274416700-3-16-2021-07-CC-EBEN-BZ6R2A-20210316123759

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 274416700
Report Date: 03/15/2021
Date Signed: 03/16/2021 12:39:25 PM

Document Has Been Signed on 03/16/2021 12:39 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, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME:	SALAZAR, ROSA		FACILITY NUMBER:	274416700
ADMINISTRATOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY: 8	TOTAL ENROLLED CHILDREN: 0	CENSUS: 0	DATE:	03/15/2021
TYPE OF VISIT:	Prelicensing	ANNOUNCED	TIME BEGAN:	02:10 PM
MET WITH:	Rosa Salazar		TIME COMPLETED:	03:45 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	Licensing Program Analyst (LPA) Elizabeth Berumen conducted an announced pre-licensing tele-inspection via video conference call (via Zoom) with Applicant, Rosa Salazar. Rosa, her mother and sister were present during the tele-inspection. LPA Berumen reviewed the application. The Applicant, her sister, mother and father are the adults residing in the home. The Applicant has a 9 year old daughter living in the home. Days and hours of operation will be Monday to Friday from 6:00 AM to 5:30 PM. The Applicant completed the Preventative Health and Safety Child Care Training on Novemeber 19, 2020. The lead poisoning component and Nutrition were included and a copy of the certificate of completion is on file. The Applicant completed the CPR and First Aid training on 12/04/2020 and certifications are on file. Updated vaccinations (including flu vaccine) and proof of completion of the Mandated Reporter Training for Child Care Workers (completed on 12/11/2020) are on file. The Applicant rents the home and a copy of the lease agreement verifying control of property is on file. The Property Owner/Landlord Notification (LIC 9149 and LIC9151) forms are on file. Not all individuals subject to a criminal record review have obtained a criminal record and child abuse index clearances prior to today's tele-inspection. LPA Berumen learned during the inspection that Applicant's father decided to move in to the home after Applicant had submitted her application. The Applicant agreed to give LPA a tour of the home (indoor/outdoor) via ZOOM during today's tele-inspection. There is a working telephone in the home (cell #831 254-8537). The home is clean and orderly, with heating/air conditioning, and ventilation for safety & comfort. Off limit areas in the home are entire second floor. Off limit areas outside of the home are two outdoor areas that are accessible from second floor. LPA observed that the top of the stairs are barricaded.

SUPERVISORS NAME: Mary Segura
LICENSING EVALUATOR NAME: Elizabeth Berumen
LICENSING EVALUATOR SIGNATURE:	DATE: 03/15/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/15/2021

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, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME: SALAZAR, ROSA	FACILITY NUMBER: 274416700
	VISIT DATE: 03/15/2021

NARRATIVE

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The backyard is adequately fenced and is used for outdoor activity space. LPA reminded Applicant that children must be supervised at all times while outdoors. No bodies of water were observed.

There are no wall heaters in the home. There are safe and age appropriate toys, play equipment, and materials for the children in the home. The Applicant has a designated area in the home where a child(ren) can be isolated if exhibiting signs of illness.

LPA observed 2A10BC fire extinguisher. The home has working smoke/carbon monoxide detectors (tested by Applicant during today's tele-inspection). Applicant has a first aid kit in the home. Applicant also has a thermometer and sufficient emergency supplies.

LPA observed that detergents were stored inaccessible and out of reach of children. LPA reminded Applicant that all cleaning compounds, medications, hazardous, and other similar items that are dangerous to children, must be stored inaccessible, out of reach of children. Applicant states that she does not have poisons inside the home and no weapons. LPA reminded Applicant that all poisons must be locked up with a key or a combination of keys.

Applicant states that no one living in the home smokes. LPA informed Applicant that smoking is prohibited in the home during day-care hours. Applicant understands that she can not use any baby walkers/inclined sleepers and understands that baby walkers/inclined sleepers are not allowed in the home. Applicant states that she does not have any baby bouncers, jumpers, and saucer chairs in the home. Applicant understands that any food/drink which is brought by parent(s) of day care child(ren) must be properly labeled with the child(ren) name and properly stored or refrigerated. Forms of discipline used by Applicant- talking and redirection. Applicant understands that children's personal rights should not be violated, no corporal punishment. Isolation of sick children, supervision of children, capacity options, transportation of children, requirements for reporting suspected child abuse, unusual incidents/injuries, and requirements for assistant/substitute were also discussed.

SUPERVISORS NAME: Mary Segura
LICENSING EVALUATOR NAME: Elizabeth Berumen
LICENSING EVALUATOR SIGNATURE:	DATE: 03/15/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/15/2021

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, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME: SALAZAR, ROSA	FACILITY NUMBER: 274416700
	VISIT DATE: 03/15/2021

NARRATIVE

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LPA reminded Applicant that fire/disaster drills must be practiced at least once every 6 months and documented and Mandated Child Abuse Reporting Training needs to be renewed every two years.

LPA reviewed family child care packet of forms. Applicant requested a packet in English.

LPA discussed "zero tolerance" related regulations with Applicant and advised her of the assessment of an immediate $500 per day civil penalty for any violation of a "zero tolerance" related regulation. An ongoing civil penalty of $100 per day continues until the violation(s) is corrected.

LPA reminded Applicant of the applicable civil penalties for those adults who have not received fingerprint clearances, are not associated to the license, and who come in contact with or provide care and supervision to the children. Penalty amounts: $100.00 per person per day, minimum of $100.00 to a maximum of $500.00 per person for an initial violation and a minimum of $100.00 to a maximum of $3000.00 per person for any subsequent violation within a 12 month period.
Incidental Medical Services (IMS) policy was discussed. Applicant was provided the information regarding ADA: toll-free ADA Information Line at (800) 514-0301 (voice)/ (800) 514-0383 (TTY) and link to publication: http://www.ada.gov/childqanda.htm.

Applicant was informed that due to the current Covid-19 pandemic and "Shelter In Place" Order, the Facility Evaluation Report will be emailed to Applicant (email:bonitatedije@gmail.com) with "Read Receipt" notification. Applicant understands that her reply to the email will serve as acknowledgement that the report was received.

LPA conducted an exit interview and advised Applicant that a small Family Child Care Home license will be approved pending the following:

1. receiving of Acknowledgement of "receipt" of today's report.

2. Barricade the stairs from bottom (the stairs leading to 2nd floor when opening the front door).

3. Fingerprint clearance for her father

4. Updated application (LIC 279).

SUPERVISORS NAME: Mary Segura
LICENSING EVALUATOR NAME: Elizabeth Berumen
LICENSING EVALUATOR SIGNATURE:	DATE: 03/15/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/15/2021

LIC809 (FAS) - (06/04)

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