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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198006960
Report Date: 07/15/2022
Date Signed: 07/15/2022 12:20:51 PM


Document Has Been Signed on 07/15/2022 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
CCLD Regional Office, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754



FACILITY NAME:PEREZ FAMILY CHILD CAREFACILITY NUMBER:
198006960
ADMINISTRATOR:PEREZ, MARTHAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(562) 686-1707
CITY:WHITTIERSTATE: CAZIP CODE:
90605
CAPACITY:14CENSUS: 3DATE:
07/15/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
08:35 AM
MET WITH:Martha Perez, LicenseeTIME COMPLETED:
12:30 PM
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At 8:35 am Licensing Program Analyst (LPA) Lilli Babcock conducted an unannounced required 1-year inspection to the above facility. A COVID risk assessment was conducted upon entry and appropriate PPE was used. LPA met with Licensee, Martha Perez, to whom the reason for the visit was explained. Per Licensee, there are 13 children currently enrolled. There were 3 children present upon arrival. The licensee was observed to be operating within the license capacity limitations.

The licensee states that 2 adults and 1 child currently live in the home. All adults living in the home have obtained a criminal record clearance.

This is a one-story home which consists of 4 bedrooms, 2 bathrooms, living room, dining room, kitchen, detached garage, front yard, and backyard which is fenced.

Per licensee, areas off limits to children and parents include 3 bedrooms, 1 bathroom, kitchen, and front yard. The children have access to dining room, living room, one bedroom, one bathroom, and backyard which is fenced and contains a detached garage used for circle time.

Licensee guided analyst on a tour of the facility at 8:45 am. During this visit, all areas identified on the facility sketch that are accessible for children to use were toured and inspected and the following was observed.
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SUPERVISOR'S NAME: Brandi VanOostenTELEPHONE: (323) 981-3365
LICENSING EVALUATOR NAME: Lilli BabcockTELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:
DATE: 07/15/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/15/2022
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 CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME: PEREZ FAMILY CHILD CARE
FACILITY NUMBER: 198006960
VISIT DATE: 07/15/2022
NARRATIVE
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Facility License, Emergency Disaster Plan, Parent’s Rights Poster, and Earthquake Preparedness Checklist were observed to be posted in the entry way of the home. A current children’s roster was available for review.

There is telephone service via a cellphone and landline. Hours of operation are Monday – Friday, 6:00 am – 6:00 pm. There is ventilation via central air conditioning and heating via a wall heater in the living room that was observed to be screened making it inaccessible to children.

Detergents, cleaning compounds, and medications were observed to be inaccessible to children. Poisons are locked with a key lock in the off-limits kitchen. LPA advised that any poisons should be locked under key or combination lock. Licensee states that there are no firearms or weapons stored in the home.

The valve on the required 2A 10BC fire extinguisher indicates fully charged and was serviced on 1/15/22, as indicated on service tag. Smoke and carbon monoxide detectors were tested and are operable.

All homes shall conduct fire and disaster drills at least once every six months and document the date and time of each drill. Last drill documented was conducted on 5/2/22.

The home is observed to be clean and orderly. There are first aid supplies available. There are age-appropriate toys available for children. Appropriate sleeping arrangements in form of mats and playpens were observed.

Licensee states that she is currently caring for 3 infants. LPA Babcock observed a sleep log for the infants.
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SUPERVISOR'S NAME: Brandi VanOostenTELEPHONE: (323) 981-3365
LICENSING EVALUATOR NAME: Lilli BabcockTELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:

DATE: 07/15/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/15/2022
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 CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME: PEREZ FAMILY CHILD CARE
FACILITY NUMBER: 198006960
VISIT DATE: 07/15/2022
NARRATIVE
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Currently, children are using the back yard for outdoor play time. 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. No bodies of water were observed on this day.

At 9:45 am children’s records were reviewed, including emergency information, and were observed to be complete.

At 10:00 am Licensee records were reviewed, and LPA observed that Licensee does have proof of Mandated Reporter AB 1207 compliant Child Care Training Certificate on file with expiration on 1/19/24. Licensee has completed training on Pediatric First Aid and CPR. The licensee's Pediatric First Aid and CPR expires on 1/17/24. Licensee has proof of pertussis immunization, flu declination and proof of a negative TB test. Licensee is missing proof of Measles immunization.

LPA issued an LIC 857, Children’s Record Review, and LIC 859, Staff Record Review to the licensee which documents staff and children’s files reviewed during this inspection.

There are 2 dogs on the premises. Per licensee, the dogs are kept in off limits areas during daycare hours.

Smoking is prohibited in a licensed Family Child Care Home. Per Licensee, no one smokes in the home.

LPA did not observe the following items during the inspection: Infant Walkers, Johnny Jumpers, trampolines, Saucer Chairs, and/or any other item that fall into these categories are not permitted in a family child care facility.
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SUPERVISOR'S NAME: Brandi VanOostenTELEPHONE: (323) 981-3365
LICENSING EVALUATOR NAME: Lilli BabcockTELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:

DATE: 07/15/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/15/2022
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 CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME: PEREZ FAMILY CHILD CARE
FACILITY NUMBER: 198006960
VISIT DATE: 07/15/2022
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LPA also informed licensee Martha Perez 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 Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226. When any IMS is provided, an updated Plan of Operation that includes 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/process.

Licensee Martha Perez 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.

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

DATE: 07/15/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/15/2022
LIC809 (FAS) - (06/04)
Page: 5 of 6
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 CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME: PEREZ FAMILY CHILD CARE
FACILITY NUMBER: 198006960
VISIT DATE: 07/15/2022
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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.

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

Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

At this time, the licensee is in compliance with
California Code of Regulations Title 22. No deficiencies cited.

Exit interview conducted and report was reviewed with the licensee Martha Perez.

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

DATE: 07/15/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/15/2022
LIC809 (FAS) - (06/04)
Page: 6 of 6