191609404-10-18-2022-54-CC-SSAZ-CKBU46-20221018151436

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 191609404
Report Date: 10/18/2022
Date Signed: 10/18/2022 03:14:49 PM

Document Has Been Signed on 10/18/2022 03:14 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, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME:	RUIZ-CHAVARIN FAMILY CHILD CARE		FACILITY NUMBER:	191609404
ADMINISTRATOR:	CONCEPCION RUIZ CH.		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(424) 406-2106
CITY:	CARSON	STATE: CA	ZIP CODE:	90746
CAPACITY:	12	CENSUS: 5	DATE:	10/18/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	01:00 PM
MET WITH:	Concepcion Ruiz Chavarin, Licensee		TIME COMPLETED:	03:35 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	THIS REPORT WAS CONDUCTED IN SPANISH Licensing Program Analyst (LPA) Susann Sanchez made an attempted visit on 10/18/2022 at 9:45am. LPA did not hear children or observe any cars in the driveway. LPA called and spoke to Licensee Concepcion Ruiz-Chavarin, who stated the facility is open but is out of the facility at the moment and will be back in 20 minutes. LPA returned at 1:00pm, and met with Licensee outside of the facility and was with 2 children. Licensee informed LPA that she will be back in 10 minutes and has to pick up school aged children from across the street. LPA informed Licensee the purpose of inspection was to conducted a required annual inspection on this date. LPA provided the inspection Entrance Checklist, LIC 126. Licensee returned at 1:30pm and give Licensee provided tour of facility. LPA inspected rooms/areas on the facility sketch in which child-care services are provided and to which children have access. Per licensee the hours of operation are Monday-Friday 6:00am-5:00pm. LPA provided consult at 1:00pm regarding overnight care. Licensee stated that she has parents interested in overnight care. LPA discussed overnight care regulation. This is a one-story home which consists of 3 bedrooms, 2 bathroom, kitchen, dining area, living room, daycare room, garage, side yard, front yard and backyard (fenced). The children use the bathroom in the hallway, living room, day care room, kitchen, dining room, and backyard. Per licensee, areas off limits to children and parents include: all the bedrooms, garage, side yard, and front yard. The licensee provides food for children in care.

SUPERVISOR'S NAME: Valarie Cook	TELEPHONE: (323) 513-3858
LICENSING EVALUATOR NAME: Susann Sanchez	TELEPHONE: (323) 981-3366
LICENSING EVALUATOR SIGNATURE:	DATE: 10/18/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/18/2022

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, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME: RUIZ-CHAVARIN FAMILY CHILD CARE	FACILITY NUMBER: 191609404
	VISIT DATE: 10/18/2022

NARRATIVE

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All adults present have obtained the required Background Clearance. Individuals residing in the home were discussed and noted

All areas identified on the facility sketch that are accessible for children to use were inspected for safety, comfort, and cleanliness. The following was observed and reviewed during this inspection:

LPA observed required posted documentation in facility entrance which included: Facility License, Publication (PUB) 394- Notification of Parent Rights and Licensing Form (LIC) 9148- Earthquake Preparedness form. LPA observed completed facility records including; LIC 9040- Facility Roster, LIC 610- Facility Disaster Plan.

Consult was given at 1:50pm to 2:10pm regarding retirement and surrendering license. Licensee is still not sure if she wants to remain open in 2023.

An additional child arrived at 2:00pm by bus.

Smoke and carbon monoxide detectors were tested and are operable. Fire extinguisher indicated fully charged. Licensee was reminded that fire extinguisher needs to be serviced yearly. The home maintains telephone service via cell phone. The home is observed to be clean and orderly. LPA observed that detergents, cleaning compounds are in the kitchen inaccessible to children. Licensee states that there are no poisons stored in the home and understands that all poisons must be lock, not only inaccessible to children. Isolation area for sick children waiting to be picked up is in living room, away from the other children. Per Licensee there are no firearms or weapons stored in the home. Licensee has a small dog that is kept inaccessible to children in care.
The bathroom that children use is located in the hallway observed to be clean and free of hazards.

Currently, children are using the back yard for outdoor play. The outdoor play area was observed to be fenced. LPA observed that the outdoor yard has toys and other materials for children to play with. LPA did not observe any objects that could be hazardous to children in care. The facility has no bodies of water on the premises

Staff records were reviewed for approved Pediatric First Aid and CPR certification which expires on 08/27/23, LIC-501: Personnel Record, LIC 508-Criminal Record Statement, LIC 9052- Employee Rights, Proof of immunizations against measles, pertussis and influenza or influenza declination, TB clearance or risk assessment, LIC 9108- Statement Acknowledging Requirement to Report Child Abuse and current Mandated Reporter Training Certificate and expires on 09/04/23.

SUPERVISOR'S NAME: Valarie Cook	TELEPHONE: (323) 513-3858
LICENSING EVALUATOR NAME: Susann Sanchez	TELEPHONE: (323) 981-3366
LICENSING EVALUATOR SIGNATURE:	DATE: 10/18/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/18/2022

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, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME: RUIZ-CHAVARIN FAMILY CHILD CARE	FACILITY NUMBER: 191609404
	VISIT DATE: 10/18/2022

NARRATIVE

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Children’s records were reviewed for (LIC) 282- Affidavit Regarding Liability Insurance, Immunization's Records, LIC 700- Identification and Emergency Information, LIC 627- Consent for Medical Treatment, LIC 995A Notification of Parents’ Rights, and documentation of 15-minute Infant Sleep Check (0-24 months) a sample was given and explained.

LPA informed licensee of the new Safe sleep regulations, including LIC 9227 Infant Sleep Plan for infants under 12 months, 15-minute sleep check documentation for infants 0-24 months, and provided PIN 20-24-CCP. LPA provided Technical Assistance to licensee and staff. LPA discussed the safe sleep regulations with licensee 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 licensee 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.

Licensee was reminded that 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 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.

LPA reminded licensee to ensure they are aware of any new COVID-19 precautions and procedures.

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

To improve the quality and value of the new inspection process, a survey will be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or tools, please send them by email to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/inspection-process.

SUPERVISOR'S NAME: Valarie Cook	TELEPHONE: (323) 513-3858
LICENSING EVALUATOR NAME: Susann Sanchez	TELEPHONE: (323) 981-3366
LICENSING EVALUATOR SIGNATURE:	DATE: 10/18/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/18/2022

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, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME: RUIZ-CHAVARIN FAMILY CHILD CARE	FACILITY NUMBER: 191609404
	VISIT DATE: 10/18/2022

NARRATIVE

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Per Licensee, there is a big dog in the facility, but keeps dog away from children during operating hours.

LPA advised the licensee how to access forms, regulations and quarterly updates on line at: www.ccld.ca.gov

Any unusual incidents or injuries must be reported to the Department within 24 hours via telephone and within seven (7) days in writing. (use LIC624B for written report). Licensees shall reveal each facility license number in all advertisements, publications, or announcements made with the intent to attract clients.

Based on the LPA observations and records review there are no deficiencies cited.

The Notice of Site Visit (LIC 9213) – must remain posted for 30 days during the hours of operation after each site visit made by a licensing representative. Failure to maintain posting as required will result in a civil penalty of $100.00. Exit interview was conducted with licensee. Appeal Rights were given and explained in Spanish.

SUPERVISOR'S NAME: Valarie Cook	TELEPHONE: (323) 513-3858
LICENSING EVALUATOR NAME: Susann Sanchez	TELEPHONE: (323) 981-3366
LICENSING EVALUATOR SIGNATURE:	DATE: 10/18/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/18/2022

LIC809 (FAS) - (06/04)

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