015701076-3-6-2025-52-CC-BPLY-DEHVAE-20250306151546

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 015701076
Report Date: 03/06/2025
Date Signed: 03/06/2025 03:15:55 PM

Document Has Been Signed on 03/06/2025 03:15 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:	IBANEZ OLVERA, SUSANA & OLVERA DOMINGUEZ, MARIA		FACILITY NUMBER:	015701076
ADMINISTRATOR/ DIRECTOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY: 8	TOTAL ENROLLED CHILDREN: 3	CENSUS: 2	DATE:	03/06/2025
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	01:05 PM
MET WITH:	Susana Ibanez Olvera- Licensee		TIME VISIT/ INSPECTION COMPLETED:	03:30 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 3/6/25, Licensing Program Analyst Briana Plumboy, met with licensee Susana Ibanez Olvera for an UNANNOUNCED ANNUAL INSPECTION. Present for this visit was licensee, 2 infants, and fingerprint clear and associated assistant Brian Fernandez. The home was toured to conduct a Health and Safety Inspection. The facility currently operates Monday through Friday from 6:00am until 6:00pm. The home is single story. The home consists of 3 bedrooms, 1 bathroom located in one of the bedrooms, a hallway bathroom, living room, kitchen, dining room, and studio located in the backyard (the studio has a bathroom). The home is neat and clean with heating and ventilation for safety and comfort during today's inspection. The OFF LIMIT AREAS are the first bedroom located on the left side of the hallway, the bedroom located at the end of the hallway, the entire studio, and garage which will be inaccessible by closed and/or locked doors and visual supervision. The ON LIMIT AREAS are the kitchen, living room, dining room, hallway bathroom, and bedroom located on the right side of the hallway. The ISOLATION AREA will be in the living room or dining room depending on the activity occurring. Outdoor play area will be in the backyard including on the deck. There are toys and and learning materials present during the inspection. There are no pools, hot tubs or any other bodies of water on the premises during today's inspection. All hazardous materials and toxins are kept out of the reach of children and it was observed that there are no toxins or hazardous items which could be accessible to children in care. The home has a fully charged fire extinguisher, working smoke detector, working carbon monoxide detector, working telephone. Both licensee's CPR and First Aid certificates are current and expire 12/2/25, and assistant Brian Fernandez received his CPR and First Aid certificate which is current and expires 1/17/27. The licensees completed and received certificates in mandated reporter training. Susana Ibanez Olvera completed hers on 11/9/23, Maria Olvera Dominguez completed her training on 12/1/23, and Brian Fernandez completed his on 3/6/25. The fireplace is electric, controlled by a remote and located in the living room. It has a screen to prevent access by children. Per applicants, there are no firearms in the home. The licensee conducts and documents fire and disaster drills twice a year with the last one conducted on 9/13/24. (2) Children files were reviewed, facility roster reviewed and copy obtained. The licensee is in ratio today. All REQUIRED forms are posted and visible for public review. See 809-C for continuance

SUPERVISORS NAME: Wynn Norona
LICENSING EVALUATOR NAME: Briana Plumboy
LICENSING EVALUATOR SIGNATURE:	DATE: 03/06/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/06/2025

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: IBANEZ OLVERA, SUSANA & OLVERA DOMINGUEZ, MARIA	FACILITY NUMBER: 015701076
	VISIT DATE: 03/06/2025

NARRATIVE

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Licensee Susana Ibanez Olvera is aware she should have knowledge of all Title 22 Regulations and follow all Title 22 Regulations at all times, as well as follow manufacture guidelines for all equipment in the facility.

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/.

Licensee Susana Ibanez Olvera was encouraged to frequently visit our website at ccld.ca.gov for licensing regulations and updates.

Community Care Licensing Division (CCLD) regularly sends information to licensed facilities, providers, and stakeholders by way of Provider Information Notices (PIN), Program Quarterly Update Newsletters and other important information communication platforms.

To receive important licensed related information to licensed facilities, visit the CCLD Important Information website at https://www.cdss.ca.gov/inforesources/community-carelicensing/subscribe and select the Child Care option to receive email communication.

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.

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.

See 809-C for continuance

SUPERVISORS NAME: Wynn Norona
LICENSING EVALUATOR NAME: Briana Plumboy
LICENSING EVALUATOR SIGNATURE:	DATE: 03/06/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/06/2025

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: IBANEZ OLVERA, SUSANA & OLVERA DOMINGUEZ, MARIA	FACILITY NUMBER: 015701076
	VISIT DATE: 03/06/2025

NARRATIVE

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LPA discussed the safe sleep regulations with licensee Susana Ibanez Olvera 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 Susana Ibanez Olvera 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.

During the exit interview, the Licensee Susana Ibanez Olvera confirmed that there are no Registered Sex Offenders living in the facility.

A notice of site visit was given and must remain posted for 30 days.

No deficiencies today's inspection. Appeal rights provided and discussed. Exit interview conducted and report was reviewed with licensee Susana Ibanez Olvera.

SUPERVISORS NAME: Wynn Norona
LICENSING EVALUATOR NAME: Briana Plumboy
LICENSING EVALUATOR SIGNATURE:	DATE: 03/06/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/06/2025

LIC809 (FAS) - (06/04)

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