015700405-10-23-2023-52-CC-EWOS-CWVU9X-20231023152353

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 015700405
Report Date: 10/23/2023
Date Signed: 10/23/2023 03:24:03 PM

Document Has Been Signed on 10/23/2023 03:24 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:	RODRIGUEZ, KARLA		FACILITY NUMBER:	015700405
ADMINISTRATOR:	RODRIGUEZ, KARLA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(510) 584-8376
CITY:	HAYWARD	STATE: CA	ZIP CODE:	94541
CAPACITY: 14	TOTAL ENROLLED CHILDREN: 14	CENSUS: 4	DATE:	10/23/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	12:45 PM
MET WITH:	Karla Rodriguez		TIME COMPLETED:	03:45 PM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	On October 23, 2023, at 12:45 PM, Licensing Program Analyst (LPA) Elimika Woods met with licensee Karla Rodriguez for an Unannounced Required 1 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 son, Alexander Rodriguez, fingerprint cleared assistant Kristell Jordan-Lopez, two preschool age children and two infants. Licensee stated that the facility operates from Monday to Friday 8:00 AM to 5:30 PM. LPA toured the facility inside and outside to conduct a Health and Safety inspection. 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. The ON LIMIT AREAS are the entire second level of the home except the pantry. 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/top of second level of home that prevent children five years or younger access. The home has a dual working smoke/carbon monoxide detector, first aid kit, telephone, and fully charged 2A10BC fire extinguisher which meets standards established by the State Fire Marshal. The home has central heating throughout and air conditioning. Per licensee, there are no firearms in the home. LPA asked the licensee does she transport children and the licensee stated that she does not transport children. On- Limit areas are the: Living and dining room, patio, bathroom on second level, bedroom and bathroom downstairs, and kitchen Off- Limit areas are the: Entire third level of home, kitchen pantry, and garage See 809-C for continuance

SUPERVISORS NAME: Chandra Charles
LICENSING EVALUATOR NAME: Elimika Woods
LICENSING EVALUATOR SIGNATURE:	DATE: 10/23/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/23/2023

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
OAKLAND SOUTH EAST, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612

FACILITY NAME: RODRIGUEZ, KARLA	FACILITY NUMBER: 015700405
	VISIT DATE: 10/23/2023

NARRATIVE

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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.

At 1:00 PM LPA requested and reviewed the files of two children in care and one staff file. All children files contain Immunization, Parent's Rights, and Medical Consent forms and the staff file has the required Health Screening and Employee Rights. The facility roster was reviewed, and copies were obtain. The licensee has not conducted or documented any fire and disaster drills in the past six months and was reminded by the LPA to conduct disaster drills at least once every six months. The licensee's assistant Health and Safety training is completed, and CPR and First Aid certificate is current and expires 05/2024. The licensee has not completed mandated reporter training and the LPA reminded the licensee that it is required for all staff and is to be renewed every two years. The licensee is in compliance with the immunization laws which pertains to all childcare providers. All required forms are posted and visible for public review. The licensee is in ratio today

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. LPA informed the licensee 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 ("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/.

See 809-C

SUPERVISORS NAME: Chandra Charles
LICENSING EVALUATOR NAME: Elimika Woods
LICENSING EVALUATOR SIGNATURE:	DATE: 10/23/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/23/2023

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
OAKLAND SOUTH EAST, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612

FACILITY NAME: RODRIGUEZ, KARLA	FACILITY NUMBER: 015700405
	VISIT DATE: 10/23/2023

NARRATIVE

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LPA discussed the safe sleep regulations with facility representative 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.

The licensee was 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 Karla Rodriguez, confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS.

There are no 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 Karla Rodriguez.

SUPERVISORS NAME: Chandra Charles
LICENSING EVALUATOR NAME: Elimika Woods
LICENSING EVALUATOR SIGNATURE:	DATE: 10/23/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/23/2023

LIC809 (FAS) - (06/04)

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