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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 394500910
Report Date: 09/01/2023
Date Signed: 09/01/2023 02:17:26 PM

Document Has Been Signed on 09/01/2023 02:17 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
SACRAMENTO SOUTH, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME:RODRIGUEZ, ELIZABETHFACILITY NUMBER:
394500910
ADMINISTRATOR:RODRIGUEZ, ELIZABETHFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(209) 470-8900
CITY:STOCKTONSTATE: CAZIP CODE:
95215
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 0DATE:
09/01/2023
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
12:01 PM
MET WITH:Elizabeth Rodriguz TIME COMPLETED:
02:40 PM
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On 09/01/2023, Licensing Program Analyst (LPA) Stacey Williams met with Applicant Elizabeth Rodriguez (A1) for the purpose of a pre-licensing change of location inspection. A1 was previously licensed at facility # 393622751. A1’ s tentative hours of care are Monday through Friday, from 7:00 AM until 5:30 PM.

All individuals subject to criminal background review have obtained a criminal record clearance verified by LPA accessing Guardian. 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 addresses. 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.

A1 owns the home. A copy of the property records is on file confirming residency and ownership. A1 provided signed copies of LIC 9149 and LIC 9151. The home was inspected by the Waterloo Morada Fire District on August 11, 2023, and was issued a fire clearance for a large family childcare license.

A health and safety inspection was conducted inside and outside of the FCCH. A1 accompanied LPA for the entirety of the tour. The FCCH is a single-story house that sits on approximately one acre of land. The home consists of the kitchen, living room, family room dining room area, three bedrooms, one and a half bathrooms, laundry room area, and garage. Toxic and hazardous items were inaccessible to children in care. LPA observed two fireplaces in the home that are barricaded however, A1 stated that the fireplaces will not be used during operational hours. The outdoor space was toured which includes the backyard, a play area, open faced shed with wired fencing, fenced surrounding outdoor space which is currently not being utilized. There is a koi pond in the backyard that is fenced at five feet and has mesh covering surrounding the fencing to prevent climbing. A1 stated there are no pets in the home. The OFF-limits areas of the FCCH are the master bedroom, A1’s daughter’s bedroom, pond area of the backyard ,the shed in the backyard, backyard land behind the fencing, and the garage. A1 understands that Off-limits areas must remain inaccessible to children in care.

Continued on LIC 809-C

SUPERVISORS NAME: Bettina Engelman
LICENSING EVALUATOR NAME: Stacey Williams
LICENSING EVALUATOR SIGNATURE: DATE: 09/01/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/01/2023
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
SACRAMENTO SOUTH, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME: RODRIGUEZ, ELIZABETH
FACILITY NUMBER: 394500910
VISIT DATE: 09/01/2023
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The facility has a functioning smoke detector and carbon monoxide detector. LPA observed detergents and chemicals stored in the OFF-limits laundry room. Knives stored in a kitchen cabinet which is inaccessible to children.

A 2A10BC fire extinguisher was observed in the entry of the home. A1 stated there are no firearms in the home.



LPA discussed Mandated Reporter Training with A1. Health and Safety Code 1596.8662 requires all licensed providers, applicants, directors and employees complete training as specified on Mandated Reporter duties and to renew training every 2 years. Volunteers are encouraged but not required to take the training. This training requirement may be met by using the Department’s Office of Child Abuse Prevention (OCAP) online training modules. The OCAP modules are free of cost and available at http://www.mandatedreporterca.com. The training is currently provided in English and Spanish. A1 has a current Mandated Reporter Training Certificate. Current Pediatric CPR and First Aid training was verified for A1 and expires on 5/2025. Completion of Preventative Health and Safety training, including nutrition and lead exposure, was verified before the inspection. Proof of required immunizations for A1 was also verified before the inspection.

LPA discussed the Safe Sleep Regulations with A1 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 A1 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. LPA discussed the requirement to check and log infant napping every 15 minutes for infants under 24 months old. LPA provided a copy of the LIC 9227/Individual Sleeping Plan to be completed for infants under 12 months old.

This facility plans to provide Incidental Medical Services – IMS. For IMS information, see PIN 22-02-CCP. 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

Continued on LIC 809-C

SUPERVISORS NAME: Bettina Engelman
LICENSING EVALUATOR NAME: Stacey Williams
LICENSING EVALUATOR SIGNATURE:

DATE: 09/01/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/01/2023
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
SACRAMENTO SOUTH, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME: RODRIGUEZ, ELIZABETH
FACILITY NUMBER: 394500910
VISIT DATE: 09/01/2023
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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 by way of our communication platform. To receive important licensed related information, 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 communications.

A1 was informed of the MyChildCarePlan.org site, a consumer education website that helps families obtain childcare by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.

A1 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, 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 licensed Family Child Care Home. 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.

A1 understands that licenses are not transferable, and once licensed, Licensee must live in the home and be present for 80% of the operating hours. A1 understands that if an unusual incident occurs; Licensing is to be notified via phone call, e-mail or fax within 24 hours and the LIC 624/ Unusual Incident Report shall be submitted within 7 days to remain in compliance. A1 understands that if any structural changes are made to the FCCH; Licensing must be notified PRIOR to construction.

A1 understands that if she wants to make any OFF-limits area an ON-limits area, she must notify Licensing and LPA must do an inspection BEFORE children are allowed in said area. A1 understands that children’s and staff’s records are to be maintained according to Title 22 regulations and be accessible to Licensing for up to 3 years. LPA reviewed with A1 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. A1 understands that fire drills must be conducted and documented once every 6 months.

Fire Clearance was approved from Waterloo Morada Fire Department on August 11, 2023.

As of today, 9/01/2023 the facility is approved for a large Family Child Care Home license for a capacity to serve up to either 14 children ( with Landlord consent), two (2) of which must be at least 6 years of age and no more than three (3) may be infants; or 12 children, four (4) of which may be infants. Infants are children under the age of 2.

An exit interview was conducted, and the report was reviewed with A1. LPA provided Licensee Appeal Rights to A1. A Notice of Site visit was posted by LPA and must remain posted for 30 days. A Notice of Site visit was posted by LPA and must remain posted on, or immediately adjacent to, the interior side of the main door for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

SUPERVISORS NAME: Bettina Engelman
LICENSING EVALUATOR NAME: Stacey Williams
LICENSING EVALUATOR SIGNATURE:

DATE: 09/01/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/01/2023
LIC809 (FAS) - (06/04)
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