues on LIC809-C...(Page 4)

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

DATE: 10/17/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/17/2024
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: 10/17/2024
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In the areas that were evaluated, one (1) type A deficiency was cited during today’s inspection.

LPA Nguyen informed licensee, Leslie Irene Rivera that this report dated October 17th, 2024 documents one (1) Type A citation which shall be posted for 30 consecutive days as there are immediate risks to the health, safety, or personal rights of children in care.



Also, LPA Nguyen informed licensee to provide a copy of this licensing report dated October 17th, 2024, that documents any Type A citations to parents/guardians of all children currently enrolled by the next business day or the next day the children are in care, and to any newly enrolled parents/guardians for 12 months from the date of this report. A signed Acknowledgement of Receipt of Licensing Report (LIC 9224), or other written statement, must be placed in the child's file for verification.
SUPERVISORS NAME: Chayntel Hunter
LICENSING EVALUATOR NAME: David Nguyen
LICENSING EVALUATOR SIGNATURE:

DATE: 10/17/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/17/2024
LIC809 (FAS) - (06/04)
Page: 4 of 5
Document Has Been Signed on 10/17/2024 04:29 PM - It Cannot Be Edited


Created By: David Nguyen On 10/17/2024 at 03:37 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME: RIVERA, LESLIE IRENE
FACILITY NUMBER: 394500946

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/17/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
102417(g)
Operation of A Family Child Care Home
(g) The home shall be free from defects or conditions which might endanger a child. Safety precautions shall include but not limited to:

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, the licensee did not comply with the section cited above in which poses an immediate health, safety or personal rights risk to persons in care. LPAs observed the discarded household items, such as matresses, boxspring, chairs, bar stools, and other household items in the sideyard and a scrapping BBQ tool on the gas BBQ grill. LPAs also observed multiple piles of dog fecal matter in the backyard grass area. LPAs observed a stack of dirty dishes in both sides of kitchen sink. LPAs observed a bag of soiled of diapers at the entry door with flies surrounding it.
POC Due Date: 10/18/2024
Plan of Correction
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Licensee agrees to dispose all of the discarded household items by the POC due date (10/18/2024). Licensee also agrees to keep the backyard area free of dog fecal matter by the POC due date (10/18/2024). Licensee agrres to keep the kichen area claan. Licensee also agrees to keep the entry way into home free of soiled diapers.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Chayntel Hunter
LICENSING EVALUATOR NAME:David Nguyen
LICENSING EVALUATOR SIGNATURE:
DATE: 10/17/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/17/2024


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