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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 013413941
Report Date: 07/07/2021
Date Signed: 07/07/2021 01:11:25 PM

Document Has Been Signed on 07/07/2021 01:11 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
CCLD Regional Office, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
FACILITY NAME:RODRIGUEZ, IRMA & MORALES FELIX, DUNIAFACILITY NUMBER:
013413941
ADMINISTRATOR:RODRIGUEZ, IRMAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(510) 656-6530
CITY:FREMONTSTATE: CAZIP CODE:
94538
CAPACITY: 14TOTAL ENROLLED CHILDREN: 0CENSUS: 7DATE:
07/07/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Irma Rodriguez & Dunia Felix MoralesTIME COMPLETED:
01:10 PM
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On 7/07/2021 at 11:00am Licensing Program Analyst (LPA) Morgan Pringle met with Licensee’s Dunia Morales Felix and Irma Rodriguez for an unannounced annual inspection. Present during the inspection were the two (2) Licensee’s. Licensee’s live in the home with Morales’s 10-year-old son and Rodriguez’s fingerprint cleared husband Adolfo Rodriguez. There were seven (7) children present during the inspection. The Licensee’s home was toured for a health and safety inspection. The operating hours are 7:00am – 5:00pm Monday – Friday.

ON LIMITS AREA: Family Room, Living Room, Dining Room, Patio, and Back Yard


OFF LIMITS AREA: All 4 Bedrooms, Kitchen, Garage
ISOLATION AREA: Living Room

The facility is a single story home owned by the Licensee Rodriguez. The inside of the home is observed to be neat, clean with ample age appropriate materials for the children that are safe and clean. All toxins, cleaning products, medications, and hazardous materials were observed to be in inaccessible areas. Licensee has stated that there are no firearms and one dog.

The home has one (1) fully charged 2A10BC fire extinguisher located on the Patio. One (1) working carbon monoxide detector in the hallway and one (1) working smoke detector in the dining room, hallway and in front of the room next to the living room. The smoke detectors in the dining room and the detector in front of the bedroom need battery replacements. LPA discussed this with Licensee. The home is equipped with central air and heating for proper ventilation. LPA observed no bodies of water in or around the home.

Cont on 809-C
SUPERVISORS NAME: Jason Jang
LICENSING EVALUATOR NAME: Morgan Pringle
LICENSING EVALUATOR SIGNATURE: DATE: 07/07/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/07/2021
This report must be available at Child Care and Group Home facilities for public review for 3 years.

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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, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
FACILITY NAME: RODRIGUEZ, IRMA & MORALES FELIX, DUNIA
FACILITY NUMBER: 013413941
VISIT DATE: 07/07/2021
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At 11:55am LPA obtained the facility roster and requested the files for seven (7) children. The files and the facility roster were complete. One file is missing for C6. The Licensee’s Health and Safety training has been completed and CPR and First Aid training is current with an expiration date of 1/2022. Licensee’s Mandated Reporter training is current expiring on 2/23/2023 and 2/01/2023. Fire/disaster drill in complete with the last completed drill on 6/28/2021. All required forms are posted and visible for public view on the patio next to the sliding glass door.

Licensee was reminded that California Law requires licensees to report unusual incidents or injuries to children in care, to child's parents, and to the Department of Social Services using the Unusual Incident/Injury form (LIC 624). Incidents must be reported within 24 hours by phone, fax, or email. LPA informed Licensee that all forms can be downloaded at www.ccld.ca.gov. Licensee was also informed that Mandated Reporter Training ("General" and "Child Care Providers") is required for all staff and is to be renewed every 2 years by visiting www.mandatedreporterca.com.



Incidental Medical Services (IMS) policy was discussed as well. Licensee was reminded that when any IMS is provided, an updated Plan of Operation that includes IMS must be submitted to the Department. The following information 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 is reminded that ALL assistants, volunteers, frequent visitors, or adults living in the home, that are 18 years of age or older must be fingerprint cleared and associated to this facility prior to being in the presence of children in care or an immediate civil penalty will be assessed from $100 to $3,000 per person, per incident. Licensee was reminded of the responsibility as a mandated reporter.
Children’s Roster must be properly maintained, and fire/disaster drill must be conducted every six months and documented. The licensee is reminded that any structural changes to the home or additions to the childcare facility must be reported to Community Care Licensing.

Cont on 809-C
SUPERVISORS NAME: Jason Jang
LICENSING EVALUATOR NAME: Morgan Pringle
LICENSING EVALUATOR SIGNATURE:

DATE: 07/07/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/07/2021
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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, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
FACILITY NAME: RODRIGUEZ, IRMA & MORALES FELIX, DUNIA
FACILITY NUMBER: 013413941
VISIT DATE: 07/07/2021
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Licensee was encouraged to frequently visit our website at www.ccld.ca.gov for licensing regulations and updates.

This report was read and given to the Licensee for a signature. There is one deficiency being cited today CCR 102421(b). This report shall remain on file for 3 years. Appeal Rights were provided and exit interview conducted. A Notice of Site visit was given and must be posted for 30 days.

SUPERVISORS NAME: Jason Jang
LICENSING EVALUATOR NAME: Morgan Pringle
LICENSING EVALUATOR SIGNATURE:

DATE: 07/07/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/07/2021
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Document Has Been Signed on 07/07/2021 01:11 PM - It Cannot Be Edited


Created By: Morgan Pringle On 07/07/2021 at 12:37 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
, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612

FACILITY NAME: RODRIGUEZ, IRMA & MORALES FELIX, DUNIA
FACILITY NUMBER: 013413941

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/07/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
07/07/2021
Section Cited
CCR
102421(b)

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102421(b) The licensee shall maintain, in each child's record, a copy of the emergency information card as required in Section 102417(g)(7). This requirement was not met as evidenced by:
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Licensee will complete all proper documentation for child and send to LPA by 7/12/2021.
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Licensee does not have any documentation for child in care. This poses a potential health and safety risk to children in care.
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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:Jason Jang
LICENSING EVALUATOR NAME:Morgan Pringle
LICENSING EVALUATOR SIGNATURE:
DATE: 07/07/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/07/2021


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