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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198013295
Report Date: 05/16/2023
Date Signed: 05/16/2023 12:06:43 PM


Document Has Been Signed on 05/16/2023 12:06 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 S WEST, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754



FACILITY NAME:INIGUEZ FAMILY CHILD CAREFACILITY NUMBER:
198013295
ADMINISTRATOR:INIGUEZ, JOSEFINAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(323) 352-4417
CITY:HUNTINGTON PARKSTATE: CAZIP CODE:
90255
CAPACITY:10CENSUS: 1DATE:
05/16/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:45 AM
MET WITH:Josefina Iniguez, LicenseeTIME COMPLETED:
12:20 PM
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Licensing Program Analyst (LPA) Denise Gibbs conducted an unannounced annual required inspection at the above facility on 5/16/23 at 9:45AM. LPA met with Josefina Iniguez, Licensee who guided analysts on a tour of the facility.

There was one daycare child and two adults present when LPA arrived. All adults present in the home have obtained a criminal record clearance or exemption. Facility capacity is in compliance for a large Family Child Care Home. Hours of operation are Monday- Friday 8AM- 4PM.

The home is a one story that consists of three bedrooms, one bathroom home, living room, kitchen, dining room, den, detached garage/living area, front yard (not fenced) and backyard (fenced). Main care area is in the den towards the back of the home. Children also have access to the living room and, dining room and kitchen. Off limit areas include: Three bedrooms, front yard, & detached garage/living space.

All areas identified on the facility sketch that are accessible for children to use were inspected for safety, comfort, and cleanliness. The following was observed and reviewed during this inspection:



LPA reviewed required posted documentation located in the main care are, which included facility License, Publication (PUB) 394- Notification of Parent Rights, Licensing Form (LIC) 9148- Earthquake Preparedness form, and LIC 610- Facility Disaster Plan. All documents were observed.

Facility records were reviewed for LIC 9040- Facility Roster and Disaster drill log. Last drill conducted on 5/1/23. All documents were observed. Smoke and carbon monoxide detectors, located in the hallway near the bathroom were tested and are operable. Fire extinguisher indicated fully charged and was serviced, 4/2023. The home maintains telephone service via operable landline and cell phone.
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SUPERVISOR'S NAME: Karen ChambersTELEPHONE: (323) 981-3350
LICENSING EVALUATOR NAME: Denise GibbsTELEPHONE: (323) 558-2794
LICENSING EVALUATOR SIGNATURE:
DATE: 05/16/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/16/2023
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 3


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MONTEREY PARK S WEST, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME: INIGUEZ FAMILY CHILD CARE
FACILITY NUMBER: 198013295
VISIT DATE: 05/16/2023
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There are toys and other age appropriate material available for children in the living room, den and backyard. The home is observed to be clean and orderly. LPA observed that detergents, cleaning compounds and medication are stored in a cabinet under the kitchen sink, inaccessible to children. All cabinets in the kitchen, high and low have operable child locks. Isolation area for sick children waiting to be picked up is in the living room, away from the other children. The living room was observed to have a quiet reading area with child size furniture. Home has central air and heat. Food is provided by Licensee. Per Licensee, there are no firearms or weapons stored in the home.

The bathroom that children use is located off the hallway adjacent to the living room. Bathroom was observed to be clean and free of hazards.

Infant Care: Currently licensee does not have infants in care. LPA informed licensee of the Safe Sleep regulations, including LIC 9227 Infant Sleep Plan for infants under 12 months, 15-minute sleep check documentation for infants 0-24 months, and provided PIN 20-24-CCP.

Currently, children are using the back yard for outdoor play. The outdoor play area was observed to be gated. LPA observed that the outdoor yard has toys and other materials for children to play with. LPA did not observe any objects that could be hazardous to children in care. Detached garage/living space is locked during day care hours. There are no pools or spas, or other bodies of water.



Children’s records were reviewed for (LIC) 282- Affidavit Regarding Liability Insurance, Immunization Records, LIC 700- Identification and Emergency Information, LIC 627- Consent for Medical Treatment, and LIC 995A Notification of Parents’ Right. All documents were observed.

Licensee reviewed for approved Pediatric First Aid and CPR certification exp 4/2024, LIC 508- Criminal Record Statement, Proof of immunization against measles, pertussis and influenza or influenza declination, TB clearance or risk assessment, LIC 9108- Statement Acknowledging Requirement to Report Child Abuse and current Mandated Reporter Training Certificate. All items were observed.

During inspection children were observed to be treated with dignity and respect, they were observed to be receiving safe, healthful and comfortable accommodations, furnishings and equipment, and free from corporal and/or unusual punishment. -----------------PAGE 2
SUPERVISOR'S NAME: Karen ChambersTELEPHONE: (323) 981-3350
LICENSING EVALUATOR NAME: Denise GibbsTELEPHONE: (323) 558-2794
LICENSING EVALUATOR SIGNATURE:

DATE: 05/16/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/16/2023
LIC809 (FAS) - (06/04)
Page: 2 of 3
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MONTEREY PARK S WEST, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME: INIGUEZ FAMILY CHILD CARE
FACILITY NUMBER: 198013295
VISIT DATE: 05/16/2023
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Incidental Medical Services (IMS):
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 Center and the ADA, available at: http://www.ada.gov/childqanda.htm

Based on the LPA's observations and records review no deficiencies will be cited today 5/16/23.

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 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

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 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.

Exit interview conducted and report was reviewed with the Licensee, Josefina Iniguez.


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SUPERVISOR'S NAME: Karen ChambersTELEPHONE: (323) 981-3350
LICENSING EVALUATOR NAME: Denise GibbsTELEPHONE: (323) 558-2794
LICENSING EVALUATOR SIGNATURE:

DATE: 05/16/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/16/2023
LIC809 (FAS) - (06/04)
Page: 3 of 3