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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198014203
Report Date: 01/03/2024
Date Signed: 01/03/2024 02:39:42 PM


Document Has Been Signed on 01/03/2024 02:39 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 CC RO, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754



FACILITY NAME:OLIVARES FAMILY CHILD CAREFACILITY NUMBER:
198014203
ADMINISTRATOR:OLIVARES, MARIAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(909) 440-0498
CITY:POMONASTATE: CAZIP CODE:
91766
CAPACITY:14CENSUS: 8DATE:
01/03/2024
TYPE OF VISIT:Required - 3 YearUNANNOUNCEDTIME BEGAN:
12:30 PM
MET WITH:Licensee Maria OlivaresTIME COMPLETED:
03:15 PM
NARRATIVE
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At 12:30pm, Licensing Program Analysts (LPA)s Stephanie Li and Nolan Tcheng conducted an unannounced required 3 year inspection to the above facility. A risk assessment was conducted upon entry. LPA met with Licensee, Maria Olivares who guided analysts on a tour of the facility. Per Licensee, there are currently 13 children enrolled. A current children’s roster was available for review. There were 8 children present upon arrival. Facility capacity is in compliance for a Large Family Child Care Home. Hours of operation are Monday-Friday, 5:30am-6:30pm.

This is a one story home which consists of 2 bedrooms, 2 bathrooms, living room, dining room, play room, kitchen, garage, front yard and backyard (fenced). Currently residing in the home are 2 adults and one minor child.

All adults present in the home have obtained a criminal record clearance or exemption prior to working, residing or volunteering in the licensed child care home.



Areas accessible to children were inspected as follows: kitchen, living room, dining room, play room, 1 bathroom, front yard and back yard. Fire place in living room was observed to have a secured gate.

Per licensee, areas off limits to children and parents, 2 bedrooms, 1 bathroom, and garage. The LPA's toured all areas used by children during this visit. Per Licensee, there are no weapons or fire arms on the property. No bodies of water were observed. Fencing was observed outside where an above ground pool was removed.



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SUPERVISOR'S NAME: Christina GabelmanTELEPHONE: (323) 981-3380
LICENSING EVALUATOR NAME: Stephanie LiTELEPHONE: (626) 366-3362
LICENSING EVALUATOR SIGNATURE:
DATE: 01/03/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/03/2024
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
MONTEREY PARK CC RO, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME: OLIVARES FAMILY CHILD CARE
FACILITY NUMBER: 198014203
VISIT DATE: 01/03/2024
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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 a cellphone that stays at the facility during operation hours.

The following was observed and reviewed during this inspection:

LPA's observed the following required posted documentation in the main entry way of the facility: Facility License, Publication (PUB) 394- Notification of Parent Rights and Licensing Form (LIC) 9148- Earthquake Preparedness form. LPA's reviewed facility records for LIC 9040- Facility Roster, LIC 610- Facility Disaster Plan. All homes shall conduct fire and disaster drills at least once every six months, and document the date and time of each drill. LPA’s observed the last drill logged was on 10/20/2022.

The home is observed to be clean and orderly, with central air and heating. There are toys available for children. Sleeping mats were observed. The valve on the required 2A 10BC fire extinguisher indicates last charged on 08/2/2022, as indicated on service tag. LPA’s discussed with licensee requirements for servicing fire extinguishers yearly. Smoke and carbon monoxide detectors were tested and are operable. Detergents, cleaning compounds, and medications were observed to be inaccessible to children. Per Licensee, there are no poisons in the home and understands that all poisons must be locked, to be made inaccessible to children. Licensing staff reminded licensee smoking is not allowed in a family child care home. The restroom that children use was observed to be safe and sanitary.

LPA's 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-andresources/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. Page 2 of 4


SUPERVISOR'S NAME: Christina GabelmanTELEPHONE: (323) 981-3380
LICENSING EVALUATOR NAME: Stephanie LiTELEPHONE: (626) 366-3362
LICENSING EVALUATOR SIGNATURE:

DATE: 01/03/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/03/2024
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
MONTEREY PARK CC RO, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME: OLIVARES FAMILY CHILD CARE
FACILITY NUMBER: 198014203
VISIT DATE: 01/03/2024
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's observed that the outdoor yard has toys and other materials for children to play with. LPA’s observed objects (yard tools) that can pose a danger to children in the outdoor yard. Licensee had her husband remove them to the side yard that is inaccessible to children during the visit.

The licensee is observed to be operating within the license capacity limitations.

Children’s records were reviewed, including emergency information and were observed to be complete.

The licensee has completed training on preventive health practices including Pediatric First Aid and CPR. The licensee and husband (Assistant) Pediatric First Aid and CPR expires on 11/2024. Licensee and husband has current Mandated Reporter AB 1207 compliant Child Care Training Certificate on file expires on 08/18/2024.

LPA's observed that the Licensee and assistant does have proof of immunizations.

Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02- CCP. 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: https://www.ada.gov/resources/child-care-centers/.



Licensee was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain child care by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.
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SUPERVISOR'S NAME: Christina GabelmanTELEPHONE: (323) 981-3380
LICENSING EVALUATOR NAME: Stephanie LiTELEPHONE: (626) 366-3362
LICENSING EVALUATOR SIGNATURE:

DATE: 01/03/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/03/2024
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
MONTEREY PARK CC RO, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME: OLIVARES FAMILY CHILD CARE
FACILITY NUMBER: 198014203
VISIT DATE: 01/03/2024
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LPA's advised the licensee to access forms, regulations and quarterly updates on line at: www.ccld.ca.gov.

To improve the quality and value of the new inspection process, a survey may 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 CARE tools, please send email inquiries 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, except as specified in Health and Safety Code section 1596.871, 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 for a maximum of 5 days or, if the penalty is for a repeat violation, for a maximum of 30 days per person will be assessed if this regulation is violated.



During the exit interview, the LICENSEE Maria Olivares, confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS.

A notice of site visit was given and must remain posted for 30 days. Exit interview conducted and report was reviewed with Licensee Maria Olivares.

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SUPERVISOR'S NAME: Christina GabelmanTELEPHONE: (323) 981-3380
LICENSING EVALUATOR NAME: Stephanie LiTELEPHONE: (626) 366-3362
LICENSING EVALUATOR SIGNATURE:

DATE: 01/03/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/03/2024
LIC809 (FAS) - (06/04)
Page: 4 of 5
Document Has Been Signed on 01/03/2024 02:39 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MONTEREY PARK CC RO, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754


FACILITY NAME: OLIVARES FAMILY CHILD CARE
FACILITY NUMBER: 198014203

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/03/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102417(g)(1)
Operation of A Family Child Care Home
(g) The home shall be free from defects or conditions which might endanger a child. Safety precautions shall include but not limited to: (1) Fireplaces and open face heaters shall be screened to prevent access by children. The home shall contain a fire extinguisher and smoke detector device which meet standards established by the State Fire Marshall.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, the licensee did not comply with the section cited above, fire extinguisher was last serviced 08/02/2022, which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 01/17/2024
Plan of Correction
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Licensee contacted her fire service company during the inspection to get her fire extinguisher serviced. Licensee will take a photo and send to LPA Stephanie Li.
Type B
Section Cited
CCR
102417(g)(9)(A)
Operation of A Family Child Care Home
(g) The home shall be free from defects or conditions which might endanger a child. Safety precautions shall include but not limited to: (9) Each family child care home shall have a written disaster plan of action prepared on a form approved by the Department. All children, age and ability permitting, and the provider, the assistant provider, and other members of the household, shall be instructed in their duties under the disaster plan. As their age and ability permit, newly enrolled children shall be informed promptly of their duties as required in the plan. (A) Each family child care home shall conduct fire drills and disaster drills at least once every six months.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, the licensee did not comply with the section cited above as the last distater drill logged was on 10/20/2022 which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 01/17/2024
Plan of Correction
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LPA's observed a disaster drill log. Last drill logged was 10/20/2022. Licensee stated she will wait till after winter break to conduct her disaster drill so all the children enrolled can participate and practice for safety.
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: Christina GabelmanTELEPHONE: (323) 981-3380
LICENSING EVALUATOR NAME: Stephanie LiTELEPHONE: (626) 366-3362
LICENSING EVALUATOR SIGNATURE:
DATE: 01/03/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/03/2024
LIC809 (FAS) - (06/04)
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