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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 394500373
Report Date: 04/01/2021
Date Signed: 04/02/2021 01:26:53 PM

Document Has Been Signed on 04/02/2021 01:26 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, 2525 NATOMAS PARK DR. STE 250
SACRAMENTO, CA 95833
FACILITY NAME:CASTRO, ROSAFACILITY NUMBER:
394500373
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 0CENSUS: 0DATE:
04/01/2021
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
03:00 PM
MET WITH:Rosa CastroTIME COMPLETED:
05:15 PM
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Rosa Castro is Spanish speaking and Licensing Program Analyst (LPA) Marissa Soto spoke with Rosa Castro in Spanish and have translated the conversation to English below.

Due to the COVID-19 pandemic Licensing Program Analyst (LPA) Marissa Soto met with applicant Rosa Castro for the purpose of a Pre-Licensing inspection Tele-Visit via FaceTime on April 1, 2021 at 3:00pm in lieu of conducting a Pre-Licensing site inspection. During today's Tele-Visit inspection the Applicant was the only person present in the home. With the help of the Applicant, the Applicant took LPA on a tour of the entire 1 story home both inside and out. The facility consists of 3 bedrooms, 1 1/2 bathrooms, kitchen, living room, garage and fenced backyard. Off limit areas will consist of: Bedroom #2, Bedroom #3, right and left side of back yard and garage. Hours of operation will be Monday - Saturday 24 hours. Licensee understand that care cannot exceed more than 24 hours in a day.

Applicant owns the home and LPA obtained proof. Applicant's CPR and First aid certification was verified. LPA reviewed required forms for children's records including immunization card and Safe Sleep Regulation Concepts. LPA also provided the Parent's Rights form/poster, new regulations were reviewed which include seat belt/booster seat laws, vaccination requirements for staff and children, and smoking prohibition. 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

(report continued next page, LIC 809-C)
SUPERVISORS NAME: Bettina Engelman
LICENSING EVALUATOR NAME: Marissa Soto
LICENSING EVALUATOR SIGNATURE: DATE: 04/01/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/01/2021
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, 2525 NATOMAS PARK DR. STE 250
SACRAMENTO, CA 95833
FACILITY NAME: CASTRO, ROSA
FACILITY NUMBER: 394500373
VISIT DATE: 04/01/2021
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There were no bodies of water at the home. Kitchen cabinets are latched, and cleaning compounds, knives and medications are inaccessible to children. LPA received self-assessment guide and uploaded attachment to FAS. LPA confirmed COVID-19 posters have been displayed at the entry of the home with the parents’ rights poster. The emergency disaster plan has been updated to reflect Health Department contact information and is posted. LPA observed a 2A10BC fire extinguisher, an operational smoke and carbon monoxide detector in the home that meet regulatory standards. LPA advised the applicant that it there are any poisons at the home, all poisons must be locked with a key lock or combination lock.

Applicant has completed the required AB1207 Mandated Reporter training. Applicant understand that the training must be completed once every two years, training is accessible at www.mandatedreporterca.com. Applicant understands that a current roster must be maintained and that a fire drill must be conducted and documented once every six months. Applicant is informed all adults, 18 years and older living in the home, helper or assistant must have criminal record clearance and must be associated to the facility prior to having any contact with children in care. Failure to do so could result in an immediate civil penalty of $100.00 each day.

Applicant understands that licenses are not transferable, and once licensed, licensee must live in the home and be present for 80% of the operating hours. LPA explained to applicant that if she relocates and wants to continue to provide care, she must submit a change of location application and have the new home inspected. Applicant understands that if an unusual incident occurs; licensing is to be notified via phone call or fax within 24 hours and the Unusual Incident Report LIC 624 shall be submitted within seven days to remain in compliance. Applicant understands that if any structural changes are made to the home; licensing must be notified prior to construction. Licensee was informed about the Provider Information Notices (PINs) on CCLD website.

This facility evaluation report was reviewed and discussed with the applicant. Records, postings and reporting requirements were discussed. LIC311D was provided and discussed. Applicant was encouraged to visit the department website at WWW.CCLD.CA.GOV for information regarding child care updates, forms, regulations and legislation pertaining to family child care homes.

*LPA discussed guidance and practices regarding social and physical distancing for providers to prevent exposure to COVID-19 while providing care for children. COVID-19 Posting documents and the use of Personal Protective Equipment during COVID-19 Outbreak guidance*.

As of today 04/01/2021 facility is approved for a Small Family Child Care Home license for a capacity of 6 children with no more than 3 infants, or 4 infants only, or up to 8 children with no more than 2 infants, 1 child in Transitional Kindergarten or above and 1 child at least age 6. Infants are children under the age of 2.
SUPERVISORS NAME: Bettina Engelman
LICENSING EVALUATOR NAME: Marissa Soto
LICENSING EVALUATOR SIGNATURE:

DATE: 04/01/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/01/2021
LIC809 (FAS) - (06/04)
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