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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 013417644
Report Date: 11/08/2021
Date Signed: 11/08/2021 11:10:57 AM

Document Has Been Signed on 11/08/2021 11:10 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:BERRIOS, ALIXFACILITY NUMBER:
013417644
ADMINISTRATOR:CASTRO, ALIXFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(510) 676-3935
CITY:UNION CITYSTATE: CAZIP CODE:
94587
CAPACITY: 14TOTAL ENROLLED CHILDREN: 7CENSUS: 6DATE:
11/08/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:57 AM
MET WITH:Veronica Perez- AssistantTIME COMPLETED:
11:20 AM
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On 11/8/21 at 9:57am, Licensing Program Analyst Briana Plumboy met with assistant Veronica Perez for an UNANNOUNCED RANDOM INSPECTION. Present for this visit was 2 infants and 4 preschool age children, and fingerprint clear assistant Tomasa Perez. The home was toured to conduct a Health and Safety Inspection. The facility currently operates Monday through Friday from 6:30am until 5:30pm.

The home is single story. The On limit areas are the sun/patio room, living room, family room, dining room, hallway bathroom, and the first hallway bedroom located on the right side of the hallway. The isolation area is the family room. The home is neat and clean with heating and ventilation for safety and comfort. The BACKYARD play area is fenced. There are toys, learning materials, and play equipment present at the facility today. There are no play structures present during today's inspection which are required to be anchored. There are no pools, hot tubs or any other bodies of water present at the facility during today's inspection All hazardous materials and toxins are kept out of the reach of children and it was observed that there are no toxins or hazardous items accessible to children in care during today's inspection.
The home has a fully charged 3A40BC fire extinguisher, emergency supplies, working smoke detector, working carbon monoxide detector, working telephone, and First Aid Kit. The licensee and assistant Veronica's CPR and First Aid certificates are current and expires 07/2023. Licensee and assistants Tomasa Perez and Veronica Perez are in compliance with the immunization law. Licensee and assistant Veronica Perez received certificates in mandated reporter training. Licensee Alix Berrios received her certificate on 01/27/20 and Veronica Perez received her certificate on 1/28/20. The fireplace is screened to prevent access by children. Per licensee, there are no firearms in the home. The licensee conducts and documents fire and disaster drills at least twice a year with the last one conducted on 6/2/21.

Facility roster reviewed and copy obtained. All REQUIRED forms are posted and visible for public review. See 809-C for continuance
SUPERVISORS NAME: Wynn Norona
LICENSING EVALUATOR NAME: Briana Plumboy
LICENSING EVALUATOR SIGNATURE: DATE: 11/08/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/08/2021
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: BERRIOS, ALIX
FACILITY NUMBER: 013417644
VISIT DATE: 11/08/2021
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Incidental Medical Services (IMS) policy was discussed. 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 encouraged to frequently visit our website at ccld.ca.gov for licensing regulations and updates.

Licensee is reminded that ALL assistants, volunteers, and staff, 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 $3000 per person, per incident. Licensee was reminded of the responsibility as a mandated reporter. All forms can be downloaded at www.ccld.ca.gov



LPA discussed the safe sleep regulations with assistant Veonica Perez 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 assistant Veronica Perez 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 notice of site visit was given and must remain posted for 30 days.

No deficiencies cited during today's inspection. Appeal rights provided and discussed. Exit interview conducted and report was reviewed with assistant Veronica Perez

SUPERVISORS NAME: Wynn Norona
LICENSING EVALUATOR NAME: Briana Plumboy
LICENSING EVALUATOR SIGNATURE:

DATE: 11/08/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/08/2021
LIC809 (FAS) - (06/04)
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