Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 493007074
Report Date: 05/15/2015 12:00:00 AM
Date Signed 05/19/2015 07:11:29 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 101 GOLF COURSE DR. STE. A-230
ROHNERT PARK, CA 94928
FACILITY NAME:SERRANO, MARIA FCCHFACILITY NUMBER:
493007074
ADMINISTRATOR:SERRANO, MARIA FCCHFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(707) 293-4911
CITY:SANTA ROSASTATE: CAZIP CODE:
95407
CAPACITY:14CENSUS: 8DATE:
05/15/2015
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
02:10 PM
MET WITH:Maria SerranoTIME COMPLETED:
04:25 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
LPA Leticia Rosales-Meza conducted a Random visit today. Also present in the home are four infants, four older day care children between the ages 2 - 3, and Licensee's son, Omar Orozco. The facility is toured inside and outside. Services are provided Monday - Friday 7:00 AM-5:00 PM. The interior area includes the living room, kitchen, dining room, both downstairs bathrooms, and bedroom #3 for napping. "Off limits" areas are downstairs bedrooms #1 and #2 (access is prevented by door knob covers) and the second story (a gate is in place at the bottom of the stairs). Flex locks are used on the lower cabinet doors in the kitchen and bathrooms to prevent access to toxins. The back yard is used for play. Exterior "off limits" area includes the front yard, right side yard, and the detached garage. (There is a gate to prevent access to the side yard and the door is latched). There are no pools, spas, hot tubs, fish ponds, or similar bodies of water. Licensee states there are no firearms in the home and none were seen during this visit. Storage area for poisons are stored in the outside shed and is locked using a key lock. Detergents, cleaning compounds, and other items which could pose a danger to children are stored in the laundry where they are inaccessible to children. Medications are stored in bedroom #1.Fire extinguisher located in the kitchen and is charged. Smoke detector in the hallway is in working order. The home appears clean and orderly, with heating and ventilation for safety and comfort. Stairs are barricaded or fenced because there are children in care who are less than five years old. The home is providing a variety of safe toys, play equipment and materials indoor and outdoor. There is a working telephone in the home. Family pet is a Chihuahua named, "Mini". Licensee states the dog's shot records are current.

The licensee is present in the home to ensure that children in care are supervised at all times. Andres Orozco, Licensee's spouse and Omar Orozco, Licensee's son are the substitute adults who cares for and supervised children when Licensee is absent. Licensee is aware of regulation that children shall not be left in parked vehicles. The outdoor play area is fenced or children are directly supervised by Licensee when using the yard. The home is licensed for fourteen children and today meets the capacity guidelines specified on the license.

A copy of the emergency information card, containing all of the information specified by regulation, is kept in each child's record. Facility Roster is current and complete. Children's files are reviewed and complete. Pg. #2
SUPERVISOR'S NAME: Linda WalkerTELEPHONE: (707) 588-5026
LICENSING EVALUATOR NAME: Leticia RosalesTELEPHONE: (707) 588-5077
LICENSING EVALUATOR SIGNATURE:

DATE: 05/15/2015
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/15/2015
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC809 (FAS) - (06/04)
Page: 1 of 2


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 101 GOLF COURSE DR. STE. A-230
ROHNERT PARK, CA 94928
FACILITY NAME: SERRANO, MARIA FCCH
FACILITY NUMBER: 493007074
VISIT DATE: 05/15/2015
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
26
27
28
29
30
31
32
A review of staff records on 05/14/15 indicates that all individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions prior to working, residing, or volunteering in a licensed home. Licensee has completed training on preventive health practices. Pediatric CPR and Pediatric First aid cards expire March 2017 for Licensee and assistants, Andres Orozco and Omar Orozco.

Required information to be posted in the family child care home includes the License (LIC 203), Emergency Disaster Plan (LIC 610A), Earthquake Preparedness Checklist (LIC 9148), and Parents' Rights Poster (PUB 394). These forms are posted in the day care space and are easily seen by parents and the public. Forms/Records to Keep in your Family Child Care Home (LIC 311D) is reviewed. Unusual Incident Report (LIC 624B) is reviewed as well as reporting responsibility and specific issues to be immediately reported to CCL (within 24 hours or the next business day). Emergency drills are to be conducted and documented two times a year. The most recent drill was on 03/2017.

All adult residents (age 18 or over) or care givers are required to complete a criminal record background clearance and obtain a TB clearance. Smoking is prohibited during the hours of operation and in areas of the home where children are present. If children are transported, the required vehicle restraints will be used and the equipment safety will be maintained. Children are to be transported only by an adult with a criminal record clearance. Infants or children shall not be allowed to sleep in car carriers in the home.

Any proposed changes to the physical plant, telephone number, change of address, or change in service shall be immediately reported to CCL.

If a licensee is cited for a Type A violation, upon receipt of the licensing report, they shall post 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 (LIC 9224). Failure to comply with this requirement shall be a violation of HSC section 1596.8595(c). Removal of any posted documents before 30 days is a $100.00 civil penalty violation.

Shaken Baby Syndrome Brochure, and Tips for Licensee to Prevent Heat-related Illnesses, and information regarding healthy beverages in child care (AB 2084) is given. No deficiencies are cited today.

NOTICE OF SITE VISIT IS POSTED
SUPERVISOR'S NAME: Linda WalkerTELEPHONE: (707) 588-5026
LICENSING EVALUATOR NAME: Leticia RosalesTELEPHONE: (707) 588-5077
LICENSING EVALUATOR SIGNATURE:

DATE: 05/15/2015
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/15/2015
LIC809 (FAS) - (06/04)
Page: 2 of 2