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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 336300860
Report Date: 08/16/2023
Date Signed: 08/16/2023 03:51:22 PM

Document Has Been Signed on 08/16/2023 03:51 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, 3737 MAIN STREET, STE 700
RIVERSIDE, CA 92501
FACILITY NAME:RODRIGUEZ FAMILY CHILD CAREFACILITY NUMBER:
336300860
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 0DATE:
08/16/2023
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
02:13 PM
MET WITH:Jazmin RodriguezTIME COMPLETED:
04:09 PM
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On August 16, 2023, at 2:13 PM, Licensing Program Analyst (LPA) Anastasia Flores, arrived at the facility to conduct a pre-licensing inspection. Present during this inspection were: Jazmin Rodriguez. The home has 3 bedrooms, 2 bathrooms, with attached garage. LPA toured the facility, inside and out with Jazmin Rodriguez, and the following was observed and/or discussed:

· Per Applicant, off-limit areas include garage, Master bedroom, child's bedroom and backyard. Off-limit areas include child proof door handles, making them inaccessible to children.
· Normal hours of operation will be Monday through Friday 6:00 AM to 6:00 PM.
· Smoke detectors and Carbon Monoxide detectors were tested by the applicant during this inspection and were in working order.
· There is central heating and air conditioning.
· The fire extinguisher expires on 12/27/2023, is fully charged and meets standards established by the State Fire Marshal.
· All hazardous items were observed to be inaccessible. Storage of poisons and toxins are inaccessible to children and locked in garage. Sharp items including kitchen knives, are inaccessible and stored in the cabinet above the stove to the left. Medicines are locked and stored in master bathroom.
· First Aid Kit is located in the kitchen closet and contains all required items.
· No guns or weapons are stored in the facility as of this date. Applicant understands all guns, weapons and ammunition must be key locked separately and made inaccessible per Title 22 Regulations.
· This is a single-story home.
· This is a relocation application the cribs for infants will be moved over once this license is approved. During inspection, licensee showed LPA Flores photos of two cribs, one playpen for the infants in care at previous licensed facility.
SUPERVISORS NAME: Pauline Beschorner
LICENSING EVALUATOR NAME: Anastasia Flores
LICENSING EVALUATOR SIGNATURE: DATE: 08/16/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/16/2023
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, 3737 MAIN STREET, STE 700
RIVERSIDE, CA 92501
FACILITY NAME: RODRIGUEZ FAMILY CHILD CARE
FACILITY NUMBER: 336300860
VISIT DATE: 08/16/2023
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·Clean, safe and age-appropriate toys were observed.
· LPA observed a working telephone (the applicant’s cell phone).
· There were no toxic plants inside or outside the facility observed at this time
· The outside activity area will be a local park until the backyard is safe to be utilized by children.
· There are no bodies of water observed on this date. Applicant understands all bodies of water including ponds, above ground pools and spas, in-ground pools and spas, and some fountains must be properly covered or fenced per title 22 regulations. The Department must be notified before and after installation of the bodies of water described. In addition, all wading pools or similar product must be emptied immediately after use and stored in an upright position when not in use.
· Applicant will not be transporting children.
· Verification of control of property is maintained by applicant.
· Facility Sketch and Emergency Disaster Plan are posted to the left of the front door.
· Pediatric CPR and First Aid Card expires 12/24.
· Mandated Reporter certificate expires 12/24.
· Preventive Health and Safety training, including nutrition and lead components were completed on 12/20/22.

Licensee, was reminded all adults 18 and over responsible for administration or direct supervision of staff, persons who provides care and supervision to children, and staff who have contact with children, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a Child Care Center. A civil penalty of $100.00 minimum/day for a maximum of 5-days or, if the penalty is for a repeat violation, for a maximum of 30-days per person will be assessed if this regulation is violated.

Incidental Medical Services (IMS) policy was discussed. 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) or (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
SUPERVISORS NAME: Pauline Beschorner
LICENSING EVALUATOR NAME: Anastasia Flores
LICENSING EVALUATOR SIGNATURE:

DATE: 08/16/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/16/2023
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, 3737 MAIN STREET, STE 700
RIVERSIDE, CA 92501
FACILITY NAME: RODRIGUEZ FAMILY CHILD CARE
FACILITY NUMBER: 336300860
VISIT DATE: 08/16/2023
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LPA reviewed with licensee the LIC 311A, Forms/Records to Be Maintained At The Facility, for child’s records, personnel records, administrative records, and documents to be posted.
LPA discussed the safe sleep regulations with licensee and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPA also informed licensee 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.

On this date, 08/02/23, The California Attorney General – Megan’s Law website was searched for information on sex offenders required to register with local law enforcement under California’s Megan’s Law. No registered sex offenders were found at the facility address. Under state law, some registered sex offenders are not subject to public disclosure; therefore, they may not have been included in this search. However, the Department conducts a monthly cross reference of each address on record for all registered sex offenders against all CCLD facility addresses pursuant to information shared by California DOJ.

Licensee was informed of the MyChildCarePlan.org site, a consumer education website that helps families obtain child care by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.
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.

The following items were also reviewed with the applicant during inspection:
- Failure to meet the posting requirements shall result in an immediate $100 civil penalty.
- Documentation of fire & earthquake drills to be conducted every six months
- Responsibilities of being a mandated reporter and updating training every 2 years
- Personal rights of children in care, including no corporal punishment
SUPERVISORS NAME: Pauline Beschorner
LICENSING EVALUATOR NAME: Anastasia Flores
LICENSING EVALUATOR SIGNATURE:

DATE: 08/16/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/16/2023
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, 3737 MAIN STREET, STE 700
RIVERSIDE, CA 92501
FACILITY NAME: RODRIGUEZ FAMILY CHILD CARE
FACILITY NUMBER: 336300860
VISIT DATE: 08/16/2023
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- Responsibility to know the Title 22 Regulations for anyone providing care and supervision
- Capacity and Supervision requirements
- Inaccessibility of hazards must be constantly reassessed depending on the children in care
- Current facility phone numbers must always be on file with the licensing office
- Baby walkers, bouncy seats, exer-saucers, and other similar items are prohibited
- Car seat law
- Smoking is prohibited in the facility while providing child care or transporting children
- Once licensed, the Notice of Site Visit must be posted at the entrance of the facility for a period of
30 days. If a serious violation is cited, a copy of the licensing report (LIC809/LIC9099) must also
be posted for 30 days. A civil penalty of $100 per violation will be assessed for noncompliance.
- Applicant was informed of their reporting requirements and is provided with the Regional Office’s Unusual Incident Reporting email mailbox: UnusualIncidentReportsDO10@dss.ca.gov

-The Applicant can submit fingerprint transfer forms to associate new individuals or to disassociate someone from the facility at: Associations_Disassociations858@dss.ca.gov

- Access to forms & Title 22 Regulations for Family Child Care Homes online at www.ccld.ca.gov
- The Duty Officer is available to answer questions Monday – Friday 8:00am to 5:00pm at: 951-782-4200.

Before licensure, the following needs to be completed:
1. Licensee will install the stove in the kitchen and send photo to LPA Flores via email.
2. Licensee will install a child safety lock on bedroom #2 and send photo to LPA Flores.

Once all corrections have been verified, the application for a Small Family Child Care Home will be submitted for approval with a maximum capacity of 6 or 8 with parent notification. Applicant advised that all corrections are due within 30 days, or the application may be withdrawn.

Exit interview conducted and report was reviewed with the licensee, Jazmin Rodriguez.
SUPERVISORS NAME: Pauline Beschorner
LICENSING EVALUATOR NAME: Anastasia Flores
LICENSING EVALUATOR SIGNATURE:

DATE: 08/16/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/16/2023
LIC809 (FAS) - (06/04)
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