013422116-4-20-2023-52-CC-AWRT-CR3VDE-20230420162038

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 013422116
Report Date: 04/20/2023
Date Signed: 04/20/2023 04:20:44 PM

Document Has Been Signed on 04/20/2023 04:20 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
OAKLAND SOUTH EAST, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612

FACILITY NAME:	VILLEGAS, FABIOLA		FACILITY NUMBER:	013422116
ADMINISTRATOR:	VILLEGAS, FABIOLA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(510) 673-4055
CITY:	NEWARK	STATE: CA	ZIP CODE:	94560
CAPACITY: 14	TOTAL ENROLLED CHILDREN: 14	CENSUS: 12	DATE:	04/20/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	01:10 PM
MET WITH:	Fabiola Villegas		TIME COMPLETED:	04:30 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	On April 20th, 2023 at approximately 1:10pm, Licensing Program Analysts (LPAs) April Wright and Michael Mathew met with licensee Fabiola Villegas for an Unannounced Required 1 Year Inspection. LPA disclosed the purpose of the inspection and was granted entry into the facility by the licensee. Present during inspection were 12 children fingerprint cleared spouse Fausto Villegas, and daughters age 13 and 17 years old. Hours of operation are 7:30am - 5:30pm Monday through Friday. LPA toured the facility to conduct a health and safety inspection. The single story home was neat and orderly, with heating and ventilation for safety and comfort of children in care. Licensee has 2 dogs in the home located in the gated off limits area of the home. 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. The off limits area and will be made inaccessible by closed and/or locked doors and visual supervision. There are no pools, hot tubs or any other bodies of water present in the on-limit areas during today’s inspection. LPA did not observe any hazardous materials or toxins accessible to children in care. There are age appropriate toys that appear to be safe and in good condition. The home has a fully charged 2A10BC fire extinguisher, working smoke/carbon monoxide detector, fully stock First Aid Kit. and telephone. There is a fireplace in that is blocked and inaccessible to children in care. Per licensee there are no firearms in the home. The licensee is in compliance with the immunization laws which pertains to all childcare providers. See LIC809 -C for continuance.

SUPERVISORS NAME: Chandra Charles
LICENSING EVALUATOR NAME: April Wright
LICENSING EVALUATOR SIGNATURE:	DATE: 04/14/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/14/2023

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
OAKLAND SOUTH EAST, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612

FACILITY NAME: VILLEGAS, FABIOLA	FACILITY NUMBER: 013422116
	VISIT DATE: 04/20/2023

NARRATIVE

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LPA requested and reviewed the files of eight (8) children in care. The children's files contained, Parents rights, medical consent forms and identification and emergency contacts. The facility roster was review and copies were obtained. The licensee conducts fire and disaster drills twice a year and the last was conducted on 4/4/2023. The licensee has a current CPR/First aid certificate which expires on 1/2025 and Mandated Reporter completed on 1/3/2023. The licensee is in ratio today. All required forms are posted and visible for public review.

Incidental Medical Services (IMS) policy was discussed. NO IMS PROVIDED AT THIS FACILITY. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226. When any IMS is provided, an updated Plan of Operation that includes 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

California Law requires Child Care Centers licensees 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. Roster of the children must be properly maintained, and fire/disaster drill every six months must be documented. The licensee is reminded any structural changes to the home or additions to the childcare facility must be reported to Community Care Licensing. All forms can be downloaded at www.ccld.ca.gov

LPA discussed the Safe sleep regulations with licensee and discussed Child Care Licensing Safe Sleep webpage 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.

See LIC 809 C for continuance...

SUPERVISORS NAME: Chandra Charles
LICENSING EVALUATOR NAME: April Wright
LICENSING EVALUATOR SIGNATURE:	DATE: 04/20/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/20/2023

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
OAKLAND SOUTH EAST, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612

FACILITY NAME: VILLEGAS, FABIOLA	FACILITY NUMBER: 013422116
	VISIT DATE: 04/20/2023

NARRATIVE

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Licensee was encouraged to frequently visit our website at ccld.ca.gov for licensing regulations and updates.

The licensee is reminded any structural changes to the home or additions to the childcare facility must be reported to Community Care Licensing.

There are no deficiencies cited. A notice of site visit was given and must remain posted 30 days. Exit interview conducted and report was reviewed with License Fabiola Villegas

SUPERVISORS NAME: Chandra Charles
LICENSING EVALUATOR NAME: April Wright
LICENSING EVALUATOR SIGNATURE:	DATE: 04/20/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/20/2023

LIC809 (FAS) - (06/04)

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