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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 013413941
Report Date: 09/10/2021
Date Signed: 09/10/2021 10:54:32 AM

Document Has Been Signed on 09/10/2021 10:54 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, 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: 3DATE:
09/10/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:05 AM
MET WITH:Irma Rodriguez & Dunia Morales FelixTIME COMPLETED:
10:40 AM
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On 9/10/2021 at 9:05am Licensing Program Analyst (LPA) Morgan Pringle met with Licensee's Irma Rodriguez for an unannounced annual inspection. Co-Licensee Dunia Morales Felix arrived at 9:47am. Present during the inspection were the Licensee's and Rodriguez’s fingerprint cleared husband Adolfo Rodriguez. There were three (3) preschool 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 Licensee Rodriguez and her husband. 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 in the home.

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 home is equipped with central air and heating for proper ventilation. LPA observed one small fountain in the front yard of the home which is off-limits. Licensee stated that children do not enter from the front of the home, but from the side of the home into the patio area.

Continued on 809-C
SUPERVISORS NAME: Jason Jang
LICENSING EVALUATOR NAME: Morgan Pringle
LICENSING EVALUATOR SIGNATURE: DATE: 09/10/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/10/2021
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, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
FACILITY NAME: RODRIGUEZ, IRMA & MORALES FELIX, DUNIA
FACILITY NUMBER: 013413941
VISIT DATE: 09/10/2021
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At 9:20am LPA obtained the facility roster and requested the files for six (6) children. The files and the facility roster were complete. 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 9/01/2021. 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, child's parents and Licensees and helpers 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 two (2) years by visiting www.mandatedreporterca.com.



Licensee was reminded that EMSA approved Pediatric CPR & First Aid training must be completed every two (2) years. Children’s Roster must be properly maintained, and fire/disaster drill must be conducted every six (6) 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.

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

Licensee was reminded that all adults 18 and over living or working in the home, including employees and volunteers, 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 up to $500.00 maximum per day/per person will be assessed if this regulation is violated.
Continued on 809-C
SUPERVISORS NAME: Jason Jang
LICENSING EVALUATOR NAME: Morgan Pringle
LICENSING EVALUATOR SIGNATURE:

DATE: 09/10/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/10/2021
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, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
FACILITY NAME: RODRIGUEZ, IRMA & MORALES FELIX, DUNIA
FACILITY NUMBER: 013413941
VISIT DATE: 09/10/2021
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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.

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/process.

A notice of site visit was given and must remain posted for 30 days. Exit interview conducted and report was reviewed with the licensee.
SUPERVISORS NAME: Jason Jang
LICENSING EVALUATOR NAME: Morgan Pringle
LICENSING EVALUATOR SIGNATURE:

DATE: 09/10/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/10/2021
LIC809 (FAS) - (06/04)
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