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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 136610546
Report Date: 08/16/2021
Date Signed: 08/16/2021 12:44:09 PM

Document Has Been Signed on 08/16/2021 12:44 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, 7575 METROPOLITAN DR., STE 110
SAN DIEGO, CA 92108
FACILITY NAME:COTA, EDA FAMILY CHILD CAREFACILITY NUMBER:
136610546
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 0CENSUS: 0DATE:
08/16/2021
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
11:15 AM
MET WITH:Eda CotaTIME COMPLETED:
12:50 PM
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On 8/16/21 at 11:15 AM, Licensing Program Analysts (LPAs), Crystal Tillory and Adrian Castellon conducted an announced Pre-Licensing inspection. Upon arrival, LPA met with applicant, Eda Cota. This one story, three bedroom and one bath home was toured and inspected to ensure an environment safe for the care and supervision of children. The following areas will be used for daycare purposes: living room, kitchen and dining area, daycare room, hallway bathroom. The fully fenced backyard will be used for outdoor play. Off limit areas include: front yard, all bedrooms and laundry room. Applicant plans to operate Monday through Friday from 7:00 AM to 5:00 PM. All cleaning compounds, detergents, medications and other items which could pose a danger to children are stored where they are inaccessible to children and poisons are to be locked away. The fire extinguisher, smoke and carbon monoxide detectors meet requirements and are operational.  Children’s toys and play equipment are safe and age appropriate. There are no bodies of water observed by LPA during inspection. There are no firearms or other weapons in the home, per applicant.  Pediatric CPR and First Aid certifications expire 03/2023. Preventative Health Practices course was completed on 5/6/21.  Primary telephone is a cell which is operational. A review of staff records on this date indicates that all facility staff or other individuals who require caregiver background checks have received criminal record and child abuse clearances or exemptions.  Applicant owns the home and has submitted proof. Applicant states they are financially secure to operate a family child care home for children and will comply with all regulations and laws governing family child care homes. Applicant has met immunization requirement per SB792 and has completed the AB1207 Mandated Reporter Training.


See LIC809-C continuation pg.
SUPERVISORS NAME: Cynthia Gray
LICENSING EVALUATOR NAME: Crystal Tillory
LICENSING EVALUATOR SIGNATURE: DATE: 08/16/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/16/2021
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, 7575 METROPOLITAN DR., STE 110
SAN DIEGO, CA 92108
FACILITY NAME: COTA, EDA FAMILY CHILD CARE
FACILITY NUMBER: 136610546
VISIT DATE: 08/16/2021
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LPA discussed and provided applicant with the following: information on SIDS, shaken baby syndrome, lead poisoning effects brochure, Heart and Nutrition Months hand out, insurance, child abuse reporting, mandated reporter requirements, community resources, children’s records/facility records/required postings- LIC911D, immunization requirements, unusual incident report- LIC624B, roster requirements- LIC9040, visual for ratio/capacity, prohibited items handout (walkers, exersaucers, jumpers and bouncy seats), emergency drill log example, and the YMCA Resource Center. SAFE SLEEP PLAN and documentation was discussed. The provider physically checks on sleeping infants every 15 minutes. An Individual Infant Sleeping Plan [LIC 9227 (3/20)] is maintained for each infant up to 12 months of age and shall be available to the Department for review. The provider places infants up to 12 months of age on their backs for sleeping. 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 provided 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. LPA discussed California Megan's Law and provided Applicant with the following website: www.meganslaw.ca.gov. LPA informed applicant in order to access CCLD-Childcare regulations, quarterly updates, licensing forms, pay annual fee to visit the following website:  http://ccld.ca.gov. LPA discussed and provided applicant with the following: Child Care Advocates - (916) 654-1541 and email address childcareadvocatesprogram@dss.ca.gov. In addition, for common questions or questions regarding licensing requirements to contact Child Care Licensing duty line at 619-767-2248. LPA discussed the following with applicant: maximum capacity for a small family child care home: 4 infants only (infants mean any children under 24 months); or 6 children with no more than 3 infants; or (with landlord consent) 8 children with no more than 2 infants, 1 child in kindergarten or elementary school and 1 child at least age 6 including children under age 10 who live in the licensee's home.
LPA informed applicant, license will be mailed. LPA informed applicant upon receipt of the license, the applicant shall post the license it in a prominent place.
SUPERVISORS NAME: Cynthia Gray
LICENSING EVALUATOR NAME: Crystal Tillory
LICENSING EVALUATOR SIGNATURE:

DATE: 08/16/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/16/2021
LIC809 (FAS) - (06/04)
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