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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 013417672
Report Date: 07/08/2021
Date Signed: 07/08/2021 05:43:42 PM


COMPREHENSIVE INSPECTION

Document Has Been Signed on 07/08/2021 05:43 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:NOGUERA, RAQUELFACILITY NUMBER:
013417672
ADMINISTRATOR:NOGUERA, RAQUELFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(510) 794-1159
CITY:FREMONTSTATE: CAZIP CODE:
94555
CAPACITY: 14TOTAL ENROLLED CHILDREN: 0CENSUS: DATE:
07/08/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
03:56 PM
MET WITH:Raquel NogueraTIME COMPLETED:
05:32 PM
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On 7/08/2021 at 3:50pm Licensing Program Analyst (LPA) Morgan Pringle met with Licensee Raquel Noguera for an unannounced annual inspection. Present during the inspection was the Licensee and her fingerprint cleared assistant Antonette Galera. Licensee’s live in the home with their fingerprint cleared husband Raymond Noguera and fingerprint cleared daughter Naomi Noguera and 17 year old son. There were nine (9) children present during the inspection. Two (2) school age children, five (5) preschool children and (2) infants present during the inspection. The Licensee’s home was toured for a health and safety inspection. The operating hours are 7:00am – 6:00pm Monday – Friday.

ON LIMITS AREA: Kitchen, Dining Room, Living Room, Hallway Bathroom and Backyard


OFF LIMITS AREA: All three (3) bedrooms, Garage and Storage Unit
ISOLATION AREA: Living Room

The facility is a single-story home owned by the Licensee. 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 firearms and one dog in the home.

The home has one (1) fully charged 3A40BC fire extinguisher located in the dining room next to the sliding glass door. One (1) working carbon monoxide detector in the corner bedroom and one (1) smoke detector in the living room and the hallway. The home is equipped with heating and many working windows 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: 07/08/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/08/2021
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 3
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: NOGUERA, RAQUEL
FACILITY NUMBER: 013417672
VISIT DATE: 07/08/2021
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At 4:17pm LPA obtained the facility roster, children’s files and assistants file. 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 9/14/2021. Licensee’s Mandated Reporter training is current expiring on 9/21/2022. All required forms are posted and visible for public view in the dining room. Licensee's fire and disaster drill log is complete with the last drill logged 6/30/2021.

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

DATE: 07/08/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/08/2021
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: NOGUERA, RAQUEL
FACILITY NUMBER: 013417672
VISIT DATE: 07/08/2021
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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 are no deficiencies being cited today. 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: 07/08/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/08/2021
LIC809 (FAS) - (06/04)
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