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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434416040
Report Date: 02/18/2022
Date Signed: 02/18/2022 11:23:35 AM

Document Has Been Signed on 02/18/2022 11:23 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
CCLD Regional Office, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME:ROJAS, ALBERTOFACILITY NUMBER:
434416040
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 0CENSUS: 0DATE:
02/18/2022
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Alberto RojasTIME COMPLETED:
11:30 AM
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Licensing Program Analysts (LPAs) Deanna Villagrana and Teodoro Trujillo met with applicant Albert Rojas to conduct an announced pre-licensing inspection to the home today. The adults that reside in the home are the Applicant and his husband and aunt.

Days and hours of operation will be Monday - Friday from 6:00 AM to 7:00 PM. Applicant has completed her Preventative Health and Safety Child Care Training on 10/27/2021 and a copy of the certification is on file. Applicant's CPR and First Aid certifications are current and expire on 10/2023. Applicant rents the home and the Owner/Landlord Notification form (LIC 9149) is on file. Applicant does not have liability insurance and will issue affidavit regarding liability insurance for FCCH.

LPAs toured the indoor and outdoor areas during today's visit. The home is one of the units of a duplex. There are no stairs in the home. LPAs observed a barricaded fireplace in the home. Off limit areas inside the home: master bedroom/bath, two bedrooms, and the garage that is accessible from the front yard. LPAs observed a fully charged 3A40BC fire extinguisher, working smoke detector, working carbon monoxide, fenced backyard, and no bodies of water. Outdoor activities will be conducted in the front yard. Licensee understands that children must be supervised at all times while playing outdoor. Applicant states that there are no weapons in the home. Cleaning Products, toxic agents, medications, and sharp objects were inaccessible to children. LPAs reminded Applicant that smoking, baby walkers, bouncers, jumpers, and similar items are not allowed in Family Child Care Homes.

A review of staff records on 02/16/2022 indicates that all Facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions. LPAs reminded Applicant of the applicable civil penalties for those adults who have not received fingerprint clearances, are not associated to the license and who come in contact with or provide care and supervision to the children. Penalty amounts: $100.00 per person
SUPERVISORS NAME: Mary Segura
LICENSING EVALUATOR NAME: Deanna Villagrana
LICENSING EVALUATOR SIGNATURE: DATE: 02/18/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/18/2022
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
CCLD Regional Office, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME: ROJAS, ALBERTO
FACILITY NUMBER: 434416040
VISIT DATE: 02/18/2022
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per day, minimum of $100.00 to a maximum of $500.00 per person for an initial violation and a minimum of $100.00 to a maximum of $3000.00 per person for any subsequent violation within a 12 month period.

Forms of discipline used by Applicant: talking to children and redirection. Applicant understands that children's personal rights should not be violated; including no corporal punishment. Isolation of sick children, supervision of children, capacity options, transportation of children, requirements for reporting suspected child abuse, unusual incidents/injuries, heat related illnesses, and requirements for assistant/substitute were also discussed. LPAs informed Applicant that fire/disaster drills must be practiced at least once every 6 months and documented. LPA discussed the safe sleep regulations with licensee Alberto Rojas 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 Alberto Rojas 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.

A Family Child Care Home packet with updated Licensing forms was provided to and reviewed with the Applicant. LPAs discussed the requirements of AB 633 with the Applicant and provided her the AB 633 fact sheet and a copy of Acknowledgement of Receipt of Licensing Reports (LIC 9224) and Applicant understands the requirements. LPAs also discussed "zero tolerance" related regulations with the Applicant and advised her of the assessment of an immediate $500 civil penalty for any violation of a "zero tolerance" related regulation. An ongoing civil penalty of $100 per day continues until the violation(s) is corrected. 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. SB 792 Immunization Requirements was also discussed. Applicant's immunization records are on file.

LPAs conducted an exit interview with the Applicant and advised him that a small Family Child Care Home license is approved pending photos of a barricaded wall heater, and updated facility sketch showing the duplex attached to right side of the home, additional toys and supplies for children and managers approval.
SUPERVISORS NAME: Mary Segura
LICENSING EVALUATOR NAME: Deanna Villagrana
LICENSING EVALUATOR SIGNATURE:

DATE: 02/18/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/18/2022
LIC809 (FAS) - (06/04)
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