<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 493010010
Report Date: 11/03/2021
Date Signed: 11/03/2021 12:47:54 PM

Document Has Been Signed on 11/03/2021 12:47 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,
, CA
FACILITY NAME:ESCOBAR, VANESSA FCCHFACILITY NUMBER:
493010010
ADMINISTRATOR:ESCOBAR, VANESSAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(650) 770-3527
CITY:PETALUMASTATE: CAZIP CODE:
94954
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 12DATE:
11/03/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:50 AM
MET WITH:Vanessa EscobarTIME COMPLETED:
12:10 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
A required annual inspection of the facility was conducted by Licensing Program Analyst Jennifer Velasco (LPA). During today’s inspection the home and grounds were toured. Licensee Vanessa Escobar (L1) and Staff Jose Escobar (S1) were present in the home and supervising 12 children, of which four were infants, and operating within the licensed capacity and ratio requirements. No children were observed left in any parked vehicle. The facility’s operating hours are 8:00 a.m. - 6:00 p.m., Monday - Friday, year round, with rare, occasional weekend care provided. The floor plan submitted by the licensee was reviewed and verified. The children will have access to the kitchen, living room, family room, three bedrooms, hall bathroom, side patio, dining room, and a large, fully fenced backyard. The garage, side yard, hall closets, and primary en suite bathroom are "off limits" to the day care children. These areas have been made inaccessible by door locks, key locks, and locked gates. The home was observed to be clean and orderly and was at a comfortable indoor temperature. There were safe toys and equipment available for children. There is a working telephone in the home. L1's pediatric CPR and First Aid certifications were reviewed and expire in 12/2021 Items which could pose a danger to children (such as detergents, cleaning compounds, medications, etc.) were observed to be stored out of the reach of children in the locked garage and upper kitchen cupboard. L1 stated there are no poisons but if there were any poisons they would be kept in a high cupboard in the key locked garage. The home has heaters for heat and fans for cooling. LPA observed a working smoke detector, carbon monoxide detector, and fire extinguisher, rated at least 2A10BC, in the home. The roster of children in care was reviewed and was current. The licensee has conducted an emergency drill within the past six months, documented most recently in 10/2021. L1 stated there are no guns on premises, and none were observed during this inspection.
Continued on LIC 809-C.
SUPERVISORS NAME: Alexis Hollon
LICENSING EVALUATOR NAME: Jennifer Velasco
LICENSING EVALUATOR SIGNATURE: DATE: 11/03/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/03/2021
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 2
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office,
, CA
FACILITY NAME: ESCOBAR, VANESSA FCCH
FACILITY NUMBER: 493010010
VISIT DATE: 11/03/2021
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
Continued from LIC 809.
The children use the yard as the outdoor play area, and the property is fully fenced. L1 stated there were no pools or other bodies of water, and none were observed. Twelve children's records were reviewed at 10:20 a.m., and current immunizations and Notification of Parent’s Rights forms were on file. Facility and personnel files were reviewed at 10:50 a.m. and contained necessary records. L1 was reminded that all adults 18 and over living or working in the home, 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. LPA discussed the safe sleep regulations with L1 and discussed the Child Care Licensing Safe Sleep web page at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPA also informed L1 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. 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 Exit interview conducted and report was reviewed with L1. A notice of site visit was given and must remain posted for 30 days. To improve the quality and value of the new inspection process, a survey will be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or tools, please send them by email to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/process
SUPERVISORS NAME: Alexis Hollon
LICENSING EVALUATOR NAME: Jennifer Velasco
LICENSING EVALUATOR SIGNATURE:

DATE: 11/03/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/03/2021
LIC809 (FAS) - (06/04)
Page: 2 of 2