153909341-6-11-2022-12-CC-EROZ-CFAKKK-20220611075827

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 153909341
Report Date: 06/10/2022
Date Signed: 06/11/2022 07:58:39 AM

Document Has Been Signed on 06/11/2022 07:58 AM - 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, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551

FACILITY NAME:	JUAREZ, ZEFERINO & YOLANDA FAMILY CHILD CARE		FACILITY NUMBER:	153909341
ADMINISTRATOR:	JUAREZ,ZEFERINO/YOLANDA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(661) 854-3591
CITY:	ARVIN	STATE: CA	ZIP CODE:	93203
CAPACITY:	14	CENSUS: 2	DATE:	06/10/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	12:34 AM
MET WITH:	Yolanda Juarez		TIME COMPLETED:	03:55 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 06/10/22 at 12:34 p..m. Licensing Program Analysts (LPA) Esequiel Rodriguez conducted an unannounced annual inspection at the Family Child Care Home to assess the Facility operation of their program and current physical plant status. Also, to evaluate the Facility's continuing ability to meet compliance with California Code of Regulations (CCR) Title 22, Health and Safety requirements, and other applicable State and Licensing Statutory requirements. LPA Rodriguez met with Licensee, Yolanda Juarez and stated the reason for the inspection. The LPA provided a copy of the Entrance checklist form, LIC 126. Mr. Zeferino Juarez came in little later. LPA Rodriguez told providers that to better assure and promote the health and safety of each individual being cared for in licensed setting, the Community Care Licensing Division's (CCLD) is focusing efforts on three priority areas: Prevention, compliance, and enforcement; Therefore, CCLD launched the Inspection Process Project (IPP) to meet these goals. As a result it developed the Compliance and Regulatory Enforcement (CARE) Tools for the Child Care Program which is being used during today's inspection. These does not impose any new requirement on the provider. At 1:05 p.m. LPA Rodriguez along with the Licensee conducted a walk trough of the inside and outside of the facility along with the entire operation of the Facility. The LPA observed the Licensee that the Facility license, and the Notification of Parents' Rights Poster (PUB 394) shall be posted in a more prominent place of the facility where it can be easily seen. The home is licensed to provide day care services to 8 children. The facility does not have play yards or playpens. However, the Licensee understands that if ever needed, she will make sure the items are made of material (mesh or fabric) that has not been banned or recalled by the United States Consumer Product Safety Commission. The home is clean, safe and orderly, with heating and ventilation for safety and comfort. The home maintain telephone service (Licensee was advised the cell phone shall be charged and available during day care hours.) The facility has safe age appropriate toys, play equipment and materials for the children care to use. There are no

SUPERVISOR'S NAME: Scott Herring	TELEPHONE: (661) 202-3314
LICENSING EVALUATOR NAME: Esequiel Rodriguez	TELEPHONE: (661) 202-3321
LICENSING EVALUATOR SIGNATURE:	DATE: 06/10/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/10/2022

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

FACILITY NAME: JUAREZ, ZEFERINO & YOLANDA FAMILY CHILD CARE	FACILITY NUMBER: 153909341
	VISIT DATE: 06/10/2022

NARRATIVE

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fixtures, furniture, and/or equipment that have been banned or recalled by the United States Consumer Product Safety Commission present or accessible to children at the facility at the time of this inspection. Per
Licensee, if food is brought from the children's homes, the container is labeled with the child's name and properly stored or refrigerated.

The facility is free from defects or conditions which might endanger a child. The backyard, at the time of this is off limits to the children. This area is schedule for cleaning because there are several items and debris that may create a hazard to the children if allow to play in the back yard. The fireplace .is properly screened to prevent access by children. The facility sketch/floor plan needs to be updated to reflect proper location of designated areas (windows, doors, chimney, etc) The facility has an operational carbon monoxide detector and fire extinguisher which meet established standards. Although the fire extinguisher is on status green, the LPA advised to have Fire Department officials check it out, so that an inspection data sheet can be placed on it.

There are no stairs in the home. Poisons, detergents, cleaning compounds, medicines, firearms (no fire arms at this facility) and other items which could pose a danger if readily available to children are stored where they are locked and inaccessible to children. The facility has a written disaster plan of action prepared. All children, age and ability permitting, and the provider, the assistant provider, and other members of the household, have been instructed in their duties under the disaster plan. Newly enrolled children are informed promptly of their duties as required in the emergency plan. Fire drills and disaster drills are conducted at least once every six months and/or more often, the licensee document the drills, including the date and time of each drill. There are no baby walkers in the facility.

Smoking is prohibited on the premises of a family child care home. There are no infants in care. Nonetheless, the LPA provided a copy of the recently approved safe sleep regulations information and PIN 20-21-CCP.

The Facility does not have any bodies of water. The outside back yard is the play area for the children in care and is free of hazards. It is properly fenced and contains age appropriate toys. When the children are in the play yard they are supervised by one of Mr. or Mrs. Juarez.

SUPERVISOR'S NAME: Scott Herring	TELEPHONE: (661) 202-3314
LICENSING EVALUATOR NAME: Esequiel Rodriguez	TELEPHONE: (661) 202-3321
LICENSING EVALUATOR SIGNATURE:	DATE: 06/10/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/10/2022

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

FACILITY NAME: JUAREZ, ZEFERINO & YOLANDA FAMILY CHILD CARE	FACILITY NUMBER: 153909341
	VISIT DATE: 06/10/2022

NARRATIVE

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Per Mr. Juarez, one of them or both are present in the home during child care time and ensure all children in care are supervised at all times. When circumstances requires her to be temporarily absent from the home, she arranges for a substitute adult to care for and supervise the children during her absence. Per Licensee, her temporary absences does not exceed 20 percent of the hours that the facility is providing care per day. Licensee states that when a child shows signs of illness he/she shall be separated from other children, and the nature of the illness is determined. If it is a communicable disease he/she shall be separated from other children until the infectious stage is over.

The licensee has completed or renewed the required mandated reporter training and is current with all required vaccines. The Licensee and other persons associated to the facility have obtained appropriate clearance or a criminal record exemption as required by the Department. The licensee completed training on preventive health practices, including pediatric cardiopulmonary resuscitation and pediatric first aid.

Licensee is aware of the requirement to report unusual incidents and/or injuries to the parent/guardian and Licensing within 24 hours of incident by telephone and in writing within 7 day of incident on the form LIC624B.
The report unusual incident/injuries report should be emailed to unusualIncidentReport@dss.ca.gov.

Personnel records are maintained on the licensee and contain the following information:
Licensee full name. A signed and dated copy of the Notice of Employee Rights [LIC 9052,] A signed statement regarding their criminal record history, LIC 508. Driver's license number if the employee is to transport children. Date of employment. Date of birth. Current home address and phone number. Documentation of completion of training on preventative health practices as required by Section 102416(c). Licensee and other adults living in the home or working at the facility have received criminal record clearance and association.

There is an emergency information card maintained for each child in care, including the child's full name, telephone number and location of a parent or other responsible adult to be contacted in an emergency, the name and telephone number of the child's physician and the parent's authorization for the licensee or registrant to consent to emergency medical care.

SUPERVISOR'S NAME: Scott Herring	TELEPHONE: (661) 202-3314
LICENSING EVALUATOR NAME: Esequiel Rodriguez	TELEPHONE: (661) 202-3321
LICENSING EVALUATOR SIGNATURE:	DATE: 06/10/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/10/2022

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

FACILITY NAME: JUAREZ, ZEFERINO & YOLANDA FAMILY CHILD CARE	FACILITY NUMBER: 153909341
	VISIT DATE: 06/10/2022

NARRATIVE

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Per Licensee, prior to admission the children are immunized with required vaccines, and it documents on each child's record. The immunization record is maintain such documentation for as long as the child is enrolled. The record maintain to keep track of immunization is the PM 286 (CDPH 286) Copy of the notice Family Child Care Home Notification of Parent's Rights, LIC 995A; the Caregiver Background Check Process, LIC 995E, and the Family child Care Consumer Awareness Information, LIC 9212 are provided to the parents. The licensee maintain, in each child's record, the signed and dated notice form required, including, a copy of an emergency information card.

Licensee is aware that in the child’s record, a copy of documentation verifying the child’s enrollment and attendance at kindergarten, including transitional kindergarten, or elementary school. The facility has a current roster of children. Children records contain the bottom portion of the, signed and dated, notice form LIC 995A.,There is proof that the parent or authorized representative has been notified of his or her rights and received a copy of the Caregiver background Check Process, LIC995E, and the Family Child Care Consumer Awareness Information, LIC 9212. PUB 394 (8/02), Family Child Care Home Notification of Parents’ Rights Poster is posted and the parents have been informed that the Facility does not carry liability insurance or a bond according to standards established by the state. At the time of acceptance of each child into care, the licensee child's parent or authorized representative receive a copy of the notice Family Child Care Home Notification of Parent's Rights, LIC 995A, the Caregiver Background Check Process, LIC 995E (6/05), and the Family child Care Consumer Awareness Information, LIC 9212 (10/05).

Licensee stated that she is present in the home all the time when children are present, and ensure the children are properly supervised at all times. Licensee stated that facility does not provides transportation for day care children. Licensee is aware of the capacity stated on the facility license. The maximum number of children for whom care may be provided at any one time is eight.

Per Licensee, each child receiving services at the Facility are treated with dignity and respect. They are provided with safe, healthful, and comfortable accommodations, furnishings, and equipment. There is no corporal or unusual punishment of any kind, infliction of pain, humiliation, intimidation, ridicule, coercion, threat, mental abuse, or other actions of a punitive nature, including, but not limited to: interference with eating, sleeping or toileting; or withholding shelter, clothing, medication or aids to physical functioning.

SUPERVISOR'S NAME: Scott Herring	TELEPHONE: (661) 202-3314
LICENSING EVALUATOR NAME: Esequiel Rodriguez	TELEPHONE: (661) 202-3321
LICENSING EVALUATOR SIGNATURE:	DATE: 06/10/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/10/2022

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

FACILITY NAME: JUAREZ, ZEFERINO & YOLANDA FAMILY CHILD CARE	FACILITY NUMBER: 153909341
	VISIT DATE: 06/10/2022

NARRATIVE

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The LPA informed the provider that CCLD will continue to evaluate and research the effects and efficiency of the new inspection tools. To implement this continuous quality improvement process, CCLD requests that licensees participate in a short survey relating to their experiences with the CARE tool. The licensee was told that she may receive a link to the survey after each completed inspection. Participation is voluntary, and all responses will be kept confidential.

To assist with the implementation of policies related to provisions of Incidental Medical Services (IMS) the LPA explained that PIN 22-02-CCP provides information and best practices for administering Incidental Medical Services (IMS) in licensed Family Child Care Homes (FCCHs) During the inspection process, the Licensee obtained copy of PIN 22-02-CCP.

LPA encouraged licensee to become familiar with the CARE Tools and inspection processes by periodically visiting the Inspection Process Project and CARE Tools Website. The page will be updated regularly with information related to the new tools and related documents:
https://www.cdss.ca.gov/inforesources/community-care-licensing/inspection-process.

Overall, the Facility is in compliance per Title 22 regulations. During today's inspection the LPA observed no deficiencies that may hinder the health and safety of the children in care. Therefore, no deficiencies were cited

An exit Interview was conducted and a copy of this Report, Children's Record Review form (LIC 857) Review of Staff Records form (LIC 859) Notice of Site Visit (IC 9213) were provided to Licensee.

SUPERVISOR'S NAME: Scott Herring	TELEPHONE: (661) 202-3314
LICENSING EVALUATOR NAME: Esequiel Rodriguez	TELEPHONE: (661) 202-3321
LICENSING EVALUATOR SIGNATURE:	DATE: 06/10/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/10/2022

LIC809 (FAS) - (06/04)

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