073409205-12-10-2021-02-CC-CFES-C9KRKS-20211210120602

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 073409205
Report Date: 12/10/2021
Date Signed: 12/10/2021 12:06:09 PM

Document Has Been Signed on 12/10/2021 12:06 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:	CHINCHILLA, SARA		FACILITY NUMBER:	073409205
ADMINISTRATOR:	CHINCHILLA, SARA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(510) 965-8517
CITY:	EL SOBRANTE	STATE: CA	ZIP CODE:	94503
CAPACITY: 14	TOTAL ENROLLED CHILDREN: 14	CENSUS: 0	DATE:	12/10/2021
TYPE OF VISIT:	Prelicensing	UNANNOUNCED	TIME BEGAN:	10:15 AM
MET WITH:	Sara Chinchilla		TIME COMPLETED:	12:15 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 December 10, 2021, at 10:15AM, Licensing Program Analyst (LPA) Catherine Fernandes met with the applicant Sara Chinchilla for an announced pre-licensing inspection. Residing in the home is the applicant, her two fingerprint cleared adult children, her finger print cleared son in law and underage granddaughter. Present for this inspection was the applicant, her adult daughter. The home was inspected to conduct a Health and Safety check. Operating hours will be Monday through Friday 6AM to 6PM. The entrance to the day care is on the left side of the driveway. The home is a two story house that consists of four bedrooms and four bathrooms. The OFF LIMIT AREAS will be the entire main house and the right side of the yard, which will be inaccessible by gate, closed and/or locked doors and visual supervision. The ON LIMIT AREAS are fenced in backyard, the deck, and the small studio on the left side of the main house that has a kitchen and a bathroom. The ISOLATION AREA will be in the next to the front door. The outdoor play area will be the backyard. There are age appropriate toys that are observed safe, clean and in good repair. There are no bodies of water during todays inspection. The home has a working smoke/carbon monoxide detector located in the main room, a working telephone, a 3-A-40-BC fire extinguisher and fully stocked First Aid Kit. The applicant’s Health and Safety training was completed and CPR and First Aid certificate is current and expires on 03/2023. The heaters vents are high on the walls which prevents access by children. LPA observed safety gates placed to block off the kitchen area and safety plugs. Per applicant, there are no firearms in the home. LPA was provided a document that shows control of property. A packet of forms pertaining to the children’s files and facility files were reviewed and discussed, and copies were left with the applicant. Report continues on 809C.

SUPERVISORS NAME: Mayla Mendoza
LICENSING EVALUATOR NAME: Catherine Fernandes
LICENSING EVALUATOR SIGNATURE:	DATE: 12/10/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/10/2021

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: CHINCHILLA, SARA	FACILITY NUMBER: 073409205
	VISIT DATE: 12/10/2021

NARRATIVE

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The applicant was 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. The applicant was reminded of the responsibility as a mandated reporter. The applicant has provided proof of the required training, which has been completed on 04/22/2021.

Individual Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Family Child Care Homes Section 102417. 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: http://www.ada.gov/childqanda.htm

The applicant was encouraged to frequently visit our website at www.ccld.ca.gov for licensing regulations and updates. the applicant was given a copy of A Child Care Provider's Guide to Safe Sleep pamphlet and the updated copy of the car seat laws. For licensing updates email childcareadvocatesprogram@dss.ca.gov to be added to the email list.

The following corrections are required before the home can be licensed.
- The heater needs to be in working condition
- The sharp plants need to be moved out of reach from children
- A parent board with the required forms must be placed in a visual area for parents to observe

These corrections shall be submitted by email within 30 days. This report shall remain on file for 3 years.
Exit interview conducted.
Report provided.

SUPERVISORS NAME: Mayla Mendoza
LICENSING EVALUATOR NAME: Catherine Fernandes
LICENSING EVALUATOR SIGNATURE:	DATE: 12/10/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/10/2021

LIC809 (FAS) - (06/04)

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