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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 015700204
Report Date: 01/11/2024
Date Signed: 01/11/2024 02:08:47 PM

Document Has Been Signed on 01/11/2024 02:08 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
OAKLAND SOUTH EAST, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
FACILITY NAME:ESCOBEDO, GRACIELAFACILITY NUMBER:
015700204
ADMINISTRATOR:ESCOBEDO, GRACIELAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(510) 750-6918
CITY:HAYWARDSTATE: CAZIP CODE:
94541
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 9DATE:
01/11/2024
TYPE OF VISIT:Required - 3 YearUNANNOUNCEDTIME BEGAN:
11:35 AM
MET WITH:Graciela EscobedoTIME COMPLETED:
02:15 PM
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On January 11, 2024, at 11:35 AM, Licensing Program Analyst (LPA) Elimika Woods met with licensee Graciela Escobedo for an Unannounced Required 3 Year Inspection. LPA disclosed the purpose of the inspection and was granted entry into the facility by the licensee. Present during the inspection were the licensee's fingerprint cleared assistants, F. DeLa Torres, and K. Espinoza, eight (8) preschool age children and one infant. Licensee stated that the facility operates from Monday to Friday 7:00 AM to 5:00 PM.

LPA toured the facility inside and outside to conduct a Health and Safety inspection. This single story home was clean and orderly, with heating and ventilation for the safety and comfort. The Isolation area of the home will be a section of the living room, away from other children in care.

The off-limits are will be made inaccessible by closed and/or locked doors and visual supervision. LPA did not observe any hazardous materials or toxins accessible to children during today’s inspection. There are no pools, hot tubs or any other bodies of water present in the on-limit areas during today's inspection. Both side-yards and outside deck are off-limits to children in care.

The home has a working smoke detector, working carbon monoxide detector, pull down fire alarm, telephone, and a fully charged 2A10BC fire extinguisher which meets standards established by the State Fire Marshal. The home has floor heaters that are covered and no fireplace. Per licensee, there are no firearms in the home and the licensee does not transport children in care.

On- Limit areas are the: Living and dining room, kitchen, child care room, nap room, front-yard, bedroom (2) and bathroom next to nap room

Off- Limit areas are the: bedroom (1) next to bathroom, master bedroom and bath, laundry room, both side yards, side deck, and garage

See 809-C for continuance
SUPERVISORS NAME: Chandra Charles
LICENSING EVALUATOR NAME: Elimika Woods
LICENSING EVALUATOR SIGNATURE: DATE: 01/11/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/11/2024
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
OAKLAND SOUTH EAST, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
FACILITY NAME: ESCOBEDO, GRACIELA
FACILITY NUMBER: 015700204
VISIT DATE: 01/11/2024
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The OUTDOOR PLAY area is the fully fenced front yard area and LPA observed that it is free from defects or dangerous conditions. During today's inspection, LPA inspected a swing set that children were swinging on and confirmed that it was anchored to the ground. There are ample age appropriate toys that appear to be safe and in good condition and plenty of shade that's provided by the trees in the yard.

At 12:00 PM LPA requested and reviewed the files of three (3) children in care and two (2) staff files. All children files contain Immunization, Parent's Rights, and Medical Consent forms and all staff files have Employee Rights and TB results. The facility roster was reviewed, and copies were obtain. The licensee conducts and documents fire and disaster drills twice a year with the last one conducted on 12/13/23. The licensee's Health and Safety training is completed, and CPR and First Aid certificate is current and expires 08/2024. The licensee has completed mandated reporter training on 11/22/2024. All required forms are posted and visible for public review. The licensee is in ratio today

The following deficiencies were observed during today's inspection: FCCH
· At 12:30 PM, LPA observed during the record review that the licensee's two assistants didn't have their Immunization records in their files.

Effective August 1, 2003 California Law requires Family Child Care Home 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 624B). Incidents must be reported within 24 hours by phone, fax, or electronic mail. The licensee was also reminded 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. For IMS information see PIN 22-02CCP. 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: https://www.ada.gov/resources/child-care-centers/.



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-andresources/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.

See 809-C

SUPERVISORS NAME: Chandra Charles
LICENSING EVALUATOR NAME: Elimika Woods
LICENSING EVALUATOR SIGNATURE:

DATE: 01/11/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/11/2024
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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
OAKLAND SOUTH EAST, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
FACILITY NAME: ESCOBEDO, GRACIELA
FACILITY NUMBER: 015700204
VISIT DATE: 01/11/2024
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Licensee was reminded that all adults 18 and over living or working in the home, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, 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 for a maximum of 5 days or, if the penalty is for a repeat violation, for a maximum of 30 days per person will be assessed if this regulation is violated.

To improve the quality and value of the new inspection process, a survey may 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 CARE tools, please send email inquiries 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/inspection-process.

Licensee was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain child care by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.

During the exit interview, the LICENSEE Graciela Escobedo, confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS.

See 809-D for deficiencies cited today. A notice of site visit was given and must remain posted for 30 days. Exit interview conducted and report was reviewed with the licensee Graciela Escobedo.

SUPERVISORS NAME: Chandra Charles
LICENSING EVALUATOR NAME: Elimika Woods
LICENSING EVALUATOR SIGNATURE:

DATE: 01/11/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/11/2024
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Document Has Been Signed on 01/11/2024 02:08 PM - It Cannot Be Edited


Created By: Elimika Woods On 01/11/2024 at 01:51 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 STE 1102
OAKLAND, CA 94612

FACILITY NAME: ESCOBEDO, GRACIELA
FACILITY NUMBER: 015700204

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/11/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
HSC
1597.622(c)
Administration of Child Day Care Licensing
(c) The family day care home shall maintain documentation of the required immunizations or exemptions from immunization, as set forth in this section, in the person's personnel record that is maintained by the family day care home.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, the licensee did not comply with the section cited above in which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 02/12/2024
Plan of Correction
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Licensee will email, fax, or mail her assistants Immunization Records to LPA by 02/12/24
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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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:Chandra Charles
LICENSING EVALUATOR NAME:Elimika Woods
LICENSING EVALUATOR SIGNATURE:
DATE: 01/11/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/11/2024


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