015700279-10-5-2021-52-CC-JWIS-C7HRFD-20211005125859

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 015700279
Report Date: 10/05/2021
Date Signed: 10/05/2021 12:59:23 PM

Document Has Been Signed on 10/05/2021 12:59 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:	TORRES, MARIA		FACILITY NUMBER:	015700279
ADMINISTRATOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY: 8	TOTAL ENROLLED CHILDREN: 0	CENSUS: 0	DATE:	10/05/2021
TYPE OF VISIT:	Prelicensing	ANNOUNCED	TIME BEGAN:	09:00 AM
MET WITH:	Maria Torres		TIME COMPLETED:	01:15 PM

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On 10/05/2021 at 09:00am, Licensing Program Analyst (LPA) Jonathan Williams met with Applicant, Maria Torres, for the purposes of conducting an announced prelicensing inspection. Present during today's inspection was the Applicant, the Applicant's fingerprint cleared and associated husband, and two unfingerprinted adults. Per Applicant, the two unfingerprinted adults are the Applicant's son and his girlfriend. The home was toured to conduct a health and safety inspection.

On-limit-areas: Living room, dining room, TV room, hallway bathroom, backyard.
Off-limit-areas: Entire second floor, downstairs bedrooms including master bathroom, garage, kitchen, additional dwelling unit attached to the side of the home.
Isolation area: Area of the TV room.

The facility is a 2 story home owned by the Applicant consisting of six bedrooms (two on first floor and four on the second floor), three bathrooms, kitchen, living room, dining room, "TV room", and backyard. An additional dwelling unit (ADU) is located on the side of the home and is rented out to three adult tenants by the Applicant. The ADU is not accessible from within the home and enters through the left side of the house. None of the tenants are fingerprint cleared.

The home is neat and clean. Medications, toxins, and cleaning compounds were observed to be accessible to children via unlocked doors in the on-limits bathroom. Per Applicant statement at 9:46am, there are no firearms in the facility. Per Applicant statement at 10:12am, no pets are kept in the home. Applicant tested carbon monoxide/smoke detector (combined) and LPA observed them to be functional at 12:00pm. The backyard was toured at 9:49am. LPA observed gardening equipment accessible in the backyard as well as an unlocked shed. The backyard contains a raised area with a ledge next to a concrete surface that lacks cushioning material to absorb falls. LPA did not observe any bodies of water on the facility premises at this time.

SUPERVISORS NAME: Wynn Norona
LICENSING EVALUATOR NAME: Jonathan Williams
LICENSING EVALUATOR SIGNATURE:	DATE: 10/05/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/05/2021

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: TORRES, MARIA	FACILITY NUMBER: 015700279
	VISIT DATE: 10/05/2021

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Applicant has required Preventive Health and Safety Training certificate. Applicant has current CPR/1st Aid certificate which expires on 12/2022. Mandated Reporter training certificates for "Child Care Providers" and "General" for Applicant are current, and expire on 08/06/2023.

Applicant 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.

Applicant was reminded that California Law requires licensed Family Child Care Homes 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. LPA informed the Applicant that all forms can be downloaded at www.ccld.ca.gov and encouraged the Applicant to email childcareadvocatesprogram@dss.ca.gov to be included in the Child Care Quarterly Updates distribution list. The Applicant 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 at 12:42pm. Applicant 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.

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.

SUPERVISORS NAME: Wynn Norona
LICENSING EVALUATOR NAME: Jonathan Williams
LICENSING EVALUATOR SIGNATURE:	DATE: 10/05/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/05/2021

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: TORRES, MARIA	FACILITY NUMBER: 015700279
	VISIT DATE: 10/05/2021

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The Applicant is reminded any structural changes to the home or additions to the child care facility must be reported to Community Care Licensing.

Due to the following deficient conditions, a license cannot be issued at this time:

1. All adults 18 years of age or older living or working in the home, including frequent visitors, must be fingerprint cleared and associated to this facility. Such individuals include the Applicant's adult son, the son's girlfriend, and the three adult tenants living in the ADU.
2. All of the above individuals must sign both pages of the LIC508 (Criminal Record Statement).
3. Facility Sketch (Floor and Yard Plan) must match the home with off-limit areas clearly marked. Provided sketches do not match the layout of the home and do not mark off-limit areas.
4. All toxins, detergents, and cleaning compounds must be made inaccessible to children in the home, including the bathroom, where LPA observed cupboards containing said items to be unlocked.
5. All dangerous and age-inappropriate items must be removed from backyard, including gardening equipment (shears, shovels, rakes) and sharp rocks.
6. Cushioning material must be installed near concrete ledge to absorb falls.
7. Shed in the backyard must be locked to prevent access by children.
8. A fully charged fire extinguisher (2A10BC or larger, such as 3A40BC) must be present in the facility.
9. A fully stocked first aid kit must be present in the facility.

Applicant shall correct deficiencies by the due date of 11/05/2021, otherwise a license cannot be issued. Applicant is advised that failure to correct stated deficiencies may result in denial of application.

Exit interview conducted with Applicant.

SUPERVISORS NAME: Wynn Norona
LICENSING EVALUATOR NAME: Jonathan Williams
LICENSING EVALUATOR SIGNATURE:	DATE: 10/05/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/05/2021

LIC809 (FAS) - (06/04)

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