153802093-7-26-2021-12-CC-IORA-C5AU8K-20210726152141

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 153802093
Report Date: 07/26/2021
Date Signed: 07/26/2021 03:21:54 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551

FACILITY NAME:	MORENO'S DAY CARE		FACILITY NUMBER:	153802093
ADMINISTRATOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY:	8	CENSUS: 4	DATE:	07/26/2021
TYPE OF VISIT:	Case Management - Licensee Initiated	UNANNOUNCED	TIME BEGAN:	12:30 PM
MET WITH:	Rafaela Moreno		TIME COMPLETED:	03:21 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 7/26/2021 at 12:45 P.M., Licensing Program Analyst (LPA) Isabel Ortega conducted an unannounced prelicensing inspection for the purpose of an increase of capacity from a 8 Family Child Care Home(FCCH) to a 14 FCCH. LPA was greeted by licensee Moreno who guided the LPA on a tour of the Family Child Care Home. Upon arrival 4 children were in care. Licensee will operate Monday through Saturday: varied depending on Family’s need. The Licensee will continue to provide breakfast, snack, lunch, afternoon snack and dinner as needed. Licensee participate in a food nutrition program. This is a one-story family home which consist of three-bedrooms, one bathroom, a kitchen, dining room, living room, laundry room, shed and a detached garage that is maintained key locked. The living room is the primary location in which care is provided (referred to as the “Day Care area”). Children utilize the bathroom located down the hall. The back yard is gated and fenced, there is a shed storage area in the back yard maintained locked. The back yard will be utilized for outside play. The off-limit areas include all bedrooms, shed, and detached garage with laundry room (maintained key locked).

SUPERVISOR'S NAME: Carissa Bell	TELEPHONE: (661) 202-3359
LICENSING EVALUATOR NAME: Isabel Ortega	TELEPHONE: (661) 202-3786
LICENSING EVALUATOR SIGNATURE:	DATE: 07/26/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/26/2021

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, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551

FACILITY NAME: MORENO'S DAY CARE	FACILITY NUMBER: 153802093
	VISIT DATE: 07/26/2021

NARRATIVE

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The home was inspected inside and out for safety, comfort, cleanliness, telephone service, heating and center air ventilation. The home has age appropriate toys, play equipment and materials. Licensee stores sharp knives in the kitchen in a drawer, medication is stored inaccessible to children. Cleaning supplies and chemicals are stored in the kitchen underneath the sink and in the garage maintained locked. Licensee has a complete First Aid Kit in the home, which is stored inaccessible to children. Children are provided with cots during nap time.

There are no bodies of water nor pools on the premises. Licensee was reminded about ensuring proper care and visual supervision at all times.

Went over Safe Sleep with licensee and provided copy of PIN with individual Infant sleeping plan(12 months). Also, 15 min log was discussed for up to 24 month infants.

LPA observed two fire extinguisher (2A10BC) that meets the State Fire Marshal standards (reading in green). The smoke detector and carbon monoxide detector and they were found to be in operable condition. Home has central air conditioning and heating. Per the licensee, there are no weapons or firearms in the home, nor did LPA observe any weapons or firearms during the inspection. Last fire Drill was conducted 5/11/2021 at 12:30 p.m.

The licensee’s Pediatric CPR/First Aid expires on 1/30/2023. The licensee had the required immunizations against pertussis (Tdap), measles (MMR), and tuberculosis (TB). The Mandated Reporter training was completed on 6/10/2021.

SUPERVISOR'S NAME: Carissa Bell	TELEPHONE: (661) 202-3359
LICENSING EVALUATOR NAME: Isabel Ortega	TELEPHONE: (661) 202-3786
LICENSING EVALUATOR SIGNATURE:	DATE: 07/26/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/26/2021

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, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551

FACILITY NAME: MORENO'S DAY CARE	FACILITY NUMBER: 153802093
	VISIT DATE: 07/26/2021

NARRATIVE

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Licensee has the parent board and other Licensing required forms by the kitchen area visible to parents. There is a second yard on the premises inaccessible to children maintained key locked.

The following was discussed with licensee:
Mandatory licensing forms for the children’s files, facility forms/records, and information to be posted in the family child care home; Requirements to conduct fire and disaster drills once every six months and record it; Role and responsibilities of being a mandated reporter were reviewed; Licensee was made aware that it is her responsibility to know the regulations as well as anyone who assists in providing care; Licensing must have the facility’s phone number at all times; if the phone number is changed, licensing must be notified; Regulation prohibits the smoking of any kind in the family child care home.

The Licensee was informed that all adults living in or having access to the home, or employees are required to have fingerprint clearances with Department of Justice, FBI and Child Abuse Central Index prior to having contact or working with children. If the aforementioned is not adhered to, a Civil Penalty of up to $500, per non-cleared adult will be assessed immediately. Please advise your analyst of any person who will be visiting regularly or for longer than one week. The Licensee was advised to utilize the Request for Live Scan Service form LIC9163 to have adults fingerprinted and associated to the home.

SUPERVISOR'S NAME: Carissa Bell	TELEPHONE: (661) 202-3359
LICENSING EVALUATOR NAME: Isabel Ortega	TELEPHONE: (661) 202-3786
LICENSING EVALUATOR SIGNATURE:	DATE: 07/26/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/26/2021

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, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551

FACILITY NAME: MORENO'S DAY CARE	FACILITY NUMBER: 153802093
	VISIT DATE: 07/26/2021

NARRATIVE

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The Licensee was advised of the requirement to report Unusual Incidents. A report shall be made to the department by telephone or fax during the department's normal business hours before the close of the next working day following the occurrence during the operation of family day care home. In addition, a written report shall be submitted to the department within seven days following the occurrence of any events specified above. The applicant was informed to utilize the Unusual Incident Report/Injury Report form LIC624B when submitting the report to the department.

The Licensee was advised that the Notice of Site Visit must be posted at the entrance of the facility for a period of 30 days whenever a licensing inspection is conducted. If a Type A deficiency is cited, a copy of the licensing report must also be posted for 30 days. The same report must be provided to parents/guardians of children newly enrolled at the facility during the next 12 months and licensee must obtain a signed Acknowledgement of Licensing Reports (LIC 9224) from parent/guardian and place it in each child's file. Copies of the reports must be provided to each parent when a Type A violation is cited along with Acknowledgment of Receipt of Licensing Reports (LIC 9224). If these requirements are not met civil penalties per violation will be assessed.

Beginning on January 1, 2018, Assembly Bill 1207 (2015) 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. Applicants must meet requirements as a precondition to licensure. New employees shall have 90 days from date of employment to complete training as required. The training may be conducted at the following website www.mandatedreporterca.com. This certificate is valid for two years.

SUPERVISOR'S NAME: Carissa Bell	TELEPHONE: (661) 202-3359
LICENSING EVALUATOR NAME: Isabel Ortega	TELEPHONE: (661) 202-3786
LICENSING EVALUATOR SIGNATURE:	DATE: 07/26/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/26/2021

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, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551

FACILITY NAME: MORENO'S DAY CARE	FACILITY NUMBER: 153802093
	VISIT DATE: 07/26/2021

NARRATIVE

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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 publication: Commonly Asked Questions about Child Care Centers and the ADA, available at http://www.ada.gov/childqanda.htm

The licensee was advised it is her responsibility to visit the department's website to access licensing forms, Quarterly Updates and Provider Information Notices (PINs): www.ccld.ca.gov

Child Care Advocates:
To sign up for our Quarterly Updates and Provider Information Notices (PINs), please subscribe online: http://www.cdss.ca.gov/inforesources/Community-Care-Licensing/subscribeFire

Licensee has met Title 22 regulations; Fire clearance was granted 6/29/2021, therefore, a Large Family Child Care Home License capacity of 14 children has been granted effective today 7/26/2021.

An exit interview was conducted, and a copy of this report was provided to Licensee on this day. All Licensing reports are recommended to be kept on file for minimum three years.

SUPERVISOR'S NAME: Carissa Bell	TELEPHONE: (661) 202-3359
LICENSING EVALUATOR NAME: Isabel Ortega	TELEPHONE: (661) 202-3786
LICENSING EVALUATOR SIGNATURE:	DATE: 07/26/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/26/2021

LIC809 (FAS) - (06/04)

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