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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197415454
Report Date: 06/22/2021
Date Signed: 06/22/2021 06:24:39 PM

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:RIVERA FAMILY CHILD CAREFACILITY NUMBER:
197415454
ADMINISTRATOR:RIVERA, ROSAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(323) 293-4839
CITY:LOS ANGELESSTATE: CAZIP CODE:
90062
CAPACITY:14CENSUS: 8DATE:
06/22/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
02:30 PM
MET WITH:Rosa Rivera, LicenseeTIME COMPLETED:
05:30 PM
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On 6/22/21 at 2:30pm Licensing Program Analyst (LPA) Alicia Mooberry conducted an unannounced required inspection. Persons residing in the home were discussed and noted. LPA was met by Rosa Rivera, Licensee who guided LPA on a tour of the home inside. There were 8 children present including 1 infant.
Operating hours of day care are from Monday- Sunday 6am to 6pm. Licensee's daughter/assistant Cindy Rivera arrived at approximately 2:50pm.
Upon entry to the 2:45pm LPA observed that Child #1, a 3 month old-infant was sleeping on the couch face down. Licensee was present and supervising the child. This poses an immediate risk to the health and safety of children in care. LPA discussed Safe Sleep practiced and regulations with licensee. LPA observed that Child #1 has a completed Individual Infant Sleeping Plan (LIC 9227)

The home is a one story single-family house that includes: 4 bedrooms, 2 bathroom, family room, living room, kitchen, laundry space (in kitchen), detached garage, front and back yard (both enclosed).

Off limit areas include: The front yard, 3 bedrooms in the home and one bedroom in the rear of the home.

Area accessible to children are: Living room, bathroom (located in hallway by 3 bedrooms), kitchen, family room (in back of home) is the primary daycare area, backyard (enclosed)



The bedrooms were observed to have safety door knob making inaccessible to children in care.
The First Aid kit was observed on top of cubbies in family room. LPA observed last completed fire drill on 6/21. The home was previously licensed with a jacuzzi in the backyard. The licensee's daughter states the jacuzzi was removed from the premises years ago. Licensee will provide updated facility sketch to include removal of jacuzzi. LPA observed the jacuzzi enclosure is now used as additional storage space.
There are locks in kitchen and bathroom cabinets where cleaning products are stored.
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SUPERVISOR'S NAME: Brandi VanOostenTELEPHONE: (323) 981-3365
LICENSING EVALUATOR NAME: Alicia MooberryTELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:

DATE: 06/22/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/22/2021
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, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME: RIVERA FAMILY CHILD CARE
FACILITY NUMBER: 197415454
VISIT DATE: 06/22/2021
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Per Licensee, there are no weapons or firearms in the home. LPA did not observe any bodies of water on the premises. LPA observed safe toys, play equipment and materials for children in care. Emergency Disaster Plan was posted at the time of inspection. Children’s records were reviewed to ensure that each child has an Identification and Emergency form and were found to be complete. The valve on the required 2A 10BC fire extinguisher indicates service date 5/21/21. Smoke and carbon monoxide detectors were tested and are in operable condition. The Licensee and assistant has current Pediatric First Aid and CPR, which will expire on 1/16/23. Per licensee, here is a dog in the home that stays in the bedroom while children are in care. LPA did not observe the dog during this inspection.

Proof of immunization against influenza, pertussis, and measles for the Licensee and assistant was readily available and current during today's inspection. Licensee has Mandated Reporter Certificate dated 07/25/20.


The following was discussed with the licensee:

· Individuals who are 18 years of age or older living in the home must obtain a criminal record clearance. Individuals within one month of their 18th birthday must be fingerprinted immediately. Failure to obtain a criminal record background check clearances prior to initial presence in the home will result in an immediate $100.00 dollar or more per day Civil Penalty.


· In the absence of the licensee a qualified adult must be present supervising the children; a qualified adult is an individual who has a valid and current adult/infant CPR & Pediatric First Aid certification, TB clearance, immunization, and a valid criminal record clearance associated to the facility license.
· Commencing September 1, 2016, a person shall not be employed or volunteer at a family day care home if he or she has not been immunized against influenza, pertussis, and measles. Each employee and volunteer shall receive an influenza vaccination between August 1 and December 1 of each year. The family day care home shall maintain documentation...in the person’s personnel record that is maintained by the family day care home.
 A current roster of children enrolled must be available and maintained for a period of three years, even after children no longer are attending the facility.
 Annual fees must be paid promptly and by the due date or a late fee shall be assessed and/or the License shall be terminated.
 The fire extinguisher type 2A10BC must be serviced annually or as often as necessary and smoke and carbon monoxide detectors should checked and batteries replaced as needed.
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SUPERVISOR'S NAME: Brandi VanOostenTELEPHONE: (323) 981-3365
LICENSING EVALUATOR NAME: Alicia MooberryTELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:

DATE: 06/22/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/22/2021
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, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME: RIVERA FAMILY CHILD CARE
FACILITY NUMBER: 197415454
VISIT DATE: 06/22/2021
NARRATIVE
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 Changes should be reported to the Department as soon as they occur such as construction, remodeling, telephone number changes and/or if you move from your home.
 Any unusual incidents or injuries must be reported to the Department within 24 hours via telephone and within seven (7) days in writing.
 Fire and safety drills must be performed every six months and documented for review by the Department.
 Smoking is prohibited in a family child care home.
 Children and Staff records must be maintained and updated as needed and must be available for review by the Department.
 Saucer chairs, bouncers, walkers, or any similar items are prohibited.
 All adults living and working in the home shall be made of aware of the Departments right to inspection authority, which includes but not limited to the right to enter the home when children are being cared for, interview children and adults and review documentation.
 Emergency Disaster Plan, Parent’s Rights Poster and the Facility License are required to be posted.

Incidental Medical Services (IMS) policy was discussed. 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

LPA advised the applicant how to access forms, regulations and quarterly updates on the Child Care Licensing website at: https://www.cdss.ca.gov/inforesources/forms-brochures

Per licensee children and staff will wear face coverings in accordance to Department of Health Guidelines. Licensee will ensure children are properly hand washing throughout the day as recommended. LPA observed soap and paper towels in the bathroom as well as hand washing poster for children. Applicant has a supply of cleaning and sanitizing products. Per Applicant high touched areas will be cleaned throughout the day as needed. LPA observed multiple tables in the facility to be used for activities and meals. Tables were spaced apart following social distancing guidelines. LPA observed space in the main care area to socially distance children during nap time.

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SUPERVISOR'S NAME: Brandi VanOostenTELEPHONE: (323) 981-3365
LICENSING EVALUATOR NAME: Alicia MooberryTELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:

DATE: 06/22/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/22/2021
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, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME: RIVERA FAMILY CHILD CARE
FACILITY NUMBER: 197415454
VISIT DATE: 06/22/2021
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LPA provided licensee the new Safe Sleep regulation and provided PIN 20-24-CCP for when Applicant is ready to enroll infants. LPA provided the applicant with a copy of the Child Care Provider’s Guide to Safe Sleep, by American Academy of Pediatrics. Applicant was also advised children shall not be left in parked vehicles at any time.
This facility is being cited today in accordance with Title 22 Regulations.

Whenever a type A is cited: The report and the Notice of Site visit shall be posted for 30 consecutive days. Failure to maintain posting as required, will result in an immediate $100 civil penalty.

A copy of this report shall be provided to the parent/guardian of children currently enrolled by the next business day or immediately upon return. A copy of this report shall also be provided to the parent/guardian of any newly enrolled children for the next 12 months (1 year).

The Acknowledgement form must be maintained in each child’s file immediately upon receipt from parent. Licensee was provided with a copy of the parent Acknowledgement of Receipt of Licensing Reports Form during this visit. A copy of the Parent Notification Requirements was also provided to the licensee

Exit interview was conducted with Rosa Rivera, Licensee, including, but not limited to Appeal Procedures, Site Visit and Initial Appeal Rights.

End of Report

SUPERVISOR'S NAME: Brandi VanOostenTELEPHONE: (323) 981-3365
LICENSING EVALUATOR NAME: Alicia MooberryTELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:

DATE: 06/22/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/22/2021
LIC809 (FAS) - (06/04)
Page: 4 of 5
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: RIVERA FAMILY CHILD CARE
FACILITY NUMBER: 197415454
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/22/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
06/22/2021
Section Cited

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INFANT SAFE SLEEP (a)There shall be one crib or play yard for each infant who is unable to climb out of the crib or play yard. (d)The provider shall place infants up to 12 month of age on their backs for sleeping.

This requirement is not met as evidenced by:
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LPA observed Child #1, a 3 month-old infant, sleeping on the sofa face down. Per licensee, parent wants child to sleep face down.

This poses an immediate threat to the health and safety of children in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Brandi VanOostenTELEPHONE: (323) 981-3365
LICENSING EVALUATOR NAME: Alicia MooberryTELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:
DATE: 06/22/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/22/2021
LIC809 (FAS) - (06/04)
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