Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 073407702
Report Date: 03/22/2018
Date Signed 03/22/2018 04:39:52 PM

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, SUITE 1102
OAKLAND, CA 94612
FACILITY NAME:PACHECO, VALERIAFACILITY NUMBER:
073407702
ADMINISTRATOR:PACHECO, VALERIAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(510) 504-2114
CITY:SAN PABLOSTATE: CAZIP CODE:
94806
CAPACITY:14CENSUS: 12DATE:
03/22/2018
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
03:05 PM
MET WITH:Valerie PachecoTIME COMPLETED:
04:30 PM
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Licensing Program Analyst (LPA) Paul Petersen conducted an unannounced random site inspection for this facility. LPA met with and toured the facility with licensee, Valerie Pacheco and licensee's daughter, Karen Zepeda. There were 12 children in care present including daughter's five year old son plus two infants, eight preschoolers and one school age child. There are no changes to the off limits areas since the most recent inspection. Off limits areas are made inaccessible via closed doors or child safety gating and visual supervision. The home is clean and organized with heating and ventilation for safety and comfort. The fully fenced outdoor play areas/yard are available for children with the exception of the outdoor baby area which will remain off limits until cleared to be on limits. The back yard storage room is off limits for children. There are no pools, hot tubs or any other accessible bodies of water. There are no toxins/hazardous items observed to be accessible to children. There are age appropriate toys and equipment, including infant sleeping equipment, that appear to be safe and in good condition. The home has a fully charged 2A10BC fire extinguisher, working smoke detector, working carbon monoxide detector, and working telephone. There is a fireplace which is fully screened and non-operational. Per licensee, there are no firearms in the home. LPA reviewed the facility and children's records including the roster, disaster drill log, children's immunization records and parents rights forms. The licensee is in ratio today. LPA and licensee reviewed the Facility Personnel Report Summary and verified that all adults requiring background clearances are cleared and associated to this facility. Licensee was provided a copy of the Child Care Providers Guide to Safe Sleep as well as information on the mandated reporter training requirements. All forms can be downloaded at www.ccld.ca.gov Licensing update are available online or by emailing: childcareadvocatesprogram@dss.ca.gov. Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual-Regulation Interpretations and Procedures for Family Child Care Homes Sections 102417. When any IMS is provided, an updated Plan of Operation that includes IMS must be submitted to the Department. The following information 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 There are no deficiencies cited during this inspection. An exit interview was conducted. Licensee was provided a copy of their appeal rights. A notice of site visit was provided by LPA and must remain posted for 30 days. This report must be available for public review for 3 years.
SUPERVISOR'S NAME: Anika EvansTELEPHONE: (510) 286-4350
LICENSING EVALUATOR NAME: Paul PetersonTELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:

DATE: 03/22/2018
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/22/2018
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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