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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 073409267
Report Date: 10/20/2022
Date Signed: 10/20/2022 12:01:39 PM

Document Has Been Signed on 10/20/2022 12:01 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:ANZASTIGA, BRENDAFACILITY NUMBER:
073409267
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: DATE:
10/20/2022
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:BRENDA ANZASTIGATIME COMPLETED:
12:00 PM
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9:00AM Licensing Program Analyst Alexander met today with Brenda Anzastiga for an ANNOUNCED PRE-LICENSING INSPECTION. Applicant and Husband Robert Rodriguez are present for the inspection. The home is a two story house consisting of 4 bedrooms, 3 bathrooms, loft, living room, office, family room, kitchen, laundry room and garage. The living room, down stairs hall bathroom, and backyard will be used as the primary areas for day care. The off limits areas will be the entire upstairs which includes 3 bedrooms, laundry room, loft and 2 bathrooms. The down stairs bedroom and garage will also be off limits. These areas will be inaccessible to children in care by closed and/or locked doors, visual supervision and a safety gate at the bottom of the stairs. Applicant and her husband own the home; proof was shown. Per applicant there are no firearms/weapons located on the premises. There is a fully charged 3A40BC fire extinguisher in the home. There is also a working smoke alarm, recommend periodic servicing. Unable to locate a carbon monoxide detector today. There are no swimming pools, hot tubs or other bodies of water located on the premises. All sharp knives, cleaning solutions and medications are inaccessible to children in care and located upstairs in the off limits laundry room. First aid kit is available and complete. The isolation area for sick children will be an area in the living room. Outdoor play will be in the backyard. There are toys and play space available. Applicant was instructed to conduct and document periodic fire and disaster drills. Applicant was informed that baby walkers, exersaucers and baby bouncers are not allowed. Applicant has completed CPR and first aid training which expires in 2/2024 respectively. Applicant has completed her 16 hours of health and safety training which included the 1 hour of Nutrition and 1 hour of Lead poisoning training.

DURING TODAY'S PRE-LICENSING INSPECTION THE RESOURCE MATERIALS FOR COVID-19 WERE ALSO DISCUSSED TO HELP THE FACILITY STAY SAFE DURING THIS PANDEMIC.

All forms can be downloaded at www.ccld.ca.gov. www.myccl.gov for day-care updates.

SUPERVISORS NAME: Loretta Dyson
LICENSING EVALUATOR NAME: Tasha Hackett-Alexander
LICENSING EVALUATOR SIGNATURE: DATE: 10/20/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/20/2022
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: ANZASTIGA, BRENDA
FACILITY NUMBER: 073409267
VISIT DATE: 10/20/2022
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Mandated reporter and appeal rights were discussed. Licensing forms were reviewed and copies given to applicant. Applicant was reminded 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.
Incidental 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:

The following needs to be corrected before a license can be issued:



1. THE HOME NEEDS A CARBON MONOXIDE DETECTOR
2. THE FIREPLACE DOORS NEED TO BE LOCKED OR THE FIREPLACE NEEDS TO BE GATED TO PREVENT ACCESSIBILITY TO CHILDREN IN CARE.

An exit interview was conducted
SUPERVISORS NAME: Loretta Dyson
LICENSING EVALUATOR NAME: Tasha Hackett-Alexander
LICENSING EVALUATOR SIGNATURE:

DATE: 10/20/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/20/2022
LIC809 (FAS) - (06/04)
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