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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 173010115
Report Date: 11/04/2021
Date Signed: 11/04/2021 03:42:22 PM

Document Has Been Signed on 11/04/2021 03:42 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, 101 GOLF COURSE DR. STE. A-230
ROHNERT PARK, CA 94928
FACILITY NAME:CORDERO MARROQUIN, HERLINDA FCCHFACILITY NUMBER:
173010115
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 1DATE:
11/04/2021
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Herlinda Cordero-MarroquinTIME COMPLETED:
03:50 PM
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A Pre-licensing inspection was conducted today by Licensing Program Analyst (LPA), Leticia Rosales-Meza. The applicant is Spanish speaking. The applicant is requesting a license for a capacity of 8 children. Services will be available Monday - Friday 6:00 AM - 4:00 PM. The applicant understands that 24hr consecutive care is prohibited. The applicant understand that childcare must be provided in the "primary" residence of the applicant. The residence is a three bedroom two in a half bath home. There are currently three adults living in the home. Applicant was advised that all adults residing or working at the facility must have a criminal background clearance on file with CCLD. All minors residing in the home must be fingerprinted within 30 days of reaching their 18th birthday and obtain a TB clearance. The applicant is aware of the immediate $100 per day civil penalty for adults working or residing in the home without a criminal record clearance. During the pre-licensing inspection, LPA provided technical assistance to Applicant related to COVID-19 guidelines and self-assessment.

The floor and yard plans are verified. The day care space is the living room, dining room, kitchen, half bathroom, and one bedroom (#2). The "off limits" areas include master bedroom/bath (#1), bedroom (#3), hallway bathroom and detached garage. These areas have been made inaccessible by key locked doors. The home appears to be clean and orderly at this time and will remain so during child care hours. There is a working telephone. The sharp knives, cleaning supplies, medicines, are stored out of the reach of children. Latches are used underneath the kitchen and bathroom sinks and all drawers. The applicant stated there are no Firearms or Weapons and none were observed. Applicant stated there are no poisons in the home. The requirement that poisons be stored in a space locked with a key lock/combination lock is reviewed. First Aid supplies are kept in the kitchen. The children in care will have access to age appropriate toys and equipment. The home is equipped with a working smoke detector, carbon monoxide detector and fire extinguisher rated at least 2-A, 10:BC. There is a wood burning stove in the living room. The wood burning stove is surrounded by a wrought iron barrier to prevent access to the children. The home is heated and cooled by a central unit. The children will use the backyard as the outdoor play area and it is completely fenced. The children will also use the front yard as outdoor play with direct supervision. There is no trampoline, pool, pond, or fountain.
SUPERVISORS NAME: Alexis Hollon
LICENSING EVALUATOR NAME: Leticia Rosales
LICENSING EVALUATOR SIGNATURE: DATE: 11/04/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/04/2021
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, 101 GOLF COURSE DR. STE. A-230
ROHNERT PARK, CA 94928
FACILITY NAME: CORDERO MARROQUIN, HERLINDA FCCH
FACILITY NUMBER: 173010115
VISIT DATE: 11/04/2021
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Incidental Medical Services (IMS) regulations were reviewed with the applicant. The applicant understands that if Incidental Medical Services are provided, an updated Plan of Operation shall be submitted and on file with the Department.

Parents will be required to sign insurance affidavits if the provider does not plan to purchase additional child care liability insurance. Proof of control of property or landlord notification/consent is on file. Parent's rights are posted. Emergency drills must be conducted at least once every six months and the date documented. Children's records to be maintained were reviewed. The roster is to remain current at all times. Unusual Incident Report procedures were explained, to include notification before close of next business day and follow-up with written report within seven days. The applicant will maintain current on Pediatric CPR and First Aid. CPR and First Aid cards expire 04/2023. The applicant shall be present in the home and shall ensure that children in care are supervised by a fingerprinted adult with current Pediatric CPR and First Aid certification. The applicant understands that children may only be transported by adults with a criminal record clearance and are never to be left unattended in a vehicle. Infants or children shall not be allowed to sleep in car carriers in the home. The applicant clearly understands the maximum number of children for whom care can be provided and the limitations on the number of infants (birth to age 2) that may be cared for and when two of the children in care must be school aged. Smoking is prohibited at all times in any area where child care is provided. The applicant understands the responsibility to read and have knowledge of the laws and regulations for operation of a family child care home. Forms and regulations must be obtained from the website. http://ccld.ca.gov/ Megan's Law web site was provided (http://www.meganslaw.ca.gov). The Applicant understands that any authorized employee of the Department may enter and inspect the facility with or without advance notice.

Any proposed changes to the physical plant, telephone number, or change of address shall be immediately reported to the Department.

This facility meets licensing standards and is now licensed as a Small Family Child Care Home.
SUPERVISORS NAME: Alexis Hollon
LICENSING EVALUATOR NAME: Leticia Rosales
LICENSING EVALUATOR SIGNATURE:

DATE: 11/04/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/04/2021
LIC809 (FAS) - (06/04)
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