<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198014085
Report Date: 03/03/2020
Date Signed: 03/03/2020 11:47:37 AM

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:CAZARES FAMILY CHILD CAREFACILITY NUMBER:
198014085
ADMINISTRATOR:CAZARES, KAREYFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(562) 991-1358
CITY:LAKEWOODSTATE: CAZIP CODE:
90712
CAPACITY:14CENSUS: 9DATE:
03/03/2020
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Karey CazaresTIME COMPLETED:
12:00 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
Licensing Program Analysts, Ariel Cazares and Jonah Myson conducted an unannounced annual site inspection to the home. Upon arrival, LPAs met with Licensee Karey Cazares and toured the facility. There were 9 children present. Individuals residing in the home are the licensee, licensee's spouse, licensee's 4 children, a dog, and 2 turtles. Licensee’s operating hours are Monday-Friday 7am-6pm.

The home is a two story, 4-Bedroom, 1-Bath home. The following areas are accessible for day-care: 1st floor and kitchen, backyard, and detached garage. Off limit areas include: Second floor bedroom.

Licensee has the required postings on a parent board at the entrance of the facility. Licensee’s First Aid/CPR certificates are valid through 08/10/2020. Licensee's disaster drill log notes last drill conducted on 01/09/2020. Licensee has a working telephone.

LPAs inspected the areas accessible to daycare children. There are adequate age appropriate toys, books, and games. LPAs observed electrical outlets to be covered (or no exposed electrical outlets). The fire extinguisher located in the kitchen was last purchased on 09/04/2019, and was fully charged. There is an operational smoke detector and carbon monoxide in the living room, which was tested by LPAs and found operational. The facility does have a First Aid Kit located in the kitchen. Per Licensee, there are no firearms present on the premises.

LPAs inspected the backyard which children used for outdoor activity. There is a detached garage that is used for additional activity space. There are no pools or spas. There is a turtle tank in the garage. LPAs advised licensee to supervise children when they are engaging with pets.

SUPERVISOR'S NAME: Karen ChambersTELEPHONE: (323) 981-3368
LICENSING EVALUATOR NAME: Jonah MysonTELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:

DATE: 03/03/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/03/2020
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: CAZARES FAMILY CHILD CARE
FACILITY NUMBER: 198014085
VISIT DATE: 03/03/2020
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
Children’s roster and files were reviewed. Staff files were reviewed. Licensee is missing proof of measles immunization.

The following were discussed: Individuals who are 18 years of age or older living in the home must be finger print cleared prior to being in the presence of the children in care. Individuals within one month of their 18th birthday must be fingerprinted immediately. No smoking, No infant walkers, No baby bouncers, No Johnny jumpers, No exersaucers and any other item that falls into that category.

Mandated child abuse reporter training was conducted by licensing and assistant on 04/19/2018.

· LPA reviewed SIDs, Never Shake A Baby, and safe sleeping practices. Infants should sleep mouth up, on their backs, free of clutter surrounding their sleeping space. Safe sleep concepts were provided on this date.

· 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

· A qualified Assistant must be present and actively involved in caring for children whenever nine (9) or more children are present at the facility in a large family child care home.
· LPA advised the Licensee to access forms and regulations on line at: www.ccld.ca.gov
· Mandated reporter training must be completed every 2 years. www.mandatedreporterca.com
SUPERVISOR'S NAME: Karen ChambersTELEPHONE: (323) 981-3368
LICENSING EVALUATOR NAME: Jonah MysonTELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:

DATE: 03/03/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/03/2020
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: CAZARES FAMILY CHILD CARE
FACILITY NUMBER: 198014085
VISIT DATE: 03/03/2020
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
Deficiencies were cited in accordance with California Code of Regulations Title 22. See 809-D.

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 Licensee Karey Cazares. A copy of this report and appeal rights were provided and explained.
SUPERVISOR'S NAME: Karen ChambersTELEPHONE: (323) 981-3368
LICENSING EVALUATOR NAME: Jonah MysonTELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:

DATE: 03/03/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/03/2020
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: CAZARES FAMILY CHILD CARE
FACILITY NUMBER: 198014085
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/03/2020
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
03/17/2020
Section Cited

1
2
3
4
5
6
7
The family day care home shall maintain documentation of the required immunizations or exemptions from immunization, as set forth in this section, in the person’s personnel record that is maintained by the family day care home.

This requirement has not been met as
8
9
10
11
12
13
14
evidenced by licensee's file review did not contain proof of measles vacine. This poses a potential risk to the health and safety of the children in care.
8
9
10
11
12
13
14

1
2
3
4
5
6
7

1
2
3
4
5
6
7
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: Karen ChambersTELEPHONE: (323) 981-3368
LICENSING EVALUATOR NAME: Jonah MysonTELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:
DATE: 03/03/2020
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/03/2020
LIC809 (FAS) - (06/04)
Page: 4 of 4