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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 136610581
Report Date: 06/03/2022
Date Signed: 06/03/2022 03:44:16 PM


Document Has Been Signed on 06/03/2022 03:44 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
CCLD Regional Office, 7575 METROPOLITAN DR., STE 110
SAN DIEGO, CA 92108



FACILITY NAME:PEREZ, MARISELA FAMILY CHILD CAREFACILITY NUMBER:
136610581
ADMINISTRATOR:MARISELA PEREZFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(760) 344-1973
CITY:BRAWLEYSTATE: CAZIP CODE:
92227
CAPACITY:14CENSUS: 0DATE:
06/03/2022
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
10:15 AM
MET WITH:Marisela Perez,TIME COMPLETED:
11:30 AM
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On 06/03/2022 at 10:15 am, Licensing Program Analyst (LPA) Michelle Hood conducted an announced pre-licensing inspection for a change of location with the applicant, Marisela Perez. The purpose of the inspection is to ensure that the home is in compliance with standards established in CCR, Title 22, Division 12, Chapter 3, for Family Child Care Homes. This 2 story 5-bedroom, 3 bath home was toured and inspected to ensure the environment is safe for the care and supervision of children. Per applicant operating hours are 7:00 a.m. to 3:30 p.m., Monday through Friday.

The applicant provided proof of control of the property for review by the Department. The applicant will use the following areas for childcare: backyard, living room, family room, kitchen, dining room, downstairs bathroom, and bedroom 1. Off-limits areas include the garage, and entire upstairs (four bedrooms and two bathrooms) They are made inaccessible to daycare children through the use of safety gates, doorknob covers, and door latches. The stairs are barricaded with a safety gate. There are no bodies of water observed during the time of visit. The fire extinguisher is rated 2A 10B: C, smoke, and carbon monoxide detectors meet requirements and are operational. All poisons, cleaners, and hazardous items in the home are inaccessible to children through latches, locks, and/or placed on high surfaces.

Children’s toys and play equipment are available. The applicant stated there are NO firearms or other weapons in the home. The applicant has completed the 8 hours of preventative health. Pediatric CPR and First Aid certifications expire on 04/2023. The applicant completed the Mandated Reporter AB1207 training certification on 03/02/2022. Immunization records per SB792 were reviewed and are in compliance for the applicant.



The applicant, spouse and adult son have been cleared for criminal record and child abuse index clearances. The applicant was reminded all adults 18 and over living or working in the home, including employees and volunteers, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to the 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 applicant was advised any new/additional adults must be cleared prior to working or residing in the home. Any minor upon his/her 18th birthday must be fingerprinted within 30 days.
SUPERVISOR'S NAME: Cynthia GrayTELEPHONE: (619) 767-2258
LICENSING EVALUATOR NAME: Michelle HoodTELEPHONE: (691) 767-2241
LICENSING EVALUATOR SIGNATURE:
DATE: 06/03/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/03/2022
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, 7575 METROPOLITAN DR., STE 110
SAN DIEGO, CA 92108
FACILITY NAME: PEREZ, MARISELA FAMILY CHILD CARE
FACILITY NUMBER: 136610581
VISIT DATE: 06/03/2022
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The applicant does not plan on providing IMS to clients at this time. Incidental Medical Services (IMS) policy was discussed. 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 the publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: http://www.ada.gov/childqanda.htm. LPA discussed and provided Licensee with the following: child care advocates email address: childcareadvocatesprogram@dss.ca.gov. In addition, for general questions or questions regarding licensing requirements contact the Child Care Licensing Duty Line at (619) 767-2248.

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.

LPA reviewed with the applicant LIC 311D, forms/records to keep in your Family Child Care home, children forms/records, facility forms/records, and information to be posted. The applicant was also informed the following items are prohibited during daycare operating hours (walkers, exersaucers, jumpers, and bouncy seats). Corporal punishment and smoking are not allowed in the daycare.

LPA and applicant discussed California Megan's Law and LPA provided: www.meganslaw.ca.gov. LPA and applicant discussed Safe Sleep. LPA provided the applicant with Safe sleep documents. LPA discussed the safe sleep regulations with the applicant 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. LPA also informed the 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. The applicant understands they must physically check on sleeping infants every 15 minutes. An Individual Infant Sleeping Plan [LIC 9227 (3/20)] will be maintained for each infant up to 12 months of age and shall be available to the Department for review. The applicant understands infants up to 12 months of age must be placed on their backs for sleeping.
SUPERVISOR'S NAME: Cynthia GrayTELEPHONE: (619) 767-2258
LICENSING EVALUATOR NAME: Michelle HoodTELEPHONE: (691) 767-2241
LICENSING EVALUATOR SIGNATURE:

DATE: 06/03/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/03/2022
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, 7575 METROPOLITAN DR., STE 110
SAN DIEGO, CA 92108
FACILITY NAME: PEREZ, MARISELA FAMILY CHILD CARE
FACILITY NUMBER: 136610581
VISIT DATE: 06/03/2022
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The maximum capacity for a large family child care home: 12 children (with a qualified assistant) with no more than 4 infants; or (with landlord consent) 14 children (with a qualified assistant) with no more than 3 infants, 1 child enrolled in kindergarten or elementary school and 1 child at least age 6 including children under age 10 who live in the licensee's home. When there are no Qualified Assistants, 14 years of age or present, the capacity reverts back to the requirements for a Small Family Child Care. To access our Regulations and Forms please use our WEBSITE: http://ccld.ca.gov.

The applicants spouse interpreted and explained the inspection report to the applicant in Spanish, applicant stated she understood.

A Large Family Child Care Home License for 14 may be issued upon a final file review. Exit interview conducted and report was reviewed with the applicant Marisela Perez..
SUPERVISOR'S NAME: Cynthia GrayTELEPHONE: (619) 767-2258
LICENSING EVALUATOR NAME: Michelle HoodTELEPHONE: (691) 767-2241
LICENSING EVALUATOR SIGNATURE:

DATE: 06/03/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/03/2022
LIC809 (FAS) - (06/04)
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