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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 493010205
Report Date: 06/13/2022
Date Signed: 06/13/2022 10:28:00 AM

Document Has Been Signed on 06/13/2022 10:28 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, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405
FACILITY NAME:SANCHEZ, PERLA FCCHFACILITY NUMBER:
493010205
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 0DATE:
06/13/2022
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
08:25 AM
MET WITH:Perla SanchezTIME COMPLETED:
10:35 AM
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A prelicensing inspection was conducted today by Licensing Program Analyst (LPA), Sebastian Phouthavong. The applicant, Perla Sanchez is requesting a license for a capacity of 8 children. Services will be available Monday through Friday 7:30am – 5:00pm. The applicant understands that 24-hour consecutive care is prohibited. The home is a 2 bedroom/1 bath home. There are two adults living in the home. Applicant 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.

The floor plans were verified. The children will have access to the living room, dining room, kids’ room, master bedroom and bathroom. The off-limits areas of the home include the kitchen, made inaccessible by means of door locks or baby gates. The home appears to be clean and orderly at this time and will remain so during childcare hours. There is a working telephone in the home. The sharp knives, cleaning supplies, and medicines, are stored out of the reach of children. The applicant states there are no guns or dangerous weapons in the home, and none were observed. Applicant states there are no poisons in the home, and none were observed during today's inspection. The requirement that poisons be stored in a space locked with a key lock/combination lock is reviewed. LPA observed safe toys and equipment available for children. The home is equipped with a working smoke detector and carbon monoxide detector. The fire extinguisher is rated at least 2A10BC was charged. The children will use the outdoor play area, and it is completely fenced. here is a hot tub located at the premise, fully covered and LPA reviewed the requirements for when a body of water is present.

Continued on LIC 809-C

SUPERVISORS NAME: Leslie Lepori
LICENSING EVALUATOR NAME: Sebastian Phouthavong
LICENSING EVALUATOR SIGNATURE: DATE: 06/13/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/13/2022
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 3
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405
FACILITY NAME: SANCHEZ, PERLA FCCH
FACILITY NUMBER: 493010205
VISIT DATE: 06/13/2022
NARRATIVE
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Incidental Medical Services regulations were reviewed with the licensee. The licensee understands that if Incidental Medical Services are provided, an updated Plan of Operation shall be submitted and on file with the Department. LPA reviewed with licensee 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. Parents will be required to sign insurance affidavits if the provider does not plan to purchase additional childcare liability insurance. Proof of control of property or landlord notification/consent is on file. Parent's rights are posted. Emergency drills must be conducted at least once every six months and the date documented. Children's records to be maintained were reviewed. The roster is to remain current at all times.

Unusual Incident Report procedures were explained, to include notification before close of next business day and follow-up with written report within seven days. The licensee will maintain current pediatric CPR, First Aid, and child abuse mandated reporter training certifications. The licensee shall be present in the home and shall ensure that children in care are supervised by a fingerprinted adult with current pediatric CPR and First Aid certification. The licensee understands that children may only be transported by adults with a criminal record clearance and are never to be left unattended in a vehicle. Infants and children shall not be allowed to sleep in car carriers in the home. The licensee clearly understands the maximum number of children for whom care can be provided and the limitations on the number of infants (birth to age 2) that may be cared for and when two of the children in care must be school aged.

LPA discussed the safe sleep regulations with licensee and discussed the Child Care Licensing Safe Sleep webpage athttps://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPA also informed licensee 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.


Smoking is prohibited at all times in any area where childcare is provided. The licensee understands the responsibility to read and have knowledge of the laws and regulations for operation of a family childcare home. Forms and regulations must be obtained from the website http://ccld.ca.gov/. The licensee understands that any authorized employee of the Department may enter and inspect the facility with or without advance notice. Exit interview conducted and report was reviewed with the licensee Perla Sanchez.

Continued on LIC 809-C

SUPERVISORS NAME: Leslie Lepori
LICENSING EVALUATOR NAME: Sebastian Phouthavong
LICENSING EVALUATOR SIGNATURE:

DATE: 06/13/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/13/2022
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, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405
FACILITY NAME: SANCHEZ, PERLA FCCH
FACILITY NUMBER: 493010205
VISIT DATE: 06/13/2022
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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 communication platform.

To receive important license-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.

Any proposed changes to the physical plant, telephone number, or change of address shall be immediately reported to the Department.



Application will be submitted and reviewed prior to becoming active.
Licensee will be notice once licenses becomes active.
SUPERVISORS NAME: Leslie Lepori
LICENSING EVALUATOR NAME: Sebastian Phouthavong
LICENSING EVALUATOR SIGNATURE:

DATE: 06/13/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/13/2022
LIC809 (FAS) - (06/04)
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