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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376100906
Report Date: 09/14/2022
Date Signed: 09/14/2022 02:05:43 PM

Document Has Been Signed on 09/14/2022 02:05 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:VASQUEZ, OLIVIA FAMILY CHILD CAREFACILITY NUMBER:
376100906
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 2DATE:
09/14/2022
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
12:48 PM
MET WITH:Olivia VasquezTIME COMPLETED:
02:15 PM
NARRATIVE
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Licensing Program Analyst, (LPA), Tyra Block, conducted an unannounced inspection for a capacity increase with the licensee. This visit is to verify that the licensee remains in substantial compliance with the health & safety standards as required by regulations governing family child care homes. LPA met with licensee, also present was 2 day care children and licensee's adult children. Licensee has all appropriate forms posted. Licensee stated First Aid/CPR certification was renewed and will submit proof by email. Mandated reporter training expires 11/2023. LPA confirmed with licensee that all adults residing/working in the home have criminal record and child abuse/TB clearances. The single story apartment home was toured and inspected to ensure an environment safe for the care and supervision of children. The fire extinguisher (2A10BC), carbon monoxide detector, and smoke detector meet requirements and are operational. All hazardous items were latched/locked and secured out of reach of children. There are no bodies of water on the property, there is a pool located in the complex that is gated and requires a key for entry. Licensee stated that there are no weapons in the home. Licensee has provided landlord notification. The home appears to be large enough to accommodate up to 14 children. Fire clearance was received on 8/18/22. Licensee stated fire drills/ disaster drills have not been conducted.

Applicant will be using the following rooms for childcare: Living Room, Kitchen, Dining Room, 3 bedrooms and 2 bathrooms. There are no off-limit areas. The applicant has sufficient toys and equipment available. The home has a fenced backyard/ patio available for outdoor activities.

Licensee was reminded that all adults 18 and over living in the home, persons who provide care and supervision to children, and staff who have contact with children, 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.
SUPERVISORS NAME: Tashima Daniel
LICENSING EVALUATOR NAME: Tyra Block
LICENSING EVALUATOR SIGNATURE: DATE: 09/14/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/14/2022
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, 7575 METROPOLITAN DR STE 110
SAN DIEGO, CA 92108
FACILITY NAME: VASQUEZ, OLIVIA FAMILY CHILD CARE
FACILITY NUMBER: 376100906
VISIT DATE: 09/14/2022
NARRATIVE
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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 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.

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. Licensee was encouraged to subscribe.

Licensee is advised to regularly visit the Community Care Licensing WEB SITE: http://www.ccld.ca.gov/ for forms and updated regulation information. Duty Line was provided: (619) 767-2248. Southern California Child Care Advocate information was provided: (714) 703-2800 or childcareadvocatesprogram@dss.ca.gov.



The following correction is needed:
Current CPR/FA certification

A Type B citation was issued, see LIC 809D. A provisional license for 14 children will be issued effective today pending completion of CPR/ First Aid. LPA provided technical assistance regarding fire drills and documentation of drills.

LPA discussed the following with licensee: MAX. CAP (WHEN THERE IS AN ASSISTANT PRESENT): 12 - NO MORE THAN 4 INFANTS. CAP 14 - NO MORE THAN 3 INFANTS. 1 CHILD IN KINDERGARTEN OR ELEMENTARY SCHOOL AND 1 CHILD AT LEAST AGE 6. Signed Parent Notification of Additional Children in Care also required when caring for more than 12, additionally, Landlord Consent is to be maintained on file.

An exit interview was conducted with licensee and report reviewed with licensee, Olivia Vasquez.
LPA provided notice of site visit, it must remain posted at the facility for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.
SUPERVISORS NAME: Tashima Daniel
LICENSING EVALUATOR NAME: Tyra Block
LICENSING EVALUATOR SIGNATURE:

DATE: 09/14/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/14/2022
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 09/14/2022 02:05 PM - It Cannot Be Edited


Created By: Tyra Block On 09/14/2022 at 01:35 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 7575 METROPOLITAN DR STE 110
SAN DIEGO, CA 92108

FACILITY NAME: VASQUEZ, OLIVIA FAMILY CHILD CARE
FACILITY NUMBER: 376100906

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/14/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
10/14/2022
Section Cited
CCR
102416(c)

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102416 Personnel Requirements- The licensee and other personnel as specified shall complete training on preventive health practices, including pediatric cardiopulmonary resuscitation and pediatric first aid, pursuant to Health and Safety Code Section 1596.866. This requirement was not met as evidenced by:
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Licensee stated she renewed her CPR/ First Aid training and would email LPA proof when found.LPA advised if certification is not found it will need to be renewed within 30 days and proof submitted to RO/ LPA by POC due date of 10/14/22.
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Based on interview and record review licensee did not have current ceritfication in CPR and First Aid available upon request by LPA. Cerification expired 4/2022. This poses a potential health and safety risk to children in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Tashima Daniel
LICENSING EVALUATOR NAME:Tyra Block
LICENSING EVALUATOR SIGNATURE:
DATE: 09/14/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/14/2022


LIC809 (FAS) - (06/04)
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