334846350-3-28-2023-09-CC-SBRR-CQCQYV-20230328123545

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 334846350
Report Date: 03/28/2023
Date Signed: 03/28/2023 12:36:00 PM

Document Has Been Signed on 03/28/2023 12:36 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
INLAND EMPIRE CHILD, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501

FACILITY NAME:	RODRIGUEZ-SAN MARTIN FAMILY CHILD CARE		FACILITY NUMBER:	334846350
ADMINISTRATOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY: 8	TOTAL ENROLLED CHILDREN: 0	CENSUS: 0	DATE:	03/28/2023
TYPE OF VISIT:	Prelicensing	UNANNOUNCED	TIME BEGAN:	09:00 AM
MET WITH:	Licensee Applicants Alicia Rodriguez and Devi San Martin		TIME COMPLETED:	12:45 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 03/28/2023 at 9:00 AM, Licensing Program Analysts (LPAs) Susan Brewer and Perla Ordones, arrived at the facility to conduct a Pre-licensing inspection, for a re-location and application to increase the capacity to that of a Large Family Child Care Home. Present during this inspection were: Licensee Applicants Alicia Rodriguez and Devi San Martin. LPAs were greeted by the licensees and granted entry to tour the facility, inside and out and the following was observed and/or discussed: A census was taken and no children were present. Normal days and hours of operation are Monday-Friday, 6:30 AM to 6:30 PM OFF-LIMIT AREAS INCLUDE: 1^st Floor closet, Staircase, Garage, Entire 2^nd Floor; Outdoor shed and North-West Side Yard. · Appropriate fire extinguisher (2A:10BC), smoke detector and carbon monoxide detector are present, are in working order and were tested by the applicant during this inspection on 03/28/2023. · The home has a working telephone, verified. · All hazardous items are NOT inaccessible. LPAs observed miscellaneous household cleaning items and vehicle liquids under the kitchen sink and garage, which were not inaccessible. · No guns or weapons present as of this date. Applicant understands all guns, weapons and ammunition must be key locked separately and made inaccessible per Title 22 Regulations. · Stairs are barricaded on 03/2023. · No fire place. · Storage of poisons is NOT inaccessible to children and locked, referenced the cleaning items in garage and under kitchen sink. · Verification of control of property on file. · Facility Sketch and Emergency Disaster Plan are posted: Yes and located in daycare room. · Pediatric CPR and First Aid Cards - expire on 12/2024 for both licensees.

SUPERVISORS NAME: Kimberly Williams
LICENSING EVALUATOR NAME: Susan Brewer
LICENSING EVALUATOR SIGNATURE:	DATE: 03/28/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/28/2023

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
INLAND EMPIRE CHILD, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501

FACILITY NAME: RODRIGUEZ-SAN MARTIN FAMILY CHILD CARE	FACILITY NUMBER: 334846350
	VISIT DATE: 03/28/2023

NARRATIVE

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· Health & Safety Certificate for licensees were completed on 02/19/2023
· Mandated reporter General: NOT ON FILE; AB1207 Child Care certificates expire: 11/30/2024
· Fire clearance: 03/15/2023
· Applicants understand all bodies of water including ponds, above ground pools and spas, in-ground pools and spas, and some fountains must be properly covered or fenced per title 22 regulations. The Department must be notified before and after installation of the above types of bodies of water. In addition, all wading pools or similar product must be emptied immediately after use and stored in an upright position when not in use. LPAs did not observe any large bodies of water on 03/28/2023.
· Clean, Safe and age appropriate toys and equipment are present for both indoor and outdoor activities. LPAs observed a wooden changing table/station of the licensees' own design, that is set on top of the bath tub/restroom designated for daycare children. The changing table/station stands 3 ft off of the ground and does not have raised sides at this time, which was discussed with the licensees.
· There are no toxic plants observed at this time and outdoor perimeter is secured with a fence and gates/unsecured, however LPAs observed broken glass on the ground from a broken window.
· The Applicant was informed of their reporting requirements and is provided with the Regional Office’s Unusual Incident Reporting email mailbox: [email protected]
· Issued applicant the following: SIDS information and Shaken Baby Syndrome pamphlet
Incidental Medical Services (IMS) policy was discussed with Licensee Applicants Alicia Rodriguez and Devi San Martin. For IMS information, see PIN 22-02-CCP. 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

LPAs discussed the safe sleep regulations with Licensee Applicants Alicia Rodriguez and Devi San Martin 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. LPAs 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.

SUPERVISORS NAME: Kimberly Williams
LICENSING EVALUATOR NAME: Susan Brewer
LICENSING EVALUATOR SIGNATURE:	DATE: 03/28/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/28/2023

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
INLAND EMPIRE CHILD, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501

FACILITY NAME: RODRIGUEZ-SAN MARTIN FAMILY CHILD CARE	FACILITY NUMBER: 334846350
	VISIT DATE: 03/28/2023

NARRATIVE

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Licensee Applicants Alicia Rodriguez and Devi San Martin were 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. The Licensee can submit transfer forms to associate new individuals or to disassociate someone from your facility at: [email protected] for Riverside Regional Office.

As a REMINDER: when your child(ren) turn 18 years of age, you MUST SUBMIT an updated LIC279, LIC508 and TB Screen and have your child submit for LIVESCAN background clearance.

LPAs 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. Entrance Checklist was provided to the applicant.

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.

Additionally, The following was discussed with the applicant(s):
- AB 1207 – Mandated Child Abuse Reporting: Child Day Care Personnel Training, beginning January 1, 2018 – Requires all licensed providers, applicants, directors and employees to complete training as specified on their mandated reporter duties and to renew their training every two years.
- Effective January 1, 2017 – Children under 2 years of age shall ride in a rear-facing car seat unless the child weighs 40 or more pounds OR is 40 or more inches tall. For additional information regarding car seat laws see www.chp.ca.gov

SUPERVISORS NAME: Kimberly Williams
LICENSING EVALUATOR NAME: Susan Brewer
LICENSING EVALUATOR SIGNATURE:	DATE: 03/28/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/28/2023

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
INLAND EMPIRE CHILD, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501

FACILITY NAME: RODRIGUEZ-SAN MARTIN FAMILY CHILD CARE	FACILITY NUMBER: 334846350
	VISIT DATE: 03/28/2023

NARRATIVE

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- Pre-Licensing Visit Packet provided on 03/28/2023.
- Failure to meet the posting requirements shall result in an immediate $100 civil penalty.
- Documentation of fire & earthquake drills to be conducted every six months
- Responsibilities of being a mandated reporter: Renew every 2 years for AB1207 child care providers.
- Access to forms & Regulations for Family Child Care online at www.ccld.ca.gov
- Responsibility to know the regulations for anyone providing care.
- Inaccessibility of hazards must be constantly re-assessed depending on the children in care
- Current facility’s phone numbers must be on file with the licensing office at all times
- Baby walkers, bouncy seats, exer-saucers and other similar items are prohibited
- Once licensed, the Notice of Site Visit must be posted at the entrance of the facility for a period of 30 days. If a serious violation is cited, a copy of the licensing report (LIC809/LIC9099) must also be posted for 30 days.

v The Duty Officer is available to answer questions Mon. – Fri.at 1-844-LET-US-NO (1-844-538-8766).

Before licensure, the following needs to be corrected/completed on or before 04/28/2023:
1. Make Garage inaccessible by lock or latch
2. Latch or lock under kitchen sink to make cleaning supplies inaccessible.
3. Latch/lock for hutch with stored alcohol or make alcohol inaccessible.
4. CA Child Child Abuse Mandated Reporter Part 1 General Training: Alicia Rodriguez and Devi San Martin.
5. Clear broken glass from recent broken window, prior to children entering outdoor play area.

Once all corrections have been verified, the application for a Large Family Child Care Home will be submitted for approval with a maximum capacity of 12 or 14 with parent notification. Applicant advised that all corrections are due within 30 days or the application may be withdrawn. An exit interview was conducted, and a copy of this report was provided to the applicants on 03/28/2023.

During the exit interview, the Applicant confirmed that there are no Registered Sex Offenders living in the facility and/or using the facility address for their mailing address.

Exit interview conducted and report was reviewed with the Licensee Applicants Alicia Rodriguez and Devi San Martin.

SUPERVISORS NAME: Kimberly Williams
LICENSING EVALUATOR NAME: Susan Brewer
LICENSING EVALUATOR SIGNATURE:	DATE: 03/28/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/28/2023

LIC809 (FAS) - (06/04)

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