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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 157700060
Report Date: 12/31/2021
Date Signed: 12/31/2021 02:04:59 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:RIVAS FAMILY CHILD CAREFACILITY NUMBER:
157700060
ADMINISTRATOR:AIDA RIVASFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(661) 809-5834
CITY:ARVINSTATE: CAZIP CODE:
93203
CAPACITY:14CENSUS: 0DATE:
12/31/2021
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
11:46 AM
MET WITH:Aida RivasTIME COMPLETED:
02:00 PM
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On 12/31/2021 at 11:55 a.m., Licensing Program Analysts (LPA) Isabel Ortega conducted announced prelicensing inspection for the purpose of conducting Family Child Care Home. LPA was greeted by applicant, Aida Rivas who guided the LPA on a tour of the facility.

Applicant will operate Monday through Saturday from 5:00 a.m. to 6:00 p.m. The Applicant will provide breakfast, snack, lunch, afternoon snack and dinner as needed. Applicant plans to enroll in a Food Nutrition program.



This is a one-story family home which consist of three-bedrooms, two bathrooms, a kitchen, dining room, living room, a den and a detached garage that is maintained locked LPA observed a child safety knob. The den will be the primary location in which care is provided. Children will utilize the bathroom located to the left from the main entrance of the home. The back yard is gated all around, the detached garage is utilized for storage and maintained locked. The back yard will be utilized for outside play. There is a pool on the premises which meets Title 22 regulation (off limits). The off-limit areas include the three bedrooms, one restroom, detached garage (maintained locked with a child safety knob and key locked). LPA observed a child safety gate located at the entrance of the den and a door alarm leading to the backyard.
SUPERVISOR'S NAME: Carissa BellTELEPHONE: (661) 202-3359
LICENSING EVALUATOR NAME: Isabel OrtegaTELEPHONE: (661) 202-3786
LICENSING EVALUATOR SIGNATURE:

DATE: 12/31/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/31/2021
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: RIVAS FAMILY CHILD CARE
FACILITY NUMBER: 157700060
VISIT DATE: 12/31/2021
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The home was inspected inside and out for safety, comfort, cleanliness, service, heating and center air ventilation. The home has age appropriate toys, play equipment and materials. Applicant stores sharp knives in the kitchen in a drawer (LPA observed a child safety latch), medication is stored inaccessible to children. Cleaning supplies and chemicals are stored in the kitchen under the sink and maintained locked with a child safety latch. Applicant has a complete First Aid Kit in the home, which is stored inaccessible to children. Children will be provided with cots for nap time.

There is an underground pool on the premises which is off limits and is inaccessible to children. Gate is 5 feet in height and meets Title 22 regulations. Applicant was reminded about ensuring proper care and visual supervision at all times.


LPA observed a fire extinguisher (2A10BC) that meets the State Fire Marshal standards (reading in green). Applicant tested the smoke detector and carbon monoxide detector at 12:15 p.m. and they were found to be in operable condition. The heater has a child safety gate barricaded). Per applicant, there are no weapons or firearms in the home, nor did LPA observe any weapons or firearms during the inspection.

The applicant’s Pediatric CPR/First Aid expires on 6/21/23. The 8-hour Preventative Health and Safety Certification that includes Child Nutrition and Lead Poisoning Prevention was completed on 5/20/2018. The applicant had the required immunizations against pertussis (Tdap), measles (MMR), and tuberculosis (TB). The Mandated Reporter training was completed on 6/22/2021. Family Child Care Orientation was completed 3/20/2018.
SUPERVISOR'S NAME: Carissa BellTELEPHONE: (661) 202-3359
LICENSING EVALUATOR NAME: Isabel OrtegaTELEPHONE: (661) 202-3786
LICENSING EVALUATOR SIGNATURE:

DATE: 12/31/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/31/2021
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: RIVAS FAMILY CHILD CARE
FACILITY NUMBER: 157700060
VISIT DATE: 12/31/2021
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Licensee will have the parent board and other Licensing required forms at the entrance of the home, visible to parents.
The following was discussed with applicants:
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 applicant was advised to utilize the Request for Live Scan Service form LIC9163 to have adults fingerprinted and associated to the home.


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.
SUPERVISOR'S NAME: Carissa BellTELEPHONE: (661) 202-3359
LICENSING EVALUATOR NAME: Isabel OrtegaTELEPHONE: (661) 202-3786
LICENSING EVALUATOR SIGNATURE:

DATE: 12/31/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/31/2021
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: RIVAS FAMILY CHILD CARE
FACILITY NUMBER: 157700060
VISIT DATE: 12/31/2021
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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.

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

SUPERVISOR'S NAME: Carissa BellTELEPHONE: (661) 202-3359
LICENSING EVALUATOR NAME: Isabel OrtegaTELEPHONE: (661) 202-3786
LICENSING EVALUATOR SIGNATURE:

DATE: 12/31/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/31/2021
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: RIVAS FAMILY CHILD CARE
FACILITY NUMBER: 157700060
VISIT DATE: 12/31/2021
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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/subscribe

The following was provided to the licensee by via mail. All licensing forms required in children's files; All licensing forms required in the facility; All licensing forms to be posted in the home; Fire and Disaster Drill log; California Car Seat Flyer; Safe Sleep Flyer; Parent Notification Requirements; and Safe Sleep-in Child-Care brochure; and additional resources for the applicant and her Family Child Care Home.



Licensee has met Title 22 regulations; The Fire clearance was granted 8/12/2021. Therefore, large Family Child Care Home License capacity of 14 children is granted effective Monday 1/03/2022.

An exit interview was conducted, and a copy of this report was provided to applicant 12/31/21. All Licensing reports are recommended to be kept on file for minimum three years.
SUPERVISOR'S NAME: Carissa BellTELEPHONE: (661) 202-3359
LICENSING EVALUATOR NAME: Isabel OrtegaTELEPHONE: (661) 202-3786
LICENSING EVALUATOR SIGNATURE:

DATE: 12/31/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/31/2021
LIC809 (FAS) - (06/04)
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