<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 073408688
Report Date: 06/23/2021
Date Signed: 06/23/2021 01:14:55 PM

Document Has Been Signed on 06/23/2021 01:14 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:BAEZ, GUISELAFACILITY NUMBER:
073408688
ADMINISTRATOR:BAEZ, GUISELAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(831) 776-9648
CITY:OAKELYSTATE: CAZIP CODE:
94561
CAPACITY: 14TOTAL ENROLLED CHILDREN: 0CENSUS: 7DATE:
06/23/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:33 AM
MET WITH:BAEZ, GUISELATIME COMPLETED:
01:32 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 June 23, 2021 at 09:33 AM Licensing Program Analyst (LPA) L. Chew and Licensing Program Manager (LPM) L. Dyson conducted an unannounced Annual Random inspection to ensure the health & safety standards as required by regulations governing family childcare homes. LPA met with Licensee BAEZ, GUISELA. LPA explained the purpose of today's inspection,

Licensee is operating a large family childcare home (FCCH). Licensee guided LPA on a tour of home that is utilized for childcare. Present during today inspection was licensee fingerprint cleared and associated niece/staff member Victoria Baez and licensee 3 school-age children. There were 6 children in care 1 infant and 5 preschool-age. Licensee is operating within the licensed capacity. LPA reminded Licensee, if no assistant is present at a Large FCCH, then the licensee shall comply with the capacity requirements for a Small Family Child Care Home. Licensee states 3 adults (Licensee, husband and niece/staff member) and 3 children reside in the home. Per licensee, operating hours are from 6:30 AM - 11:00 PM, (7 days a week). Mandatory forms were posted in the entryway for public view. Licensee has a current childcare roster available for review, a copy was obtained during inspection.

This is a single-family two story 5-bed 3.5-bathroom home with loft and attached 2-car garage with a fully fenced backyard. The on-limits area consists of formal dining room, kitchen, family room, and downstairs bathroom. The facility has a secured fireplace located in the family room that is inaccessible to children in care. The off-limits area of home which is made inaccessible by closed and/or locked doors, gates and visual supervision consists of entire second level of home, back yard, garage and downstairs bedroom. Isolation area consist of formal dining room. Per Licensee backyard is off limits to children in care. Licensee states the outdoor play area for children in care will be the neighborhood parks. Licensee owns this property. Control of property was confirmed by Grant of Deed, a copy was provided for file.
SUPERVISORS NAME: Loretta Dyson
LICENSING EVALUATOR NAME: Lakeisha Chew
LICENSING EVALUATOR SIGNATURE: DATE: 06/23/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/23/2021
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, SUITE 1102
OAKLAND, CA 94612
FACILITY NAME: BAEZ, GUISELA
FACILITY NUMBER: 073408688
VISIT DATE: 06/23/2021
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
26
27
28
29
30
31
32
During Inspection, 6 children’s records were reviewed and found to be complete. Licensee and staff member Certificates are up to date. The licensee and staff member is following new immunization law which pertains to day-care providers. All Pediatric CPR and First Aid certificates is current. Mandated Reporter Training is current. Preventative Heath and Safety Training which includes 1 hr. Nutrition was completed and on file. Family Childcare Home Orientation Certificate was completed and on file.

LPA confirmed the home is equipped with a fully charged 3A40BC fire extinguisher located in kitchen area, working dual smoke/carbon monoxide detector and working telephone. LPA observed First Aid Kit and thermometer on premises. During inspection, detergents, cleaning compounds, medications and other items which could pose a danger to children are stored in an off-limits area and inaccessible to children in care. Licensee states there are no firearms present on the premises. Furthermore, LPA observed the facility has no bodies of water. There were 7 pets present in the home.

Licensee was reminded that anyone working, residing or frequently visiting the home must be fingerprint cleared and associated to facility prior to being in the presence of children in care. Licensee was encouraged to frequently visit department website at www.ccld.ca.gov for licensing regulations and updates. To be included in the Child Care Quarterly Updates distribution list licensee was encouraged to email ChildCareAdvocatesProgram@dss.ca.gov.

There are no deficiencies cited during today’s inspection. Exit interview was conducted with Licensee. Appeal rights and Notice of Site visit was provided. Notice of site visit must remain posted for 30 days. A copy of report shall be maintained for 3 years and available for public review upon request.
SUPERVISORS NAME: Loretta Dyson
LICENSING EVALUATOR NAME: Lakeisha Chew
LICENSING EVALUATOR SIGNATURE:

DATE: 06/23/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/23/2021
LIC809 (FAS) - (06/04)
Page: 2 of 2