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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197493735
Report Date: 12/19/2019
Date Signed: 12/19/2019 01:48:36 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:VAZQUEZ FAMILY CHILD CAREFACILITY NUMBER:
197493735
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY:8CENSUS: 5DATE:
12/19/2019
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
12:52 PM
MET WITH:Silvias Avalos_Licensee AssistantTIME COMPLETED:
01:57 PM
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Licensing Program Analyst (LPA) Reiko Jones-Modeste conducted an unannounced annual random inspection at the facility listed above. LPA met with Licensee Assistant Silvia Avalos, who guided analyst on a tour of the facility. Upon arrival were Licensee Assistant and five daycare children including one infant. The Licensee Assistant states that four adults currently reside in the home. All adults present in the home have obtained a criminal record clearance or exemption prior to working, residing or volunteering in the licensed child care home. A current children’s roster was not available for review.

This is a one-story home which consists of three bedrooms, one bathroom, kitchen, living room, dining room, front yard and backyard (fenced). The children use the bathroom located in the hallway. The restroom that children use was observed safe and sanitary. Children’s areas include all bedrooms, living room, dining room front yard and back yard. Per Licensee Assistant, areas off limits to children and parents include: the kitchen which was observed inaccessible with a child safety gate.

All areas identified on the facility sketch that are accessible for children to use were inspected for safety, comfort, and cleanliness. There is telephone service via a cellphone which remains at the facility during operating hours. LPA observed a wall heater in the hallway without barricade as the heater is not operable.

The home was observed clean and orderly. There are appropriate toys available for children, free of sharp edges and unbroken. Appropriate sleeping arrangements including mats and a GRACO Pack-n-Play were observed.

Detergents, cleaning compounds, medications, and other items which could pose a danger to children were observed inaccessible to children. The Licensee Assistant states that there are no poisons in the home and understands that storage areas for poisons must be locked with a key or combination lock.
SUPERVISOR'S NAME: Trevino CochranTELEPHONE: (323) 981-3385
LICENSING EVALUATOR NAME: Reiko JonesTELEPHONE: (323) 558-2739
LICENSING EVALUATOR SIGNATURE:

DATE: 12/19/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/19/2019
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 4
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: VAZQUEZ FAMILY CHILD CARE
FACILITY NUMBER: 197493735
VISIT DATE: 12/19/2019
NARRATIVE
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The valve on the required 2A 10BC fire extinguisher indicates fully charged and serviced May 2019 as indicated on service tag. Smoke and carbon monoxide detectors were tested and operable.

Licensee Assistant states that there are no firearms stored in the home. The Licensee Assistant provides food for children in care.

Currently, children use the front yard for outdoor play time. The outdoor play area was observed fenced. LPA observed appropriate toys and equipment used for children. LPA did not observe any objects that can pose a danger to children in the outdoor yard. The Licensee Assistant states that supervision is always provided.

The Licensee Assistant and other personnel have completed training on preventive health practices including Pediatric First Aid and CPR. The Licensee Assistant's Pediatric First Aid and CPR expires May 2021. There are first aid supplies available.

Children’s records were reviewed, including emergency information and were observed incomplete.

The Licensee Assistant provided proof of immunization against influenza, pertussis, and measles.
LPA observed proof of the Mandated Reporter AB 1207 compliant Child Care Training Certificate on file for Licensee Assistant.

All homes shall conduct fire and disaster drills at least once every six months and document the date and time of each drill. LPA observed a Disaster Drill log.



Per Licensee Assistant there are no pets on the premises.

Emergency Disaster Plan, Parent’s Rights Poster and the Facility License were observed and posted.

LPA did not observe the following items during the inspection: Infant Walkers, Johnny Jumpers, Saucer Chairs, and/or any other item that fall into these categories are not permitted in a family child care facility.
Smoking is prohibited in a licensed Family Child Care Home. Per Licensee Assistant no one smokes in the home.
SUPERVISOR'S NAME: Trevino CochranTELEPHONE: (323) 981-3385
LICENSING EVALUATOR NAME: Reiko JonesTELEPHONE: (323) 558-2739
LICENSING EVALUATOR SIGNATURE:

DATE: 12/19/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/19/2019
LIC809 (FAS) - (06/04)
Page: 2 of 4
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: VAZQUEZ FAMILY CHILD CARE
FACILITY NUMBER: 197493735
VISIT DATE: 12/19/2019
NARRATIVE
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Licensee Assistant states that she is currently caring for infants. Licensee states that infants sleep in the living room. Licensee Assistant was advised infants are to sleep in a standard crib only, where they are constantly supervised. LPA discussed with Licensee Assistant the Child Care Provider’s Guide to Safe Sleep to reduce the risk of SUID by American Academy of Pediatrics. LPA also consulted and explained Child Abuse Reporting, Updated Parent’s Rights Poster with Complaint Hotline information, Never Shake a Baby, and Safe Sleeping practices.

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

Based on the LPA’s observations and records review, the following deficiencies listed on the attached LIC 809D (deficiency page) are being cited in accordance with California Code of Regulations Title 22. Deficiencies that are being cited must be cleared to protect the children’s health & safety.

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 Assistant including, but not limited to Appeal Procedures, Site Visit and Initial Appeal Rights.
SUPERVISOR'S NAME: Trevino CochranTELEPHONE: (323) 981-3385
LICENSING EVALUATOR NAME: Reiko JonesTELEPHONE: (323) 558-2739
LICENSING EVALUATOR SIGNATURE:

DATE: 12/19/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/19/2019
LIC809 (FAS) - (06/04)
Page: 3 of 4
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: VAZQUEZ FAMILY CHILD CARE
FACILITY NUMBER: 197493735
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/19/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
12/23/2019
Section Cited

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Facility Roster
(8) Each family child care home shall have a current roster of children as specified in Health and Safety Code Section 1596.841.
This requirement has not been met as evidenced by LPAs observation of no
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facility roster available.

This poses a potential risk 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: Trevino CochranTELEPHONE: (323) 981-3385
LICENSING EVALUATOR NAME: Reiko JonesTELEPHONE: (323) 558-2739
LICENSING EVALUATOR SIGNATURE:
DATE: 12/19/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/19/2019
LIC809 (FAS) - (06/04)
Page: 4 of 4