313624265-6-9-2022-03-CC-LHAM-CF8PGA-20220609111801

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 313624265
Report Date: 06/09/2022
Date Signed: 06/09/2022 11:18:13 AM

Document Has Been Signed on 06/09/2022 11:18 AM - 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, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833

FACILITY NAME:	ABUNDIZ, ANGELICA		FACILITY NUMBER:	313624265
ADMINISTRATOR:	ABUNDIZ, ANGELICA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(775) 470-0519
CITY:	AUBURN	STATE: CA	ZIP CODE:	95602
CAPACITY: 14	TOTAL ENROLLED CHILDREN: 14	CENSUS: 1	DATE:	06/09/2022
TYPE OF VISIT:	Case Management - Licensee Initiated	UNANNOUNCED	TIME BEGAN:	09:15 AM
MET WITH:	Angelica Abundiz		TIME COMPLETED:	11:30 AM

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	On June 9, 2022, at 9:15 AM, Licensing Program Analysts (LPA) Lea Habtom and Jeremey McClain met with licensee for a scheduled Pre- Licensing inspection, this is a change of location. Applicant was previously licensed under facility # 293617541. This current facility is located on the back house of the main home on the first level. LPA and applicant toured the entire home inside and out. PA explained about obtaining $300,000 liability insurance or completing the affidavit liability insurance form (LIC 282) if no insurance will be purchased. Applicant understands that until a policy is obtained, she must use the affidavit form LIC282. Applicant’s hours of operation are planned to be from Monday-Friday from 8:00 am - 5:00 pm and other hours as arranged. Applicant agrees to notify licensing if her days of operation will change or another job is obtained. During today's inspection there was licensee, licensee's significant other and 4 of licensee's and significant other's children ages 8, 15, 15, 17 and 19 present in the home. Applicant has certificates of completion for 15 hours of health and safety training including CPR and First Aid with expiration date of 6/2023. All adults who reside or work in the home have a criminal record clearance or exemption. There are no excluded individuals present at this home. Applicant was reminded that all adults 18 and over living or working in the home, 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. Off-limit areas include: All bedrooms downstairs, trampoline, shed and entire home upstairs. Applicant understands that children may never enter these off-limit areas. Applicant understands that she needs to notify licensing for any modification inside and out of the home. Report continued on 809-C

SUPERVISORS NAME: Keven Peters
LICENSING EVALUATOR NAME: Lea Habtom
LICENSING EVALUATOR SIGNATURE:	DATE: 06/09/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/09/2022

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, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833

FACILITY NAME: ABUNDIZ, ANGELICA	FACILITY NUMBER: 313624265
	VISIT DATE: 06/09/2022

NARRATIVE

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LPA reviewed the requirement of maintaining a fire drill log and a children’s roster. There is no fireplace downstairs in the home. Applicant stated there are no weapons in the home. Fire extinguisher, carbon monoxide detector and smoke detectors meet regulation. Hazardous cleaning compounds are inaccessible to children.

Sharp utensils and medications are inaccessible to children. The backyard is unfenced and there are no bodies of water. Applicant understands that 100% supervision is required in any unfenced areas.

LPA Habtom discussed SB277 (public health vaccination) and SB792 (day care facilities: Immunization exemptions) with Applicant at time of inspection. Applicant has met the requirements of SB792 and her vaccination record is in the RO file.

LPA observed that applicant has completed the required mandated reporter training (AB1207) at website: www.mandatedreporterca.com.

LPA discussed and gave applicant the Effects of Lead Exposure brochure. LPA discussed the safe sleep regulations with applicant and discussed the Child Care Licensing Safe Sleep web page at https://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.

Report continued on 809-C

SUPERVISORS NAME: Keven Peters
LICENSING EVALUATOR NAME: Lea Habtom
LICENSING EVALUATOR SIGNATURE:	DATE: 06/09/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/09/2022

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, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833

FACILITY NAME: ABUNDIZ, ANGELICA	FACILITY NUMBER: 313624265
	VISIT DATE: 06/09/2022

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Incidental Medical Services (IMS) policy was discussed however licensees chooses not to administer medication. For IMS information , see PIN 22-02-CCP. 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 about Child Care Centers and the ADA, available at: http://www.ada.gov/childqanda.htm

LPA provided the Community Care Licensing website www.ccld.ca.gov, so the licensee can obtain updated licensing information, new regulations and access forms. LPA advised Applicant of their responsibility to stay current in regards to new regulations. LPA also included the email address for the children's advocacy program to stay current on new laws childcareadvocatesprogram@dss.ca.gov.

LPA reviewed with licensee Angelica Abundiz the LIC 311D, Forms/Records To Keep In Your Family Child Care Homes, children’s forms/records, facility forms/records, and information to be posted and provided copies of all forms.

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.

Effective June 6, 2022 licensee’s request for a Large Family Child Care License is approved. Licensee can now provide care for 12 children (when there is an assistant present) with no more than 4 infants or capacity of 14 children when 1 child in kindergarten or elementary school and 1 child at least age 6 and a maximum of 3 infants. Infants are children under the age of two years. Licensee understands that when there is no assistant present, ratios of a small capacity must be adhered to.

SUPERVISORS NAME: Keven Peters
LICENSING EVALUATOR NAME: Lea Habtom
LICENSING EVALUATOR SIGNATURE:	DATE: 06/09/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/09/2022

LIC809 (FAS) - (06/04)

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