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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197415454
Report Date: 05/31/2024
Date Signed: 05/31/2024 12:20:12 PM


Document Has Been Signed on 05/31/2024 12:20 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
MONTEREY PARK SW RO, 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: 2DATE:
05/31/2024
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
10:10 AM
MET WITH:Rosa RiveraTIME COMPLETED:
12:45 PM
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On 5/31/24 at 10:10 AM/PM Licensing Program Analysts (LPA) Claudia Kam conducted an Unannounced Required 1 year Annual inspection to the above facility. LPA disclosed the purpose of the inspection and met with Licensee, Rosa Rivera who guided the LPA on a tour of the facility.

There are 2 adult living in the home. All adults in the home were found to have criminal record clearance. There were 2 day care children present during today’s inspection. Licensee states that there are currently 7 children enrolled. The children's roster was reviewed and is current. Licensee reports that the facility’s hours of operation are 24 hours, Monday thru Sunday. Emergency Disaster Plan, License, and Parents’ Rights were posted at the time of inspection. Per Licensee, disaster drill was last conducted on 7/22/2023.

This is a single-story home which consists of three bedrooms and two bathroom, kitchen, front living room, back living room, back yard. Areas used by the children include the back living room, bathroom, and kitchen area for dining. There is a child size table and chairs in the kitchen for the children. All cabinets have locks on the doors and drawers. Per Licensee, areas off limits to children and parents include the bedrooms master bathroom, front living room and back house. LPA observed that there is a wooden gate at the back house making it inaccessible to children in care at time of inspection and is used for storage. The kitchen is within limit during meal time only and there is a baby gate separating the back living room child care area to make it inaccessible when it is not meal time. Per licensee, off limit bedrooms are locked during operating hours, LPA observed doors to be locked.

All areas identified on the facility sketch as accessible to children were inspected to ensure that they are clean and orderly with ventilation and heating for the safety of the children. Main Care Area for day care children will be the back living room and bathroom off the kitchen for which the children are escorted. Main Care Area is located at the back of the house and a side door provides access to the back yard for outdoor play which is kept locked. LPA observed side door locked at time of inspection. There is a working telephone maintained in the home, land line and cell phone.
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SUPERVISOR'S NAME: Denise GibbsTELEPHONE: (323) 981-3385
LICENSING EVALUATOR NAME: Claudia KamTELEPHONE: (626) 602-6842
LICENSING EVALUATOR SIGNATURE:
DATE: 05/31/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/31/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 7


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MONTEREY PARK SW RO, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME: RIVERA FAMILY CHILD CARE
FACILITY NUMBER: 197415454
VISIT DATE: 05/31/2024
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LPA observed yard has adequate perimeter fencing through-out the property. LPA observed the back and side yard to be free of loose and sharp parts available for the children in the yard and all trees, shrubs and plants are maintained and fenced off. The play area has concrete flooring and was observed to be in good repair. It was observed to be equipped with a toy house, wooden blocks and tricycles. Shade is provided to the children from a large tent covering the side yard that shades the patio area.

The valve on the required 2A 10BC fire extinguisher indicates fully charged, and was last inspected and tagged by the fire department on 5/30/24. LPA checked Smoke and carbon monoxide detectors were tested and found to be in operable condition at time of inspection. LPA observed First Aid kit kept on shelf in Main Care Area and was inventoried for necessary supplies. Licensee provided proof of immunization against influenza, pertussis, and measles during today’s inspection. Licensee has current mandated reporter training with an expiration date of 5/1/23.
—CPR Card valid until: 4/2026
—Children records and required licensing forms were discussed as well as mandated child abuse reporting and criminal record clearance requirement.

Per Licensee, there are no weapons, firearms in the home and there are no bodies of water around the premises. LPA did not observe any bodies of water around the premises at time of inspection. Per licensee, they provide food for children in care. Food preparation area was toured and found in compliance for safety, cleanliness, and proper storage.

LPA reviewed with licensee the LIC 311D, Forms/Records to Keep In Your Family Child Care Homes, children’s forms/records, facility forms/records, and information to be posted. LPA provided licensee with a packet entailing each form needed. Entrance Checklist was provided to the licensee.

The following were discussed:



To improve the quality and value of the new inspection process, a survey may 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 CARE tools, please send email inquiries 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.

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SUPERVISOR'S NAME: Denise GibbsTELEPHONE: (323) 981-3385
LICENSING EVALUATOR NAME: Claudia KamTELEPHONE: (626) 602-6842
LICENSING EVALUATOR SIGNATURE:

DATE: 05/31/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/31/2024
LIC809 (FAS) - (06/04)
Page: 2 of 7
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MONTEREY PARK SW RO, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME: RIVERA FAMILY CHILD CARE
FACILITY NUMBER: 197415454
VISIT DATE: 05/31/2024
NARRATIVE
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Licensee Rosa Rivera was reminded that all adults 18 and over living or working in the home, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, 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 for a maximum of 5 days or, if the penalty is for a repeat violation, for a maximum of 30 days per person will be assessed if this regulation is violated.

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.



Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02-CCP. 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: https://www.ada.gov/resources/child-care-centers/.

Licensee was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain child care by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.

During the exit interview, the Licensee Rosa Rivera, confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS.

Based on this information the following deficiencies on the LIC 809 D are being cited today 05/31/24.

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SUPERVISOR'S NAME: Denise GibbsTELEPHONE: (323) 981-3385
LICENSING EVALUATOR NAME: Claudia KamTELEPHONE: (626) 602-6842
LICENSING EVALUATOR SIGNATURE:

DATE: 05/31/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/31/2024
LIC809 (FAS) - (06/04)
Page: 3 of 7
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MONTEREY PARK SW RO, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME: RIVERA FAMILY CHILD CARE
FACILITY NUMBER: 197415454
VISIT DATE: 05/31/2024
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LPA Claudia Kam informed licensee Rosa Rivera that this report dated 5/31/24 documents 3 Type B violations that present potential risks to the health, safety, or personal rights of children in care and a technical violation.

Also, LPA Claudia Kam discussed all violations and Plan of Correction completed in partnership with the licensee.

A notice of site visit was given and must remain posted for 30 days.

Exit interview conducted and report was reviewed with the licensee Rosa Rivera.

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SUPERVISOR'S NAME: Denise GibbsTELEPHONE: (323) 981-3385
LICENSING EVALUATOR NAME: Claudia KamTELEPHONE: (626) 602-6842
LICENSING EVALUATOR SIGNATURE:

DATE: 05/31/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/31/2024
LIC809 (FAS) - (06/04)
Page: 4 of 7
Document Has Been Signed on 05/31/2024 12:20 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MONTEREY PARK SW RO, 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: 05/31/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102425(b)
Infant Safe Sleep
(b) Cribs or play yards shall be free from all loose articles and objects.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, the licensee did not comply with the section cited above which poses/posed a potential health, safety or personal rights risk to persons in care. Child was observed sleeping in the play yard with a blanket and stuffed doll.
POC Due Date: 05/31/2024
Plan of Correction
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At time of visit licensee removed the blanket and stuffed doll from the play yard. POC cleared on 5/31/24
Type B
Section Cited
CCR
102416.1(a)
Personnel Records
(a) Personnel records shall be maintained on each employee and shall contain the following information:

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation and record review, the licensee did not comply with the section cited above which poses a potential health, safety or personal rights risk to persons in care. Employee does not have employee documents. Employee has Guardian clearance, mandated reporter and cpr/first aid only.
POC Due Date: 06/28/2024
Plan of Correction
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Licensee will collect needed documents from employee or notify department if she will be dismissed as per licensee she has not been called as of late.
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: Denise GibbsTELEPHONE: (323) 981-3385
LICENSING EVALUATOR NAME: Claudia KamTELEPHONE: (626) 602-6842
LICENSING EVALUATOR SIGNATURE:
DATE: 05/31/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/31/2024
LIC809 (FAS) - (06/04)
Page: 5 of 7


Document Has Been Signed on 05/31/2024 12:20 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MONTEREY PARK SW RO, 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: 05/31/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
HSC
1597.622(a)(1)
General Provisions and Definitions
(1) 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.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, interview with licensee and record review, the licensee did not comply with the section which poses a potential health, safety or personal rights risk to persons in care. No vaccinations for employee available at time of inspection.
POC Due Date: 06/28/2024
Plan of Correction
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Licensee will collect or inform the department if she will no longer be employed.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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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: Denise GibbsTELEPHONE: (323) 981-3385
LICENSING EVALUATOR NAME: Claudia KamTELEPHONE: (626) 602-6842
LICENSING EVALUATOR SIGNATURE:
DATE: 05/31/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/31/2024
LIC809 (FAS) - (06/04)
Page: 6 of 7