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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 073409212
Report Date: 03/18/2022
Date Signed: 03/18/2022 01:42:06 PM

Document Has Been Signed on 03/18/2022 01:42 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:MACHORRO RODRIGUEZ, ALISONFACILITY NUMBER:
073409212
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 0DATE:
03/18/2022
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
12:55 PM
MET WITH:Alison Machorro RodriguezTIME COMPLETED:
02:00 PM
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On 03/18/22, Licensing Program Analyst (LPA) Melissa Guirit met with applicant Alison Machorro Rodriguez for an announced Prelicensing Inspection. Applicant states that the hours of operation will be 7:30am to 4:30 pm Monday through Friday. Applicant will be submitting the COVID-19 Self-Assessment.

The home was toured for a Health and Safety Inspection. The home is two stories. The home consists of five bedrooms, three bathrooms, two child care areas in the front of the house, kitchen, dining area, living area, laundry room, loft, garage, and backyard. The on limits area that will be used for child care are the two areas in the front of the home and the downstairs bathroom. The remainder of the home which includes the entire upstairs area, kitchen, dining area, backyard, garage, laundry room, and living area, will be off limits which will be made inaccessible by use of closed and/or locked doors, safety gates and visual supervision. The bathroom that children will be using is next to the living area that is off limits. LPA reminded applicant that there must be supervision when a child uses the restroom. The area by the bathroom will be used as the isolation area for ill children. Per applicant, a nearby park will be used as an outdoor play area for now. Applicant was reminded that if the backyard will be used, to contact licensing prior to being used. There are age appropriate toys in the home. There are no pools, hot tubs or any other similar bodies of water at this home. Per applicant, there are no firearms in the home. LPA did not observe any hazardous materials or toxins accessible to children today. The home is equipped with a working smoke detector and carbon monoxide detector. There is a working telephone in the home. The home has a fully charged 3A40BC fire extinguisher.

Alison has current CPR/First Aid which expires 11/2023. Applicant completed mandated reporter training which must renewed by 1/30/2024. Applicant is in compliance with required immunizations. A copy of the deed was provided to LPA. Required forms were reviewed with applicant.

See 809-C for continuance.
SUPERVISORS NAME: Loretta Dyson
LICENSING EVALUATOR NAME: Melissa Guirit
LICENSING EVALUATOR SIGNATURE: DATE: 03/18/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/18/2022
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: MACHORRO RODRIGUEZ, ALISON
FACILITY NUMBER: 073409212
VISIT DATE: 03/18/2022
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LPA discussed the safe sleep regulations with applicant and discussed the Child Care Licensing Safe Sleep webpage athttps://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPA also informed applicant 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

Applicant was reminded that all adults 18 and over living in the home, persons who provide care and supervision to children, and staff who have contact with children, including employees and volunteers, 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 up to $500.00 maximum per day/per person will be assessed if this regulation is violated.

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

This facility plans to provide Incidental Medical Services-IMS. For IMS information see Evaluator Manual – Regulation Interpretations and Procedures for Family Child Care Homes Section 102417. 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 Center and the ADA, available at: http://www.ada.gov/childqanda.htm

This home is recommended for a family day care home effective today 03/18/22. Exit interview conducted and report was reviewed with the Alison Machorro Rodriguez.
SUPERVISORS NAME: Loretta Dyson
LICENSING EVALUATOR NAME: Melissa Guirit
LICENSING EVALUATOR SIGNATURE:

DATE: 03/18/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/18/2022
LIC809 (FAS) - (06/04)
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