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

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 073409133
Report Date: 03/19/2021
Date Signed: 03/19/2021 02:35:33 PM

Document Has Been Signed on 03/19/2021 02:35 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:CABRERA BALMORI, SOFIAFACILITY NUMBER:
073409133
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 0CENSUS: 3DATE:
03/19/2021
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Sofia Cabrera-BalmoriTIME 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 03/19/2021 Licensing Program Analyst (LPA) Brittany Newton conducted an announced visit for the purpose of conducting a pre-licensing inspection. LPA was met by applicant Sofia Cabrera Balmori and her fingerprint cleared mother. Additionally present was the applicants school aged little brother, school aged niece, and school aged nephew. LPA toured the entire home with the applicant.
The home is a 2 story home, fully fenced in with a side entrance for all parents and children that leads to the main daycare room. Proposed day care operation hours are Monday through Saturday 06:00am to 6:00pm. The entire home is off-limits besides the back family room that is the primary day care area, and the bathroom in the family room. The outdoor play area will be off-limits until applicant makes the area safe.
A safety gate blocks the entrance to the kitchen and other inaccessible areas. LPA toured the daycare area which was found with PPE equipment, age appropriate toys, and ample playing space. There is a heater that does not work in the day care room but it is blocked off. LPA noted that some kind of heater is needed for the room so that children can be warm and comfortable. Additionally, a thermostat should be placed so that the applicant can be aware of the room temperature at all times. Safety plugs were observed. Required forms were posted. There are no bodies of water on site. Applicant stated she does not have any firearms in the home. Applicant plans to provide breakfast and snacks as needed to children. CPR and First Aid for the applicant is current until 10/2022. LPA Newton went over record keeping for children’s files and discussed required forms. Also discussed was fire drill requirements, posting requirements, and incident reporting requirements. Applicant was able to ask questions and stated she understands the requirements for operating a family childcare home. At 2:02pm applicant tested her Carbon Monoxide and smoke detector which were found in operating condition. At 2:25pm LPA observed a fully charged 2A10BC fire extinguisher.

Individual Medical Services (IMS) policy was discussed. 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)
SUPERVISORS NAME: Mayla Mendoza
LICENSING EVALUATOR NAME: Brittany Newton
LICENSING EVALUATOR SIGNATURE: DATE: 03/19/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/19/2021
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: CABRERA BALMORI, SOFIA
FACILITY NUMBER: 073409133
VISIT DATE: 03/19/2021
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
and link to publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: http://www.ada.gov/childqanda.htm.

The applicant was given a copy of A Child Care Provider's Guide to Safe Sleep pamphlet, and LPA discussed the importance of taking preventative measures.


Applicant is reminded that ALL assistants, volunteers, frequent visitors, or adults living in the home, that are 18 years of age or older must be fingerprint cleared and associated to this facility prior to being in the presence of children in care or an immediate civil penalty will be assessed from $100 to $3000 per person, per incident. Applicant was reminded of the responsibility as a mandated reporter. All forms can be downloaded at www.ccld.ca.gov


Applicant will send me pictures of advised corrections discussed.
APPROVAL OF LICENSE

LPA has determined that the Applicant has met all of the requirements to receive a small Family Day Care license. Applicant has been granted a license to began operating as a Family Day Care home. Facility license will be mailed to Licensee. Licensee may began operating, effective immediately.

Licensee was sent the COVID-19 Self-assessment guide as well as required postings for providing care during COVID-19. Licensee will send back to LPA the self-assessment completed.

Exit interview conducted and a copy of this report was emailed to Sofia Cabrera.

SUPERVISORS NAME: Mayla Mendoza
LICENSING EVALUATOR NAME: Brittany Newton
LICENSING EVALUATOR SIGNATURE:

DATE: 03/19/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/19/2021
LIC809 (FAS) - (06/04)
Page: 2 of 2