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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 153905169
Report Date: 02/14/2020
Date Signed: 02/17/2020 05:59:59 PM

COMPREHENSIVE INSPECTION
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:JUAREZ, LILIA FAMILY CHILD CAREFACILITY NUMBER:
153905169
ADMINISTRATOR:JUAREZ, LILIAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(661) 854-2085
CITY:ARVINSTATE: CAZIP CODE:
93203
CAPACITY:14CENSUS: 1DATE:
02/14/2020
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
08:45 AM
MET WITH:Lilia Juarez, LicenseeTIME COMPLETED:
02:44 PM
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 On 02/14/2020, at 8:45 AM Licensing Program Analysts (LPA) Esequiel Rodriguez made an unannounced Required inspection at the Diaz Family Child Care Home facility. The purpose for the inspection is to inspect the facility to ensure the facility meets licensing requirements set forth by Title 22 and statutory requirements. The LPA met with Licensee, Lilia Juarez and stated the purpose for the inspection.

Ms. Juarez provided copy of the Child Care Drill Log for Emergency/Disaster Preparedness, Current Children in the Home roster; and Facility Roster.

At the time of the inspection there was one child in care.

At 9:25 AM LPA Rodriguez along with Ms. Juarez conducted an inspection tour of the inside and out of the facility physical plant.

This is a two story home family home. There is a living room, kitchen, dining area, four bedrooms (all on top floor), two full restroom and one half restroom in the bottom floor being use for the children in care. The garage was converted to be the main day care area (licensee has city permit) and was approved by CCL.



The off-limits areas are the top bedrooms, barque area, all storage areas and the stairway.

There are no bodies of water or weapons in the facility Physical plant. The carbon monoxide, fire extinguisher and smoke detectors are present, are fully operational, and meet State Fire Marshall standards. The play area are the back and side yards. They are free of defects or dangerous conditions, and are clean and safe. The toys and playthings are safe clean and appropriate. There were no baby walkers, bouncers, jumpers and/or similar items present.
SUPERVISOR'S NAME: Claretta YatesTELEPHONE: (661) 789-6944
LICENSING EVALUATOR NAME: Esequiel RodriguezTELEPHONE: (323) 981-3315
LICENSING EVALUATOR SIGNATURE:

DATE: 02/14/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/14/2020
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: JUAREZ, LILIA FAMILY CHILD CARE
FACILITY NUMBER: 153905169
VISIT DATE: 02/14/2020
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Storage areas used for poisons, detergents, cleaning compounds, medications and other items which could pose a danger to children are stored are inaccessible to children. There fireplace is properly covered and inaccessible to the children. The first aid kit is present and maintained in an area inaccessible to children.

The entire facility is clean, orderly, safe and sanitary, and with appropriate heating and ventilation for safety and comfort.

When a child has a contagious or symptoms of contagious disease, the child is not accepted for care. However, if the symptoms are noted after the child parents leave the facility, the child is immediately separated from others, and the parents or legal guardian are immediately notified. Nonetheless, the home has a designated isolation area for sick children.



The day care home provides lunch, snack throughout the day, and dinner as needed. The facility transports children to school only. The vehicle use to transport client is a Toyota Sienna Van 2001. It contains all safety requirements established by the law. It is maintained in a safe and good working conditions and the licensee and assistant have a current driver license. At the time of this inspection, Toys and equipment use by children are safe, age appropriate and in good condition. The water dispenser for the children is located in the kitchen area and when in the play ground the water is provided at the play.

The LPA noted that the facility has a log indicating emergency drills are conducted every six months or sooner. The Licensee and assistant have a current Pediatric CPR/First Aid, and has attended the required Mandated Reporter training. The facility is currently working on a more comprehensive plan for Earthquakes, Fire emergency, and floods. The facility annual fees are current.



Licensees provided proof of immunization against pertussis (TDAP), measles (MMR), Tuberculosis assessment (TB) and Influenza. Also, has a current Mandated Reported Certificate and Pediatric First Aid/CPR.

Children records were reviewed for Parent Notification notice; Additional Children in Care (LIC 9150); Affidavit Regarding Liability Insurance (LIC 282) This facility has liability insurance; Consent for Medical Treatment (LIC 627); Consent/Verification for Nebulizer Care (LIC 9166) - not applicable to this facility;
SUPERVISOR'S NAME: Claretta YatesTELEPHONE: (661) 789-6944
LICENSING EVALUATOR NAME: Esequiel RodriguezTELEPHONE: (323) 981-3315
LICENSING EVALUATOR SIGNATURE:

DATE: 02/14/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/14/2020
LIC809 (FAS) - (06/04)
Page: 2 of 4
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: JUAREZ, LILIA FAMILY CHILD CARE
FACILITY NUMBER: 153905169
VISIT DATE: 02/14/2020
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Identification and Emergency Information (LIC 700); Notification of Parents' Rights (LIC 995A) - This form must be given to each parent at the time a child is accepted for care, along with the LIC 995E - Bottom portion keep on file; Caregiver Background Check Process (LIC 995E); Family Child Care Consumer Awareness Information (LIC 9212); California School Immunization Record. Licensee has a blue form on file. However, is not the PM 286. Current "blue" form was provided to licensee. Current form can be downloaded from the following website:http://www.dhs.ca.gov/publications/forms/immunization.htm but must be printed on blue paper only; and Incident reports LIC 624B.

Personnel Records were reviewed for the following: Unusual Incident/Injury Report (LIC 624B)
licensing office when reporting any incidents or injuries occurring during day care hours.
Child Care Facility Roster (LIC 9040); Notice of Employee Rights (LIC 9052); Statement Acknowledging Requirement to Report Suspected Child Abuse (LIC 9108); Property Owner/Landlord Consent Form (LIC 9149), Property Owner/Landlord Notification Form (LIC 9151), and deed or lease/rental agreement are not applicable. Licensee owns the home and has mortgage proof documentation on file.
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A review of the facility associations against Facility Report Summary (LIS 536) dated 02/11/2020 indicates that the licensee, and other individuals who require caregiver background checks have received DOJ, FBI criminal record and child abuse index check clearances or exemptions.

The following were discussed: No smoking in the facility premises, infant walkers, Johnny jumpers, exersaucers and any other item that falls into that category are permitted in the facility. The LPA also LPA reminded Licensee that the required mandated reported training and shall be renew every two years. 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. Incidental Medical Services (IMS) policy was also discussed. LPA informed licensee that when any IMS is provided, a Plan for Providing IMS must be submitted to the Department.

The following information regarding American with Disabilities Act (AD)A was provided: US Department of Justice (USDOJ) toll-free ADA Information Line is (800) 514-0301 (voice)/ (800) 514-0383 (TTY) and link to
SUPERVISOR'S NAME: Claretta YatesTELEPHONE: (661) 789-6944
LICENSING EVALUATOR NAME: Esequiel RodriguezTELEPHONE: (323) 981-3315
LICENSING EVALUATOR SIGNATURE:

DATE: 02/14/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/14/2020
LIC809 (FAS) - (06/04)
Page: 3 of 4
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: JUAREZ, LILIA FAMILY CHILD CARE
FACILITY NUMBER: 153905169
VISIT DATE: 02/14/2020
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publication: Commonly Asked Questions about Child Care Centers and the ADA is available at http://www.ada.gov/childqanda.htm

Also advise Licensee to sign up for CCL Quarterly Updates by emailing the Child Care Advocates at
childcareadvocatesprogram@dss.ca.gov or by calling (916) 654-1541 Licensee was informed the Palmate Regional Office can be contacted for information at (661) 202-3318 Monday through Friday from 8:00 AM - 5:00 PM.

At the time of this inspection, the facility was in compliance per Title 22 regulations, and no deficiencies cited. LPA Rodriguez provided additional consultation regarding Title 22 requirements.

Exit interview conducted and a copy of this Report as well as the Notice of Site visit (LIC 9213) was provided to Ms. Juarez.
SUPERVISOR'S NAME: Claretta YatesTELEPHONE: (661) 789-6944
LICENSING EVALUATOR NAME: Esequiel RodriguezTELEPHONE: (323) 981-3315
LICENSING EVALUATOR SIGNATURE:

DATE: 02/14/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/14/2020
LIC809 (FAS) - (06/04)
Page: 4 of 4