073405330-8-28-2023-02-CC-ILOA-CV5UNV-20230828154434

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 073405330
Report Date: 08/28/2023
Date Signed: 08/28/2023 03:44:40 PM

Document Has Been Signed on 08/28/2023 03:44 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, SUITE 1102
OAKLAND, CA 94612

FACILITY NAME:	DIAZ, CARMEN		FACILITY NUMBER:	073405330
ADMINISTRATOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY: 8	TOTAL ENROLLED CHILDREN: 8	CENSUS:	DATE:	08/28/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	01:57 PM
MET WITH:	Carmen Diaz		TIME COMPLETED:	03:54 PM

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On August 28, 2023 at 1:57am Licensing Program Analyst (LPA) Indira Loza arrived and met with Licensee Carmen Diaz for the purpose of conducting an unannounced 1-year annual inspection and to conduct an Increase capacity inspection. Present for today’s inspection were the Licensee, her fingerprint cleared assistant, fingerprint cleared adult son, and five preschool age children. The facility is in ratio today. Hours of operation are Monday - Friday 7am-5:30pm

The facility is a single story home consisting of three bedrooms; two bathrooms; living room; large family room; kitchen; and a large backyard.

ON LIMIT AREAS: Bathroom next to the dining room; family room; dining room, family room, and the entire backyard.

OFF LIMIT AREAS: All three bedrooms kitchen, and once bathroom. The off-limit areas will be inaccessible by child gates, closed and/or locked doors, and adult supervision.

ISOLATION AREA is the living room

The home has heating and ventilation for safety and comfort. The home has a fully charged 3A40BC fire extinguisher next to the family room. There was a working combined smoke detector/carbon monoxide detector, and a working telephone. Fire/disaster drills are conducted at least once every 6 months, the last drill was completed in July 10, 2023. Licensee has ample age-appropriate toys and learning materials inside and outside the home. Toxins, medicines, and hazardous items were inaccessible during today's inspection. The Licensee utilizes her backyard for outdoor play. LPA reviewed children's and staff files which were found to be complete. The facility roster was reviewed, and a copy obtained. The Licensee had a current Mandated Reporter certificate which expires July 2024 and CPR expires November 2023.

Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02. When any IMS **********************************Report Continues on LIC 809-C*******************************

SUPERVISORS NAME: Mayla Mendoza
LICENSING EVALUATOR NAME: Indira Loza
LICENSING EVALUATOR SIGNATURE:	DATE: 08/28/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/28/2023

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
CCLD Regional Office, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612

FACILITY NAME: DIAZ, CARMEN	FACILITY NUMBER: 073405330
	VISIT DATE: 08/28/2023

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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 [or facility representative] 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.
- 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/.
- 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 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.
- During the exit interview, the Carmen Diaz, confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS.

The License was approved for a capacity Increase effective today, August 28, 2023.

A notice of site visit was given and must remain posted for 30 days.
Exit interview conducted and report was reviewed with the licensee Carmen Diaz

SUPERVISORS NAME: Mayla Mendoza
LICENSING EVALUATOR NAME: Indira Loza
LICENSING EVALUATOR SIGNATURE:	DATE: 08/28/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/28/2023

LIC809 (FAS) - (06/04)

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