198016776-6-15-2023-33-CC-JMOA-CSTRBH-20230615125245

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 198016776
Report Date: 06/15/2023
Date Signed: 06/15/2023 12:53:13 PM

Document Has Been Signed on 06/15/2023 12:53 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:	LUNA FAMILY CHILD CARE HOME		FACILITY NUMBER:	198016776
ADMINISTRATOR:	LUNA, SANDRA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(909) 706-9136
CITY:	POMONA	STATE: CA	ZIP CODE:	91767
CAPACITY:	14	CENSUS: 9	DATE:	06/15/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	11:40 AM
MET WITH:	Sandra Luna		TIME COMPLETED:	01:15 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 Analyst (LPA) Judy Mora conducted an unannounced annual required inspection at the above facility on 06/12/23 at 11:40 AM. LPA met with Sandra Luna, Licensee who guided LPA on a tour of the facility. Licensee's assistant, Eloisa Salas, was present during this inspection. LPA observed 09 children present. Per Licensee, there are ten children currently enrolled. Days and hours of operation are Monday - Friday, 02:00 AM to 05:00 PM. The Entrance Checklist LIC 126, was provided to the Licensee during this visit. Family members residing in the home are the Licensee, her husband (criminal record clearance on file), and two minor children. This is a one story home which consists of 3 bedrooms, 2 bathrooms, den, kitchen, living room, dinning room, fenced backyard, and detached garage. The children have access to the den which is the primary day care area, one bathroom and backyard. The Licensee has one dog that is kept outdoors or in one of the bedrooms which are inaccessible to children. All areas used by children were inspected during this visit. Fixtures, furniture and equipment were observed to be safe and in good condition. There are safe toys, play equipment and materials available for children. There is central air and heating in the home. There is a land line in the home. Detergents, cleaning compounds, medications, and other items which can pose a danger to children are inaccessible. Smoke and carbon monoxide detectors in the living room were tested and are operable. Fire extinguisher indicates fully charged, last serviced on 03/27/23. Per Licensee, she prepares snacks and/or food items. Currently children use backyard for outdoor play. 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 any objects that could be hazardous to children in care. *REPORT CONTINUES ON NEXT PAGE

SUPERVISOR'S NAME: Claudia Guangorena	TELEPHONE: (323) 981-3417
LICENSING EVALUATOR NAME: Judy Mora	TELEPHONE: (323) 896-6847
LICENSING EVALUATOR SIGNATURE:	DATE: 06/15/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/15/2023

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: LUNA FAMILY CHILD CARE HOME	FACILITY NUMBER: 198016776
	VISIT DATE: 06/15/2023

NARRATIVE

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Isolation area for sick children waiting to be picked up will be in the the living room, away from the other children. Licensee states that there are no poisons stored in the home and understands that all poisons must be locked, not only inaccessible to children. Per Licensee there are no firearms or weapons stored in the home. Licensee states there are no bodies of water on the property and LPA did not observe any bodies of water during this visit. Per Licensee, she provides transportation services for school age children. The Licensee does not provide overnight care.

Infant Care: Per Licensee she is currently caring for two infants under two years. LPA informed licensee of the new Safe sleep regulations, including LIC 9227 Infant Sleep Plan for infants under 12 months, 15-minute sleep check documentation for infants 0-24 months.

LPA observed the following required posted documentation: Facility License, Publication (PUB) 394- Notification of Parent Rights, and Earthquake Preparedness Checklist LIC 9148. LPA reviewed facility records for LIC 9040- Facility Roster, LIC 610- Facility Disaster Plan, verification of Disaster and fire drills, Earthquake and fire drill was conducted on 06/05/2023.

Children’s records were reviewed for (LIC) 282- Affidavit Regarding Liability Insurance, Immunization's Records (if applicable), LIC 700- Identification and Emergency Information, LIC 627- Consent for Medical Treatment, and LIC 995A Notification of Parents’ Rights. Children's files were observed to be complete.

Licensee's records were reviewed for approved Pediatric First Aid and CPR certification, the Licensee's certification expires 06/04/24. LPA reviewed the LIC 508- Criminal Record Statement, Proof of immunization's against measles, pertussis and influenza or influenza declination, TB clearance or risk assessment, LIC 9108- Statement Acknowledging Requirement to Report Child Abuse. AB 1207 Mandated Reporter training was completed on 06/13/23.

Incidental Medical Services (IMS) policy was discussed. Per Licensee, there are no children on medications. 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

*REPORT CONTINUES ON NEXT PAGE

SUPERVISOR'S NAME: Claudia Guangorena	TELEPHONE: (323) 981-3417
LICENSING EVALUATOR NAME: Judy Mora	TELEPHONE: (323) 896-6847
LICENSING EVALUATOR SIGNATURE:	DATE: 06/15/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/15/2023

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: LUNA FAMILY CHILD CARE HOME	FACILITY NUMBER: 198016776
	VISIT DATE: 06/15/2023

NARRATIVE

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

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 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.

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.

Exit interview conducted and report was reviewed with the Licensee, Sandra Luna.

*END OF REPORT

SUPERVISOR'S NAME: Claudia Guangorena	TELEPHONE: (323) 981-3417
LICENSING EVALUATOR NAME: Judy Mora	TELEPHONE: (323) 896-6847
LICENSING EVALUATOR SIGNATURE:	DATE: 06/15/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/15/2023

LIC809 (FAS) - (06/04)

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