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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198005762
Report Date: 11/21/2019
Date Signed: 11/21/2019 04:45:30 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:RIVAS FAMILY CHILD CAREFACILITY NUMBER:
198005762
ADMINISTRATOR:RIVAS, IRMAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(424) 351-5536
CITY:LYNWOODSTATE: CAZIP CODE:
90262
CAPACITY:14CENSUS: 7DATE:
11/21/2019
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
03:46 PM
MET WITH:Irma Rivas, Licensee TIME COMPLETED:
05:00 PM
NARRATIVE
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 THIS VISIT WAS CONDUCTED IN SPANISH
Licensing Program Analysts (LPAs) Rita Ramos and Monique Ayala conducted an unannounced case management inspection to the above facility. LPAs met with Irma Rivas, Licensee, who guided analyst on a tour of the facility. Also present was Diana Rivas, Licensee's Assistant. There were 7 children present upon arrival.

During this inspection LPAs observed that Child #1 was asleep in a stroller and Child #2 was sitting and playing inside a baby saucer. These pose an immediate health and safety risk to children in care.

In addition, LPAs observed that the Licensee had ant poison stored on the floor of an unlocked room in the yard. This also poses an immediate health and safety risk to children in care. Licensee was reminded that all poisons need to be locked under key or combination lock.

LPAs provided Licensee with the Child Care Provider’s Guide to Safe Sleep, by American Academy of Pediatrics and Helping you to reduce the risk of SIDS, and Safe Sleeping practices.

LPAs observed that the facility sketch provided by the Licensee does not match with the set-up of the home. Per Licensee, a new room was built 10 months ago and the garage was converted to a room and the new room is now a garage.

LPAs further advised the Licensee to make sure that all the off-limits areas, although closed, should be locked to ensure that they are inaccessible to children in care.

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SUPERVISOR'S NAME: Brandi VanOostenTELEPHONE: (323) 981-3365
LICENSING EVALUATOR NAME: Rita RamosTELEPHONE: (323) 981-3985
LICENSING EVALUATOR SIGNATURE:

DATE: 11/21/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/21/2019
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: RIVAS FAMILY CHILD CARE
FACILITY NUMBER: 198005762
VISIT DATE: 11/21/2019
NARRATIVE
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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.

The Notice of Site Visit (LIC 9213) – must remain posted for 30 days during the hours of operation after each site visit by a licensing representative. Failure to maintain posting as required will result in a civil penalty of $100.00. Exit interview was conducted with Irma Rivas, Licensee, including, but not limited to Provider Rights, Appeal Procedures and Agencies Consultative Role.

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SUPERVISOR'S NAME: Brandi VanOostenTELEPHONE: (323) 981-3365
LICENSING EVALUATOR NAME: Rita RamosTELEPHONE: (323) 981-3985
LICENSING EVALUATOR SIGNATURE:

DATE: 11/21/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/21/2019
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: RIVAS FAMILY CHILD CARE
FACILITY NUMBER: 198005762
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/21/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
11/22/2019
Section Cited

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Personal Rights

To receive safe, healthful, and comfortable accommodations, furnishings, and equipment.

This requirement is not met as evidenced by
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LPA observing that Child #1 was asleep in a stroller and Child #2 was sitting and playing inside a saucer. This poses an immediate health and safety risk to children in care.
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Type A
11/22/2019
Section Cited

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Operation of a Family Child Care Home

Storage areas for poisons, firearms and other dangerous weapons shall be locked.

This requirement is not met as evidenced by LPAs observing that there is ant poison stored in the unlocked room in the yard.
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This poses an immediate health and safety risk to 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: Rita RamosTELEPHONE: (323) 981-3985
LICENSING EVALUATOR SIGNATURE:
DATE: 11/21/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/21/2019
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: RIVAS FAMILY CHILD CARE
FACILITY NUMBER: 198005762
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/21/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
11/21/2019
Section Cited

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Alterations to Existing Buildings or Grounds
Prior to making alterations or additions to a family child care home or grounds, the licensee shall notify the Department of the proposed changed
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This requirement is not met as evidenced by LPAs observing that there are room additions and room changes that do not align to the facility sketch provided. Licensee admitted that there was a room addition and rooms were rearranged. This poses a potential health and safety risk to children in care.
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Type B
12/05/2019
Section Cited

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Operation of a Family Child Care Home

The home shall be free from defects or conditions which might endanger a child.

This requirement is not met as evidenced by LPAs observing that the mirror above the sink in the restroom that children use is
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broken. The Licensee placed tape over it to try to prevent it from collapsing. This poses a potential health and safety risk to 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: Rita RamosTELEPHONE: (323) 981-3985
LICENSING EVALUATOR SIGNATURE:
DATE: 11/21/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/21/2019
LIC809 (FAS) - (06/04)
Page: 4 of 4