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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198008184
Report Date: 08/26/2021
Date Signed: 08/26/2021 02:08:43 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 CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME:MORENO FAMILY CHILD CAREFACILITY NUMBER:
198008184
ADMINISTRATOR:MORENO, AMPAROFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(562) 903-5619
CITY:WHITTIERSTATE: CAZIP CODE:
90605
CAPACITY:14CENSUS: 1DATE:
08/26/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:45 AM
MET WITH:Amparo MorenoTIME COMPLETED:
02:30 PM
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Licensing Program Analyst (LPA) Alanna Gontarek conducted an unannounced annual inspection to the above facility. LPA met with Amparo Moreno, Licensee who guided analyst on a tour of the facility indoors and outdoors. Per Licensee, there are 9 children that are currently enrolled. The Licensee is within the conditions, limitations, and capacity specified on the license. A current children’s roster was available for review. There was 1 napping child present upon arrival. Hours of operation are: Monday to Friday from 6:00 a.m. to 6:00 p.m. LPA observed Licensee and Licensee's Assistant/ daughter wearing face masks due to COVID-19 preventative measures.

This is a one-story home which consists of 3 bedrooms, 2 bathrooms, kitchen, dining room, living room, front yard (fenced) and backyard (fenced). Daycare areas include: Nap Room, one bathroom in the hallway, living room, dining room, daycare room/ classroom, outdoor fenced front yard, and 2 side yards. LPA observed that there is no fireplace. Per Licensee, areas off limits to children and parents include: One bedroom, one master bedroom, one master bathroom (located in Licensee's bedroom), kitchen, and back yard (fenced). The licensee provides fresh perishable and non-perishable food in the home in a quantity to meet the needs of the next 3 meals and between meal snacks.

The licensee states that 2 additional adults and 0 children currently live in the home. Licensee, Licensee's spouse, and Licensee's daughter/Assistant have obtained a criminal record clearance or exemption prior to working or residing in the licensed Child Care home. Licensee states that there are no firearms, or firing pins, stored in the home.

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 land line and cellphone that is used and the cellphone stays at the facility during operation hours.

There is ventilation and heating (central). LPA observed an air conditioning unit located in the daycare room/classroom. Each school age child has individual storage space. LPA observed cubbies located in the daycare/ classroom. LPA observed First Aid supplies in the daycare/ classroom. The following was observed and reviewed during this inspection:
SUPERVISOR'S NAME: Claudia GuangorenaTELEPHONE: (323) 981-8417
LICENSING EVALUATOR NAME: Alanna GontarekTELEPHONE: (323) 854-8644
LICENSING EVALUATOR SIGNATURE:

DATE: 08/26/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/26/2021
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
CCLD Regional Office, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME: MORENO FAMILY CHILD CARE
FACILITY NUMBER: 198008184
VISIT DATE: 08/26/2021
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Detergents, cleaning compounds, medications and other items which could pose a danger to children were observed to be inaccessible to children. LPA observed medications stored in an inaccessible high shelf in the dining room. Per Licensee, cleaning compounds are stored in an upper latched cabinet in the hallway closet. and an inaccessible upper cabinet in the kitchen. LPA observed kitchen to be separated from the daycare areas via a child safety gate. LPA observed knives to be stored on the kitchen counter top in a wooden knife block. Per Licensee, poisons are stored in the hallway closet, made inaccessible by a door cover. At 11:04 a.m., LPA inspected the hallway closet, and observed poisons: 3 Raid cans, Zap-A-Roach Roach and Ant killer Boric Acid, d-CON Bait Station rat poison, AMDRO Ant Killing Bait, and one Hot Shot BedBug and Flea fogger. Pictures were captured LPA advised Licensee, storage areas for poisons must be locked with a key or combination lock. The restroom that children use was observed to be safe and sanitary.
At 11:25 a.m., LPA inspected the valve on the required 2A 10BC fire extinguisher, indicating fully charged, and was last serviced on 10/6/20, as indicated on service tag. At 11:28 a.m., LPA tested the smoke and carbon detector, and both are operable.

The home is observed to be clean and orderly. There are age-appropriate toys available for children. LPA observed toys, and other academic materials located in the daycare/ classroom. Children have individual mats, clean linens, and blankets that are in good repair. LPA observed 4 mats stored in the nap area. Per Licensee, she provides sheets and blankets for the children, and washes the linens every week, or every day as needed. LPA observed 3 Pack N Plays in nap room. Per Licensee, Isolation area is located in the living room.

At 11:30 a.m., LPA inspected the outdoor daycare area. Currently, children are using the front yard and side yards 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. LPA did not observe objects that can pose a danger to children on the outdoor yard. LPA observed a latched gate, separating the side yard from the off-limit backyard. The licensee states that supervision is always provided. LPA obtained a declaration. LPA did not observe bodies of water.

At 1:35 p.m., LPA reviewed records: The licensee does have proof of immunization against influenza, pertussis, and measles. LPA observed that the Licensee and assistant do have proof of immunization record and the Mandated Reporter AB 1207 compliant Child Care Training Certificate on file expiring 5/10/23. The licensee has completed training on preventive health practices including Pediatric CPR and First Aid. The licensee and licensee's Assistant's Pediatric CPR and First Aid expires on 1/18/22. There are first aid supplies available. LPA observed first aid supplies located in daycare area/classroom.
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SUPERVISOR'S NAME: Claudia GuangorenaTELEPHONE: (323) 981-8417
LICENSING EVALUATOR NAME: Alanna GontarekTELEPHONE: (323) 854-8644
LICENSING EVALUATOR SIGNATURE:

DATE: 08/26/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/26/2021
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
CCLD Regional Office, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME: MORENO FAMILY CHILD CARE
FACILITY NUMBER: 198008184
VISIT DATE: 08/26/2021
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Children’s records were reviewed, including emergency information and were observed to be complete.
LPA issued a Confidential Names List (LIC 811) to the licensee which documents Licensee and children’s files reviewed during this inspection.

All homes shall conduct disaster drills at least once every six months, and document the date and time of each drill. Last drill documented was conducted on 7/26/21.

LPA observed no pets on the premises. LPA observed required postings located inside daycare/classroom.
Emergency Disaster Plan, Parent’s Rights Poster and the Facility License were observed to be posted. LPA did not observe the following items during the inspection: Infant Walkers, Johnny Jumpers, Saucer Chairs, Trampolines 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, no one smokes in the home.

LPA observed and inspected sleeping equipment for infants. LPA observed 3 play yards for each infant who is unable to climb out of the play yard. All equipment meets the US Consumer Product Safety Commission safety standards. LPA observed the play yards are free from loose articles and objects. There are no objects hanging above or attached to the side of the crib. LPA observed the play yards do not hinder the entrance or exit to and from the nap area/room. Mattresses were observed to be firm and covered with a fitted sheet that is appropriate to the mattress size. Each infant has their individual bedding and is washed weekly as required. Soiled bedding is replaced when wet or soiled and is placed in an area inaccessible to infants. Pacifiers were not observed.

LPA discussed the following: Infants shall not be swaddled while in care. The provider shall supervise infants while they are sleeping and adhere to the following requirements: (1) The provider shall physically check on sleeping infants every 15 minutes. (2) The provider shall document the following: (A) Labored breathing. (B) Signs of distress, which includes but is not limited to flushed skin color, increase in body temperature, and restlessness. (C)Infants up to 12 months of age who are sleeping in a position other than on their back. 1. If the infant’s Individual Infant Sleeping Plan [LIC 9227 (3/20)] does not have Section C completed, the provider shall return the infant to their back for sleeping. Documentation shall be maintained in the infant’s

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SUPERVISOR'S NAME: Claudia GuangorenaTELEPHONE: (323) 981-8417
LICENSING EVALUATOR NAME: Alanna GontarekTELEPHONE: (323) 854-8644
LICENSING EVALUATOR SIGNATURE:

DATE: 08/26/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/26/2021
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
CCLD Regional Office, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME: MORENO FAMILY CHILD CARE
FACILITY NUMBER: 198008184
VISIT DATE: 08/26/2021
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condition requires immediate attention. (4) The provider shall be near enough to the sleeping infant to be able to hear them wake up. (5) If the infant is sleeping in a separate room from where the provider is stationed, the door to the room the infant is sleeping in shall remain open at all times. (A) The provider shall be able to visually observe the infant without moving the door. (6) The provider shall be on the same floor as the sleeping infant. (7) A digital video and audio monitoring device may be used in the home but shall not be used in place of the requirements enumerated in Subsection (j). 102423(a)(2) (a) Each child receiving services from a f amily child care home shall have certain rights that shall not be waived or abridged by the licensee regardless of consent or authorization from the child's authorized representative. These rights include, but are not limited to, the following: (2) To receive safe, healthful, and comfortable accommodations, furnishings, and equipment. LPA advised the licensee to sleep infants where they can always be directly supervised.

LIC 9227 (Individual Sleeping Plan) for infants up to 12 months was explained and issued to the Licensee. LPA provided the LIC 9227 in Spanish as well. Title 22 Regulation Section 102425(j) Infant Safe Sleep was discussed with the Licensee, including but not limited to documentation that shall be maintained. LPA provided the licensee with a copy of the Child Care Provider’s Guide to Safe Sleep, by American Academy of Pediatrics and Helping you to reduce the risk of SIDS. LPA also consulted and explained Child Abuse Reporting, Never Shake a Baby, and Safe Sleeping practices.

Incidental Medical Services (IMS):
The licensee states that she does not provide IMS. Per licensee, there are no children enrolled that require IMS at this time. Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Family Child Care Homes Section 102417. 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 licensee to access forms, regulations and quarterly updates on line at: www.ccld.ca.gov.

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SUPERVISOR'S NAME: Claudia GuangorenaTELEPHONE: (323) 981-8417
LICENSING EVALUATOR NAME: Alanna GontarekTELEPHONE: (323) 854-8644
LICENSING EVALUATOR SIGNATURE:

DATE: 08/26/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/26/2021
LIC809 (FAS) - (06/04)
Page: 4 of 7
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: MORENO FAMILY CHILD CARE
FACILITY NUMBER: 198008184
VISIT DATE: 08/26/2021
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file and be available to the Department for review. Documentation shall include the following: 1. Date. 2. Infant’s name. 3. Time of each 15-minute check. (3) If the provider observes labored breathing or signs of distress as specified in Subsection (j)(2)(B), the provider shall do the following: (A) Immediately notify the infant’s authorized representative. (B) Obtain specific instruction from the infant’s authorized representative regarding action to be taken and make prompt arrangements to obtain medical treatment if necessary. (C)There shall be no delay in obtaining emergency medical treatment for the infant if the infant’s condition requires immediate attention. (4) The provider shall be near enough to the sleeping infant to be able to hear them wake up. (5) If the infant is sleeping in a separate room from where the provider is stationed, the door to the room the infant is sleeping in shall remain open at all times. (A) The provider shall be able to visually observe the infant without moving the door. (6) The provider shall be on the same floor as the sleeping infant. (7) A digital video and audio monitoring device may be used in the home but shall not be used in place of the requirements enumerated in Subsection (j). 102423(a)(2) (a) Each child receiving services from a family child care home shall have certain rights that shall not be waived or abridged by the licensee regardless of consent or authorization from the child's authorized representative. These rights include, but are not limited to, the following: (2) To receive safe, healthful, and comfortable accommodations, furnishings, and equipment.

Licensee states that she is currently caring for one infant age 1 year and 11 months. Title 22 Regulation Section 102425(j) Infant Safe Sleep was discussed with the Licensee, including but not limited to documentation that shall be maintained. LPA also provided a Spanish LIC 9227 as well. LPA provided the licensee with a copy of the Child Care Provider’s Guide to Safe Sleep, by American Academy of Pediatrics and Helping you to reduce the risk of SIDS. LPA also consulted and explained Child Abuse Reporting, Capacity worksheets, Never Shake a Baby, and Safe Sleeping practices

Incidental Medical Services (IMS):

The licensee states that she does not provide IMS. Per licensee, there are no children enrolled that require IMS at this time. Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Family Child Care Homes Section 102417. 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.



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SUPERVISOR'S NAME: Claudia GuangorenaTELEPHONE: (323) 981-8417
LICENSING EVALUATOR NAME: Alanna GontarekTELEPHONE: (323) 854-8644
LICENSING EVALUATOR SIGNATURE:

DATE: 08/26/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/26/2021
LIC809 (FAS) - (06/04)
Page: 5 of 7
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: MORENO FAMILY CHILD CARE
FACILITY NUMBER: 198008184
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/26/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
08/30/2021
Section Cited

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Operation of a Family Child Care Home
(g) The home shall be free from... conditions which might endanger a child...(4) Poisons... which..if readily available to children shall be stored...(A) Storage areas for poisons... shall be locked. This requirement was not met as evidenced by: At 11:04 a.m.,LPA
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 observed 3 Raid cans, Zap-A-Roach Roach and Ant killer Boric Acid, d-CON Bait Station rat poison, AMDRO Ant Killing Bait, and one Hot Shot BedBug and Flea fogger stored in an off-limit hallway closet via door cover. 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: Claudia GuangorenaTELEPHONE: (323) 981-8417
LICENSING EVALUATOR NAME: Alanna GontarekTELEPHONE: (323) 854-8644
LICENSING EVALUATOR SIGNATURE:
DATE: 08/26/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/26/2021
LIC809 (FAS) - (06/04)
Page: 7 of 7
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: MORENO FAMILY CHILD CARE
FACILITY NUMBER: 198008184
VISIT DATE: 08/26/2021
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LPA advised the licensee to access forms, regulations and quarterly updates on line at: www.ccld.ca.gov
Based on the LPA’s observations, interviews, and records review, the following deficiency listed on the attached LIC 809D (deficiency page) is being cited in accordance with California Code of Regulations Title 22. Deficiency that is being cited needs to be cleared to protect the children’s health & safety.

At 2:15 p.m., exit interview was conducted with Amparo Moreno. A copy of this report LIC 809, Appeal Rights, and Notice of Site Visit were explained and provided during this visit. 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.


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SUPERVISOR'S NAME: Claudia GuangorenaTELEPHONE: (323) 981-8417
LICENSING EVALUATOR NAME: Alanna GontarekTELEPHONE: (323) 854-8644
LICENSING EVALUATOR SIGNATURE:

DATE: 08/26/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/26/2021
LIC809 (FAS) - (06/04)
Page: 6 of 7