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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198016015
Report Date: 09/27/2022
Date Signed: 09/27/2022 04:27:44 PM


Document Has Been Signed on 09/27/2022 04:27 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:ALVAREZ FAMILY CHILD CAREFACILITY NUMBER:
198016015
ADMINISTRATOR:ALVAREZ, MARIAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(626) 358-3292
CITY:MONROVIASTATE: CAZIP CODE:
91016
CAPACITY:14CENSUS: 1DATE:
09/27/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Maria AlvarezTIME COMPLETED:
05:00 PM
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Licensing Program Analyst (LPA) Cynthia Reyes and Enjoli Maeweather conducted an unannounced annual inspection on 09/27/2022. LPA's met with Maria Alvarez, Licensee and a copy of the Entrance Checklist for Child Care homes form (LIC 126) was provided. The facility operating hours are from Monday through Friday 6AM-6PM. Due to COVID- 19, precautionary measures were taken during the entire inspection. This is a one story, 3 bedroom, 2 bathroom home.

1:30PM Licensee guided analysts on a tour of the facility. Per Licensee, there are 5 children currently enrolled. Today in care is 1 child. . A current children’s roster was available for review.

The licensee states that 3 adults and 1 child currently live in the home. 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. Licensee states that there are no weapons on premises. No bodies of water on premises. Children will not play in front yard or back yard (temporary), but Licensee states she takes the children for short walks.

Areas that are accessible to children are as follows: Living Room, 1 Bedroom, Dining Room, and Back Yard (Back Yard will be inaccessible until October 3rd).

Areas off limits: Master bedroom with rest room, One bedroom, Kitchen, Front Yard.
**Rooms that are off-limits need to be made inaccessible during operating hours** The Licensee does understand that licensing staff may have access to off-limit areas during inspection visit if necessary.


Continue on next page.
SUPERVISOR'S NAME: Christina GabelmanTELEPHONE: (323) 981-3380
LICENSING EVALUATOR NAME: Cynthia ReyesTELEPHONE: (323) 981-3369
LICENSING EVALUATOR SIGNATURE:
DATE: 09/27/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/27/2022
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: ALVAREZ FAMILY CHILD CARE
FACILITY NUMBER: 198016015
VISIT DATE: 09/27/2022
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The following was observed and reviewed during this inspection.

02:10pm All areas identified on the facility sketch were inspected for safety, comfort, and cleanliness. Licensee will use land line and cellphone that stays at the facility during operation hours. There is ventilation and heating.

Detergents, cleaning compounds, and medications were observed to be inaccessible to children. The restroom that children use was observed to be safe and sanitary.

LPA Reyes and Maeweather observed the valve on the required 2A10BC fire extinguisher had no tag stating date. Smoke detector was tested and is operable. Licensee has a carbon monoxide detectors that was also tested and is operable. All Small family day care homes shall conduct fire and disaster drills at least once every six months, and document the date and time of each drill. NO drills documented due to no children presently in care. Emergency Disaster Plan, Parent’s Rights Poster and the Facility License were observed to be posted on the parent board and visible to parents and all to see.

LPA observed the home to be clean and orderly. There are toys available for children. Appropriate sleeping arrangements.



Licensee states that they are currently caring for infants. LPA discussed the safe sleep regulations with licensee and discussed the Child Care Licensing Safe Sleep web page 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.

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SUPERVISOR'S NAME: Christina GabelmanTELEPHONE: (323) 981-3380
LICENSING EVALUATOR NAME: Cynthia ReyesTELEPHONE: (323) 981-3369
LICENSING EVALUATOR SIGNATURE:

DATE: 09/27/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/27/2022
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: ALVAREZ FAMILY CHILD CARE
FACILITY NUMBER: 198016015
VISIT DATE: 09/27/2022
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Smoking is prohibited in a licensed Family Child Care Home. Per Licensee, no one smokes in the home.
LPA did not observe any objects that can pose a danger to children in care. There are 2 dogs on premises. Both dogs are kept on side house dog room area and will not be in the area around the children. The licensee is observed to be operating within the license capacity limitations.

At 2:15 PM 1 child records were reviewed. Licensee records were reviewed, including emergency information. Other staff records are not completed.

The licensee has completed training on preventive health practices including Pediatric First Aid and CPR. Pediatric First Aid and CPR taken on 02/11/2021. There are first aid supplies available.

LPA observed that the Licensee Desiree provided proof of all immunization with the exception of MMR (MMR/TDAP/FLU/TB) records to be on file and the Mandated Reporter, AB 1207 compliant Child Care Training Certificate on file. Mandated reporter training must be completed every 2 years. www.mandatedreporterca.com. Taken on 03/01/2021.

Licensing staff consulted with licensee Desiree regarding COVID-19 health and safety guidelines on this date. LPA informed Licensee, that the usage of mask is a mandate and that every adult and child over the age of two, is still highly recommended by our department to be wearing a mask.



LPA advised the licensee to access forms, regulations and quarterly updates on line at: www.ccld.ca.gov.
Reporting Unusual Incidents: MPROIncidentReports@dss.ca.gov. CCL Resources for Parents & Providers: https://ccld.childcarevideos.org/ Provider Information Notices (PINs): https://www.cdss.ca.gov/inforesources/community-care-licensing/policy/provider-information-notices/child-care

Licensee Email was not on file so it was provided and will be updated. A cell number was verified.

Continued on page 4

SUPERVISOR'S NAME: Christina GabelmanTELEPHONE: (323) 981-3380
LICENSING EVALUATOR NAME: Cynthia ReyesTELEPHONE: (323) 981-3369
LICENSING EVALUATOR SIGNATURE:

DATE: 09/27/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/27/2022
LIC809 (FAS) - (06/04)
Page: 3 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: ALVAREZ FAMILY CHILD CARE
FACILITY NUMBER: 198016015
VISIT DATE: 09/27/2022
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IMS (Not 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

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 minimum/day up to $500.00 maximum per day/per person will be assessed if this regulation is violated.

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.

At this time, the licensee is not in compliance with California Code of Regulations Title 22. Deficiencies and Technical Assistance was cited/given on this date.



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.

5PM Exit interview conducted and report was reviewed with Licensee, Maria Alvarez.

End of report

SUPERVISOR'S NAME: Christina GabelmanTELEPHONE: (323) 981-3380
LICENSING EVALUATOR NAME: Cynthia ReyesTELEPHONE: (323) 981-3369
LICENSING EVALUATOR SIGNATURE:

DATE: 09/27/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/27/2022
LIC809 (FAS) - (06/04)
Page: 4 of 6
Document Has Been Signed on 09/27/2022 04:27 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
CCLD Regional Office, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754


FACILITY NAME: ALVAREZ FAMILY CHILD CARE
FACILITY NUMBER: 198016015

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/27/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
HSC
1596.8662(b)(1)
Administration of Child Day Care Licensing
(1) On or before March 30, 2018, a person who, on January 1, 2018, is a licensed child day care provider, administrator, or employee of a licensed child day care facility shall complete the mandated reporter training provided pursuant to paragraphs (2) and (3) of subdivision (a), and shall complete renewal mandated reporter training every two years following the date on which he or she completed the initial mandated reporter training.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on LPAs record review, the licensee did not comply with the section cited above in 3 out of 3 persons which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 10/07/2022
Plan of Correction
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Licensee states will send copies of her and her two assistance Mandated reported certificates by the POC date.
Type B
Section Cited
HSC
1597.622(c)
Administration of Child Day Care Licensing
(c) 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 is not met as evidenced by:
Deficient Practice Statement
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Based on LPAs record review, the licensee did not comply with the section cited above in 3 out of 3 persons which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 10/07/2022
Plan of Correction
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Licensee does not have proof of Immunizations for her and her two Assistance and will send proof for all three of MMR/TDAP/FLU by the POC date.

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: Cynthia ReyesTELEPHONE: (323) 981-3369
LICENSING EVALUATOR SIGNATURE:
DATE: 09/27/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/27/2022
LIC809 (FAS) - (06/04)
Page: 5 of 6


Document Has Been Signed on 09/27/2022 04:27 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
CCLD Regional Office, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754


FACILITY NAME: ALVAREZ FAMILY CHILD CARE
FACILITY NUMBER: 198016015

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/27/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102416.1(a)
Personnel Records
(a) Personnel records shall be maintained on each employee and shall contain the following information:

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on LPAs record review, the licensee did not comply with the section cited above in 3 out of 3 persons which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 10/07/2022
Plan of Correction
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Licensee does not have a file for her and her two assistance with all the requiered docuemnts and will submit proof of all documents by the POC date.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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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: Christina GabelmanTELEPHONE: (323) 981-3380
LICENSING EVALUATOR NAME: Cynthia ReyesTELEPHONE: (323) 981-3369
LICENSING EVALUATOR SIGNATURE:
DATE: 09/27/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/27/2022
LIC809 (FAS) - (06/04)
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