013422904-2-21-2023-02-CC-CFES-CPA29F-20230221161152

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 013422904
Report Date: 02/21/2023
Date Signed: 02/21/2023 04:12:08 PM

Document Has Been Signed on 02/21/2023 04:12 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, SUITE 1102
OAKLAND, CA 94612

FACILITY NAME:	AGUILAR ROCHIN, CARMEN		FACILITY NUMBER:	013422904
ADMINISTRATOR:	AGUILAR ROCHIN, CARMEN		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(510) 282-2178
CITY:	ALAMEDA	STATE: CA	ZIP CODE:	94501
CAPACITY: 14	TOTAL ENROLLED CHILDREN: 9	CENSUS: 6	DATE:	02/21/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	02:36 PM
MET WITH:	Carmen Aguilar Rochin		TIME COMPLETED:	04:20 PM

NARRATIVE

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On 2/21/2023 at 2:27pm, Licensing Program Analyst (LPA) Catherine Fernandes met with Licensee Carmen Aquilar Rochin for an Unannounced Required Annual Inspection. Present during the inspection were one fingerprint cleared helper, four infants, one preschooler and one school age child in care. Residing in the home is Licensee, her fingerprint cleared husband and her three underage children. Licensee’s home was toured for a health and safety inspection. The facility operates 8:00am–5:00pm, Monday-Friday.

The home is a duplex with two levels and separate entrances. The day care is utilizing the lower level of the home as the main area for the day care. The home consists of two bedrooms and one bathroom. The entrance to the day care is the front door on right side of the house. The inside and outside of the home were observed to be neat, clean with age appropriate materials and toys for the children. All toxins, cleaning products, medications, and hazardous materials were observed to be in inaccessible areas. During today’s inspection, LPA observed the following precautions, there is a fireplace in the main day care room that is covered, cabinets in the kitchen have safety latches and there are gates to prevent access through walk through spaces. Licensee has stated that there are no firearms and there is little dog in the home but not around the kids.

ON LIMITS AREA: Kitchen as a walk through space, the living room/dining area which are the main areas of the day care, the closed off portion of the backyard, the two bedrooms and the bathroom.

OFF LIMITS AREA: The entire upper level of the duplex, the garage the back portion of the backyard and the right side of the yard when facing the house, which will be inaccessible by closed and/or locked doors or visual supervision.
ISOLATION AREA: will the area near the front door until picked up.
The home has a fully charged 2A10BC fire extinguisher located on the wall in the kitchen, a working smoke detector and a carbon monoxide detector in the main area of the day care.
Report Continues on 809C.

SUPERVISORS NAME: Mayla Mendoza
LICENSING EVALUATOR NAME: Catherine Fernandes
LICENSING EVALUATOR SIGNATURE:	DATE: 02/21/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/21/2023

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, SUITE 1102
OAKLAND, CA 94612

FACILITY NAME: AGUILAR ROCHIN, CARMEN	FACILITY NUMBER: 013422904
	VISIT DATE: 02/21/2023

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Licensee has a working telephone and the home has a pull down station next to the front door. All required forms are posted and visible for public view in the childcare room. The licensee conducts and documents fire and disaster drills with the last one conducted on 2/3/22. The Licensee's CPR and First Aid certificate is current and expires on 4/2023. The Licensee was reminded of the responsibility as a mandated reporter and will provide proof of the required training. LPA did not observe any bodies of water in or around the home.
LPA reviewed five children’s files, two staff files and obtained the facility roster.

The following was observed during today’s inspection:
-Fire and disaster drills were not done within 6 months from the last date
- No immunization's for adults

Licensee was reminded that California Law requires Licensee 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 two (2) years by visiting http://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

Report Continues on 809C

SUPERVISORS NAME: Mayla Mendoza
LICENSING EVALUATOR NAME: Catherine Fernandes
LICENSING EVALUATOR SIGNATURE:	DATE: 02/21/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/21/2023

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, SUITE 1102
OAKLAND, CA 94612

FACILITY NAME: AGUILAR ROCHIN, CARMEN	FACILITY NUMBER: 013422904
	VISIT DATE: 02/21/2023

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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.
-NO IMS PROVIDED AT THIS TIME

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.

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.
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.
For licensing updates email childcareadvocatesprogram@dss.ca.gov and ask to be added to the email list.
See 809C for deficiencies,
Exit interview conducted
Report and Appeals rights provided

SUPERVISORS NAME: Mayla Mendoza
LICENSING EVALUATOR NAME: Catherine Fernandes
LICENSING EVALUATOR SIGNATURE:	DATE: 02/21/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/21/2023

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 02/21/2023 04:12 PM - It Cannot Be Edited

Created By: Catherine Fernandes On 02/21/2023 at 03:51 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, SUITE 1102
OAKLAND, CA 94612

FACILITY NAME: AGUILAR ROCHIN, CARMEN	FACILITY NUMBER: 013422904
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 02/21/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

102417(g)(9)(A)

Operation of A Family Child Care Home

(g) The home shall be free from defects or conditions which might endanger a child. Safety precautions shall include but not limited to: (9) Each family child care home shall have a written disaster plan of action prepared on a form approved by the Department. All children, age and ability permitting, and the provider, the assistant provider, and other members of the household, shall be instructed in their duties under the disaster plan. As their age and ability permit, newly enrolled children shall be informed promptly of their duties as required in the plan. (A) Each family child care home shall conduct fire drills and disaster drills at least once every six months. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation, the licensee did not comply with the section cited above last drill was more than six months ago which poses a potential safety risk to persons in care.
	POC Due Date: 02/28/2023
	Plan of Correction
1 2 3 4	Licensee will conduct a drill and send a copy to CCL by POC date.

Type B

Section Cited

HSC

1597.622(a)(1)

General Provisions and Definitions

(1) Commencing September 1, 2016, a person shall not be employed or volunteer at a family day care home if he or she has not been immunized against influenza, pertussis, and measles. Each employee and volunteer shall receive an influenza vaccination between August 1 and December 1 of each year. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on record review, the licensee did not comply with the section cited above licensee needs proof of immunization's which poses a potential health risk to persons in care.
	POC Due Date: 03/21/2023
	Plan of Correction
1 2 3 4	Licensee will create files containing all required documents and send a statement of completion to CCL by POC date.

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:

Mayla Mendoza

LICENSING EVALUATOR NAME:

Catherine Fernandes

LICENSING EVALUATOR SIGNATURE:

DATE: 02/21/2023

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/21/2023

LIC809 (FAS) - (06/04)

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