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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 013422116
Report Date: 06/10/2022
Date Signed: 06/10/2022 02:35:49 PM

Document Has Been Signed on 06/10/2022 02:35 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, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
FACILITY NAME:VILLEGAS, FABIOLAFACILITY NUMBER:
013422116
ADMINISTRATOR:VILLEGAS, FABIOLAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(510) 673-4055
CITY:NEWARKSTATE: CAZIP CODE:
94560
CAPACITY: 14TOTAL ENROLLED CHILDREN: 17CENSUS: 8DATE:
06/10/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:03 AM
MET WITH:Fabiola VillegasTIME COMPLETED:
02:56 PM
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On 6/10/2022, Licensing Program Analyst (LPA) Jonathan Williams arrived at the facility unannounced for the purposes of conducting a Required 1-Year Inspection. LPA was met by Licensee, Fabiola Villegas. Present for today's inspection are the Licensee, the Licensee's spouse, the Licensee's three own children (11, 13, and 15 years of age), and eight preschool-aged children in care. All adults in the home are fingerprint cleared and associated. No other individuals were present in the home during today's inspection. Facility operating hours are 7:00am-5:00pm M-F. The facility was toured to conduct a health and safety inspection.

The facility is a one story home owned by the Licensee consisting of five bedrooms including one master bed/bath, hallway bathroom, family room, kitchen, living room, garage, and backyard.

ON LIMIT AREAS: Family room, kitchen, bathroom accessible via hallway, backyard (excluding side yard furthest from the driveway)
OFF LIMIT AREAS: All five bedrooms, master bathroom, living room, garage, side yard furthest from the driveway.
ISOLATION AREA: section of the family room

At 11:20am, LPA toured the facility interior. The home is tidy and clean with heating and ventilation for safety and comfort. There are safe age-appropriate toys and learning materials available to children throughout the home. Furniture accessible to children was observed to be age-appropriate, in operable condition, and free of loose, sharp, or pointed parts. Food/beverages capable of rapid spoiling are properly stored. Uncontaminated drinking water is available to children.
SUPERVISORS NAME: Wynn Norona
LICENSING EVALUATOR NAME: Jonathan Williams
LICENSING EVALUATOR SIGNATURE: DATE: 06/10/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/10/2022
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, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
FACILITY NAME: VILLEGAS, FABIOLA
FACILITY NUMBER: 013422116
VISIT DATE: 06/10/2022
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Refrigerator was found to be maintained in working order and kitchen was found to be free of evidence of rodents or other vermin. Fireplace is barricaded and screened. There are no firearms kept in the home at this time, per Licensee. Nobody smokes in the home, per Licensee. There are two dogs kept in off-limit areas of the home and are kept inaccessible to children.

At 11:46pm, LPA toured the backyard. All play equipment was observed to be operable and age-appropriate in the backyard during this inspection. Slides and high climbing equipment were found to be in operable condition. Cushioning material (lawn) is present to absorb falls from high climbing equipment. There are no pools, ponds, hot tubs, or any other bodies of water present in the backyard during this inspection. The backyard was found to be free of litter or evidence of animals/pets. The backyard is fenced.

The facility has a fully charged 2A10BC fire extinguisher and working telephone. Carbon monoxide detector and smoke detectors are functional (combined). CPR/1st Aid certificate for Licensee and spouse are current. Mandated Reporter certificate for Licensee and spouse are current. Children's files were reviewed for proper documentation. Fire/disaster drills are conducted at least once every six months. LIC126 (Entrance Checlist) was provided to Licensee. Roster was obtained and reviewed.

Incidental Medical Services (IMS) policy was discussed. This facility does not provide IMS to children in care at this time. 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.”

Licensee 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.
SUPERVISORS NAME: Wynn Norona
LICENSING EVALUATOR NAME: Jonathan Williams
LICENSING EVALUATOR SIGNATURE:

DATE: 06/10/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/10/2022
LIC809 (FAS) - (06/04)
Page: 2 of 4
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
FACILITY NAME: VILLEGAS, FABIOLA
FACILITY NUMBER: 013422116
VISIT DATE: 06/10/2022
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Licensee was reminded that California Law requires licensed Family Child Care Homes to report unusual incidents or injuries to children in care to child's parents and to the Department of Social Services using the Unusual Incident/Injury form (LIC 624b). Incidents must be reported within 24 hours by phone, fax, or electronic mail. LPA informed the Licensee that all forms can be downloaded at www.ccld.ca.gov and encouraged the Licensee to email [email protected] to be included in the Child Care Quarterly Updates distribution list. The Licensee was also reminded that Mandated Reporter Training ("General" and "Child Care Providers") is required for all staff and is to be renewed every 2 years by visiting www.mandatedreporterca.com.

LPA discussed the safe sleep regulations with Licensee 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 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.

No deficiencies were cited today. A notice of site visit was given and must remain posted for 30 days. Appeal rights were provided to the Licensee and the signature on this form acknowledges receipt of these rights. Exit interview was conducted and report was reviewed with the Licensee.

SUPERVISORS NAME: Wynn Norona
LICENSING EVALUATOR NAME: Jonathan Williams
LICENSING EVALUATOR SIGNATURE:

DATE: 06/10/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/10/2022
LIC809 (FAS) - (06/04)
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