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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434417595
Report Date: 11/03/2022
Date Signed: 11/03/2022 10:56:45 AM

Document Has Been Signed on 11/03/2022 10:56 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, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME:CORONA, CONSUELOFACILITY NUMBER:
434417595
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: DATE:
11/03/2022
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
08:00 AM
MET WITH:Consuelo CoronaTIME COMPLETED:
11:00 AM
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Licensing Program Analyst (LPA) Teodoro Trujillo conducted an announced pre-licensing inspection. LPA met with Applicant Consuelo Corona and explained the reason for the inspection. The purpose of this inspection is Applicant is applying for a small Family Child Care Home (FCCH). Present during today's inspection were Applicant, and her husband.

Applicant will be getting a board to post required postings, such as license, facility sketch, and notification of parent's rights. Applicant will be using her cell phone. The hours of operation are Monday through Friday 7AM to 6PM. Applicant rents the home, presented a copy of rental agreement. Applicant plans on obtaining daycare insurance. Applicant will have parents fill out the Affidavit Regarding Liability Insurance if she does not have daycare insurance.

LPA toured the inside and outside of the home with Applicant. The off-limit areas of the home are the attached garage and 3 bedroom. LPA reminded Applicant that off-limit areas need to be inaccessible to children. There are no stairs in the home. LPA discussed with Applicant that all disinfectant, cleaning supplies, or other items that could pose a risk to children need to be inaccessible to children. All other disinfectant, cleaning supplies, and other items that could pose a risk to children were observed to be inaccessible to children. Applicant has sufficient toys and equipment for children. There was a baby walkers observed during today's inspection, applicant removed baby walker to garage. Applicant understands that baby walkers and smoking is not permitted in the home, LPA observed a fully charged 2A10BC fire extinguisher. Applicant has a working Smoke detector, and carbon monoxide detector. Applicant stated that there are no weapons, such as firearms, in the home.

The backyard is used and is fenced. The off-limit areas outside are the garage, two locked storage metal sheds, dirt area, left and right side of the yard. There are equipment and toys for the children. There were no bodies of water observed during today's inspection.
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SUPERVISORS NAME: Mary Segura
LICENSING EVALUATOR NAME: Teodoro Trujillo
LICENSING EVALUATOR SIGNATURE: DATE: 11/03/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/03/2022
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, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME: CORONA, CONSUELO
FACILITY NUMBER: 434417595
VISIT DATE: 11/03/2022
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Applicant will be obtaining either cribs or play yard for infants. LPA discussed the safe sleep regulations with applicant 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 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.

This facility does not 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)/ (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

Applicant does not plan on transporting children at this time, and understands that children cannot be left alone and unattended in parked vehicles. A copy of the car seat law was provided to Applicant.

Applicant will be providing meals and snacks to children. LPA reminded Applicant that all food brought from home needs to have the child's name on it.

LPA reviewed with applicant 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. Applicant has COVID guideline and posters printed.

Entrance Checklist was provided to the applicant.

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SUPERVISORS NAME: Mary Segura
LICENSING EVALUATOR NAME: Teodoro Trujillo
LICENSING EVALUATOR SIGNATURE:

DATE: 11/03/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/03/2022
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, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME: CORONA, CONSUELO
FACILITY NUMBER: 434417595
VISIT DATE: 11/03/2022
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Applicant has a valid CPR/1st Aid, which expires on 09/02/2024. Applicant's Preventive Health and Safety certificate is on file; along with her immunization records for measles and pertussis. Applicant completed the Mandated Reporter Training on 03/04/2022. LPA reminded Applicant that the Mandated Reporter training requires renewal every two (2) years.

The adults 18 and over living in the home are Applicant, her spouse and applicantr adult daughter. All adults have cleared fingerprints and TB test. Applicant 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.

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 will submit the following:
- Photo of locked left side storage shed and photo of repaired right side fence.
Exit interview conducted and report was reviewed with the Applicant Consuelo Corona. LPA advised Applicant upon approval of Licensing Management, a license for a Small Family Child Care Home will be granted upon completion of:
  • photo of locked metal shed, on left side of home
  • photo of right side fenced properly secured, top fence not nailed.
SUPERVISORS NAME: Mary Segura
LICENSING EVALUATOR NAME: Teodoro Trujillo
LICENSING EVALUATOR SIGNATURE:

DATE: 11/03/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/03/2022
LIC809 (FAS) - (06/04)
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