Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 233007628
Report Date: 06/27/2018
Date Signed: 06/27/2018 04:46:06 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 101 GOLF COURSE DR. STE. A-230
ROHNERT PARK, CA 94928
FACILITY NAME:ALVAREZ, MARIA(ANGELICA) FCCHFACILITY NUMBER:
233007628
ADMINISTRATOR:ALVAREZ, MARIA (ANGELICA)FACILITY TYPE:
810
ADDRESS:TELEPHONE:
(707) 513-0520
CITY:UKIAHSTATE: CAZIP CODE:
95482
CAPACITY:14CENSUS: 7DATE:
06/27/2018
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
01:15 PM
MET WITH:Maria (Angelica) AlvarezTIME COMPLETED:
03:55 PM
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An unannounced Annual/Random inspection was made to the facility by Licensing Program Analyst (LPA), Leticia Rosales-Meza. A review of staff records indicates that all facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions. There are presently two adults living in the home. There were 7 children in care at the time of inspection. Fees are current.

During today’s inspection the home and grounds were toured and the licensee was operating within the licensed capacity. Operating hours are 7:00 AM 11:00 PM, Monday through Friday. The floor plan was verified. The main child care areas includes the living room, kitchen, hallway bathroom, and "play" room next to kitchen. "Off limits" areas are the bedrooms and garage. Access to these areas is prevented by door knob covers and key locked doors. The children's bathroom is free of toxins. There is a working telephone in the home. Items which could pose a danger to children (detergents, cleaning compounds, and medications) were stored out of the reach of children. Latches are used underneath the kitchen sink. The licensee stated fire arms are stored unloaded, and ammunition is key locked separately in key locked cabinets. LPA observed during today's inspection a gun safe, locked where fire arms are stored and ammunition stored separate in a key locked cabinet. Poisons are stored in the locked cabinet with a key lock in the garage. There is a working smoke detector, carbon monoxide and fire extinguisher in the home. The home is heated and cooled by a central unit. There is a fire place in the living room and is screened. Mrs. Alvarez states the fire place is not during day care hours. The fenced back yard is used for play. Exterior "Off limit" areas includes the front yard, garden area and both side yards. Access to this area is prevented by a latched gates. Family pets are a Dachshund Mix dog named, "Chocolate", a Shepherd, Germanan dog named, "Lobo" and there are several pigeons that are kept in a very large covered cage located in the backyard. Licensee states the dog's shot records are current. There are no bodies of water observed during the inspection. The licensee has a current roster of children in care. Emergency drills are conducted at least every six months and date documented. The most recent drill was on (06/15/2018). A sample of children's records (immunization's; parents' rights notification) were reviewed and found to be organized and in compliance. The licensee has completed the training on preventative health practices as required. CPR and First Aid cards expire 2/2019 for Licensee and assistant. Incidental Medical Services (IMS) policy was discussed. Licensee is not providing IMS at this time.
SUPERVISOR'S NAME: Alexis HollonTELEPHONE: (707) 588-5026
LICENSING EVALUATOR NAME: Leticia RosalesTELEPHONE: (707) 588-5061
LICENSING EVALUATOR SIGNATURE:

DATE: 06/27/2018
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/27/2018
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, 101 GOLF COURSE DR. STE. A-230
ROHNERT PARK, CA 94928
FACILITY NAME: ALVAREZ, MARIA(ANGELICA) FCCH
FACILITY NUMBER: 233007628
VISIT DATE: 06/27/2018
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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.

Immunization Requirements for 2016 were given during visit.
Personnel Immunization records for Measles, Pertussis, Influenza were discussed and regulation 1597.622 was given.

Child Care Providers Guide to Safe Sleep was given
English: https://www.cdph.ca.gov/programs/SIDS/Documents/SIDSchildcaresafesleep.pdf Spanish: https://www.cdph.ca.gov/programs/SIDS/Documents/ChildCareProvSleepSPAN2011.pdf
Also the Quarterly Update was given

All licensing reports are public information and must be made available upon request for at least three years.


There were no Title 22 deficiencies cited during today's visit.
Notice of Site Visit shall be posted for 30 days from today's visit.
SUPERVISOR'S NAME: Alexis HollonTELEPHONE: (707) 588-5026
LICENSING EVALUATOR NAME: Leticia RosalesTELEPHONE: (707) 588-5061
LICENSING EVALUATOR SIGNATURE:

DATE: 06/27/2018
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/27/2018
LIC809 (FAS) - (06/04)
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