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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 015700405
Report Date: 12/12/2022
Date Signed: 12/12/2022 09:51:39 AM

Document Has Been Signed on 12/12/2022 09:51 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:RODRIGUEZ, KARLAFACILITY NUMBER:
015700405
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 0DATE:
12/12/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
08:30 AM
MET WITH:Karla RodriguezTIME COMPLETED:
10:00 AM
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On December 12, 2022, at 8:30 AM., Licensing Program Analyst (LPA) Elimika Woods conducted an Announced Prelicensing Inspection for the purpose of a Change in Location and met with licensee, Karla Rodriguez. LPA disclosed the purpose of the inspection and was granted entry into the facility by the licensee. There were no children present during this inspection. The facility was toured to conduct a health and safety inspection. The facility plans to operate between the hours of 8:00 AM-5:30 PM, Monday -Friday

This three story home, which is neat and clean with heating and ventilation for safety and comfort. The Isolation area will be a section of the dining room, away from other children in care

On-limit-areas are the: Living and dining room, bathroom on second level, and kitchen

Off-limit-areas are : Entire third level of home, garage, kitchen pantry, and patio

The ON LIMIT AREAS are the entire second level of the home except the patio. The second level consist of a living room, bathroom, kitchen, and patio. The OFF LIMIT AREAS are the entire third level of the home which will be inaccessible by closed and/or locked doors, safety gates and visual supervision. There's gate at the bottom and second level of home that prevent children five years or younger access.

For outdoor activities, the licensee states that she would utilizes the complex's play area and the licensee is reminded to have 100% supervision at all times while away from the facility. The licensee will use the garage as a walk through to bring the children to the complex playground.

There are ample age appropriate toys that appear to be safe and in good condition. There are no pools, hot tubs or any other bodies of water present in the on-limit areas during today's inspection. LPA did not observe any hazardous materials or toxins accessible to children during today’s inspection.

The home has a fully charged 2A10BC fire extinguisher, wired smoke detector/working carbon monoxide detector, and telephone. Per licensee, there are no firearms in the home. The licensee in compliance with the immunization laws which pertains to all childcare providers. A copy of the rental agreement was reviewed and shows control of property. The licensee completed and received a certificate in mandated reporter training on 07/11/21. Licensee's CPR and First Aid certificate is current and expires 10/2023.



See 809-Continuation
SUPERVISORS NAME: Chandra Charles
LICENSING EVALUATOR NAME: Elimika Woods
LICENSING EVALUATOR SIGNATURE: DATE: 12/12/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/12/2022
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 2
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: RODRIGUEZ, KARLA
FACILITY NUMBER: 015700405
VISIT DATE: 12/12/2022
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Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226. When any IMS is provided, an updated Plan of Operation that includes 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
LPA informed the applicant that all forms can be downloaded at www.ccld.ca.gov and encouraged the licensee to email childcareadvocatesprogram@dss.ca.gov to be included in the Child Care Quarterly Updates distribution list. The licensee was also reminded that Mandated Reporter Training is required for all staff and is to be renewed every 2 years by visiting www.mandatedreporterca.com.

CPR/First Aid is also renewed every two years. Baby bouncers & drop-down cribs are not allowed at the day-care facility.

Roster of the children must be properly maintained and fire/disaster drill every six months must be documented. The licensee is reminded any structural changes to the home or additions to the child care facility must be reported to Community Care Licensing.

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.

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.

This home is recommended for Licensure on 12/12/2022. This report shall remain on file for 3 years. Exit interview conducted licensee, Karla Rodriguez

See 809-C

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

DATE: 12/12/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/12/2022
LIC809 (FAS) - (06/04)
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