Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 393616949
Report Date: 02/02/2018
Date Signed 02/02/2018 12:02:47 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833
FACILITY NAME:ALVARADO, JAZARYFACILITY NUMBER:
393616949
ADMINISTRATOR:ALVARADO, JAZARYFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(209) 229-1446
CITY:TRACYSTATE: CAZIP CODE:
95377
CAPACITY:14CENSUS: DATE:
02/02/2018
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Jazary Alvarado TIME COMPLETED:
12:15 PM
NARRATIVE
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2)Licensing Program Analyst (LPA) Mary Ponce and LPA Jeremey McClain met with licensee Jazary Alvarado for an unannounced annual inspection. The facility operations Mon-Sunday 24/7. LPAs toured all areas of the home that are accessible to the children, a current roster of children, capacity and ratio were observed. Present in the home was the licensee, licensee's two sons and licensee's assistant. LPA confirmed that all adults residing or working in the home have criminal record clearances. LPA advised licensee if anyone over the age of 18 years old moves into the home they must have a criminal record clearance as well. LPA observed posting of the license, Parent's Rights and the current disaster plan.

Off-limit areas include entire upstairs of the home. Licensee acknowledged that children may never enter these off-limit areas. The backyard is fenced and licensee acknowledges that children may never be left unsupervised in an unfenced area of the yard. There are no bodies of water on the property and licensee stated there are no weapons in the home.

LPA observed current CPR and First Aid certificates that expires on 01/19. LPA observed that poisons are locked, smoke detector and carbon monoxide detector and fire extinguisher meets regulation. Fireplace is inoperable, cleaning materials, and medications are all inaccessible to children; however there was a container of gasoline, caulk material, and grout accessible to children in the garage which is not an off-limits. LPA observed a Fire Drill Log and the licensee is conducting fire drills at least every six months. There is a working telephone,
SUPERVISOR'S NAME: Monica R FiliceTELEPHONE: (916) 263-5719
LICENSING EVALUATOR NAME: Mary PonceTELEPHONE: 916-263-5744
LICENSING EVALUATOR SIGNATURE:

DATE: 02/02/2018
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/02/2018
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833
FACILITY NAME: ALVARADO, JAZARY
FACILITY NUMBER: 393616949
VISIT DATE: 02/02/2018
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LPAs discussed the new Mandated Reporter Training with licensee. Beginning January 1, 2018, Health and Safety Code 1596.8662 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. Volunteers are encouraged but not required to take the training. In addition. existing licensees must meet requirements by March 30, 2018. This training requirement may be met by using the Department’s Office of Child Abuse Prevention (OCAP) online training modules. The OCAP modules are free of cost and available at: http://www.mandatedreporterca.com/. The training is currently provided in English.

Incidental Medical Services (IMS) policy was discussed. Licensee stated she does not administer IMS. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Family Child Care Homes Section 102417. 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
LPA provided the Community Care Licensing’s website www.ccld.ca.gov, so the licensee can obtain updated licensing information, new regulations and access forms. LPAs also provided the e-mail address for the advocates in order to be added to the quarterly newsletter mailing list. childcareadvocatesprogram@dss.ca.gov

Title 22 deficiencies are cited on the subsequent pages of this report.
Licensee acknowledges, that FOR TYPE A DEFICIENCIES ONLY upon receipt, licensee shall post LIC 809D with Type A deficiencies for 30 days and provide copies of this licensing report to parents/guardians of children in care at the facility and to parents/guardians of children newly enrolled at the facility during the next 12 months. The LIC 9224 must be signed by parents/guardians and kept with the children's forms as a receipt whenever any Type A documents are provided by the licensee (LIC 9224 was provided).

Licensing report was reviewed and discussed with licensee. Appeal rights were provided.
Exit interview was conducted. Notice of Site Visit poste
SUPERVISOR'S NAME: Monica R FiliceTELEPHONE: (916) 263-5719
LICENSING EVALUATOR NAME: Mary PonceTELEPHONE: 916-263-5744
LICENSING EVALUATOR SIGNATURE:

DATE: 02/02/2018
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/02/2018
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, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833

FACILITY NAME: ALVARADO, JAZARY
FACILITY NUMBER: 393616949
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/02/2018
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
02/05/2018
Section Cited
CCR
102417(g)(4)
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Operation of a Family Child Care Home. Poisons, detergents, cleaning compounds, medicines, firearms and other items which could pose a danger to children shall be stored where they are inaccessible to children.
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POC: Licensee removed gasoline, caulk, and grout from the garage and placed it in a locked shed. Licensee states she will not take items out during business hours.
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LPAs observed Gasoline, caulk, and grout in garage which is not an off limits area. the gasoline, caulk, and grout were within reach of children in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Monica R FiliceTELEPHONE: (916) 263-5719
LICENSING EVALUATOR NAME: Mary PonceTELEPHONE: 916-263-5744
LICENSING EVALUATOR SIGNATURE:

DATE: 02/02/2018
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/02/2018
LIC809 (FAS) - (06/04)
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