198016949-6-7-2023-54-CC-JESA-CSKU66-20230607151750

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 198016949
Report Date: 06/07/2023
Date Signed: 06/07/2023 03:18:08 PM

Document Has Been Signed on 06/07/2023 03:18 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 CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME:	CALDERON FAMILY CHILD CARE		FACILITY NUMBER:	198016949
ADMINISTRATOR:	CALDERON, ROSELIA & NOEL		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(213) 359-6919
CITY:	NORWALK	STATE: CA	ZIP CODE:	90650
CAPACITY:	14	CENSUS: 8	DATE:	06/07/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	11:35 AM
MET WITH:	Licensee Roselia Calderon		TIME COMPLETED:	03:25 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	On 6/7/2023 Licensing Program Analyst (LPA) Jeanette Estrada conducted an unannounced required 1 year inspection at the above facility. LPA met with Licensee Roselia Calderon. LPA informed Licensee of the purpose for the visit and provided Licensee with a copy of the facility entrance checklist (LIC 126). The facility provides care to children ages 0 to 11 years old. The facility is open Monday to Friday 6:30 AM to 6:00 PM. Upon arrival, LPA observed 5 children in care with the Licensee. Licensee's assistant arrived approximately 10 minutes later. An additional 3 school age children arrived at approximately 1:45PM.The facility was in compliance with capacity requirements for a Large Family Child Care Home. All residents living in the home were discussed and noted. Per Licensee, Noel Calderon(Co-Licensee) is no longer living in the home. An updated LIC 279 Application was collected during the inspection. Licensee provided a tour of the facility. This is a one story, 3 bedroom, 1 bathroom home. Per Licensee areas on limits to children are: Detached garage-Used for activities, bathroom in the garage, backyard and the living room, dining area and bathroom and two bedrooms inside the home. Per Licensee areas off limits to children are: Kitchen, and one bedroom All areas that are accessible to children were inspected for safety, comfort, and cleanliness. The following was observed and reviewed during this inspection: LPA observed required posted documentation:- Facility license, Publication (PUB) 394- Notification of Parent Rights, LIC 9148 Earthquake Preparedness checklist. LPA observed a current facility roster LIC 9040 and a disaster drill log. Last documented drill was conducted on 6/5/23. Licensee was advised disaster drills shall be conducted every 6 months. LPA did not observe a carbon monoxide detector in the home. LPA did not observe an operable smoke detector in the home. Licensee had a combination carbon monoxide/smoke detector purchased and delivered to the home during the inspection. Detector is operable and will be installed in the hallway. LPA observed two 2A10BC Fire Extinguishers in the facility. One fire extinguisher is in the garage and one is in the kitchen. Both fire extinguishers were last serviced in March 2022. The home maintains telephone service (cell phone and landline). Food is provided by Licensee. Licensee was reminded if children bring food from home it must be labeled with the child’s name and properly stored or refrigerated.

SUPERVISOR'S NAME: Valarie Cook	TELEPHONE: (323) 513-3828
LICENSING EVALUATOR NAME: Jeanette Estrada	TELEPHONE: (323) 229-6521
LICENSING EVALUATOR SIGNATURE:	DATE: 06/07/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/07/2023

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 CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME: CALDERON FAMILY CHILD CARE	FACILITY NUMBER: 198016949
	VISIT DATE: 06/07/2023

NARRATIVE

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Sharp objects, detergents and cleaning compounds and medicines are inaccessible. Knives are kept in an upper kitchen cabinet, cleaning products are kept in a latched cabinet under the sink, personal medicines are kept in an upper hallway closet. Per Licensee, at this time, there are no children who require medication.
Per Licensee, care is provided mainly in the garage and outdoor area if weather permits. There are toys and other age appropriate materials available for children in the garage and the backyard. Per Licensee, children nap in the living room and will have meals in the dining area or in the patio if weather permits. LPA observed napping cots and cribs available for children indoors. LPA observed infant high chairs in the garage/backyard area. Heating and ventilation was evaluated. LPA observed an air/heating unit in the garage. The home has central air and heating. LPA did not observe any wall heaters. LPA did not observe any fire places. The children use the restroom in the hallway next to the bedrooms and the restroom in the garage. LPA did not observe cleaning products or medicine in the restroom inside the home. The restroom in the garage has a latched cabinet under the sink where cleaning solutions are kept.
Per Licensee, Children are supervised while playing outside. Per Licensee, there are no poisons kept in the home. Licensee was advised that all poisons must be locked, not only inaccessible to children. Per Licensee, the isolation area for sick children waiting to be picked up is either in the living room or in the backyard, separated from other children but in a place they can be supervised. Per Licensee, there are no firearms or weapons stored in the home. LPA did not observe any pools or spas, or other bodies of water. LPA observed one pet dog in the home. Per Licensee, pet dog is contained inside the home separated from children in care.
Infant Care: Currently there are 3 infants enrolled. LPA observed 4 cribs available in the home. Per Licensee, infants nap in the living room. LPA discussed the following with Licensee: Napping equipment shall not block the entrances or exits. Licensee was advised Infants shall not be swaddled in care. Car seats shall not be used for sleeping. LPA discussed the new Safe sleep regulation, including LIC 9227 Infant Sleep Plan for infants under 12 months, 15-minute sleep check documentation for infants 0-24 months. LPA advised Licensee, 15 minute sleep check shall be maintained for infants 0 to 24 months.
Overnight Care: There is no overnight care provided at the moment. LPA discussed the following: Licensee is aware that they must remain awake while children are awake. If children sleep in separate area from licensee, the door must remain open. If licensee cannot hear children when they wake up, video or audio device can be used.
LPA reviewed children's records. Children's records were incomplete. Three out of five children present did not have a record to review.

SUPERVISOR'S NAME: Valarie Cook	TELEPHONE: (323) 513-3828
LICENSING EVALUATOR NAME: Jeanette Estrada	TELEPHONE: (323) 229-6521
LICENSING EVALUATOR SIGNATURE:	DATE: 06/07/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/07/2023

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 CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME: CALDERON FAMILY CHILD CARE	FACILITY NUMBER: 198016949
	VISIT DATE: 06/07/2023

NARRATIVE

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Staff records were reviewed: Licensee's and Assistant's first aid/cpr certification issued by the American Heart Association expires in March 2024. Licensee and Staff 1 had proof of TB clearance. Licensee had proof of required immunization against measles and pertussis. Assistant did not have proof of immunization against measles and pertussis. Both Licensee and Assistant did not have a current Mandated Reporter for child care providers training certificate completed.
During inspection the children present were observed to be treated with dignity and respect, they were observed to be receiving safe, healthful and comfortable accommodations, furnishings and equipment, and were free from corporal and/or unusual punishment.
Incidental Medical Services (IMS): Incidental Medical Services (IMS) policy was discussed. Per Licensee, no children enrolled require medication. Per Licensee, medication would be kept in a cabinet in the garage. 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 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 athttps://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep 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.

SUPERVISOR'S NAME: Valarie Cook	TELEPHONE: (323) 513-3828
LICENSING EVALUATOR NAME: Jeanette Estrada	TELEPHONE: (323) 229-6521
LICENSING EVALUATOR SIGNATURE:	DATE: 06/07/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/07/2023

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 06/07/2023 03:18 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 CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME: CALDERON FAMILY CHILD CARE	FACILITY NUMBER: 198016949
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 06/07/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

HSC

1597.543

Licensure Requirements

Every family day care home for children shall have one or more carbon monoxide detectors in the facility that meet the standards established in Chapter 8 (commencing with Section 13260) of Part 2 Division 12. The department shall account for the presence of these detectors during inspections. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation], the licensee did not comply with the section cited above. A carbon monoxide detector was not present in the facility which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 06/07/2023
	Plan of Correction
1 2 3 4	Cleared during visit: Licensee had a combination carbon monoxide/smoke detector purchased and delivered to the home during the inspection. Detector is operable.

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
1 2 3 4	Based on observation], the licensee did not comply with the section cited above. LPA did not observe an operable smoke detector in the facility. LPA observed the fire extinguishers in the facility were last serviced in March 2022 which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 06/14/2023
	Plan of Correction
1 2 3 4	Deficiency partially cleared during visit: Licensee had a combination carbon monoxide/smoke detector purchased and delivered to the home during the inspection. Detector is operable. Licensee will have fire extinguishers serviced or new fire extinguishers will be purchased. Proof of service of purchase will be submitted via picture.

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: Valarie Cook	TELEPHONE: (323) 513-3828
LICENSING EVALUATOR NAME: Jeanette Estrada	TELEPHONE: (323) 229-6521
LICENSING EVALUATOR SIGNATURE:	DATE: 06/07/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/07/2023

LIC809 (FAS) - (06/04)

Page: 4 of 11

Document Has Been Signed on 06/07/2023 03:18 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 CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME: CALDERON FAMILY CHILD CARE	FACILITY NUMBER: 198016949
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 06/07/2023

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
1 2 3 4	Based on record review and interview], the licensee did not comply with the section cited above in 2 out of 2 staff files reviewed (Licensee and Assistant) which did not contain a current mandated reporter certificate which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 06/28/2023
	Plan of Correction
1 2 3 4	Per Licensee, mandated reporter training will be completed by herself and Assistant. Proof of certificate for child care providers will be submitted via picture.

Type B

Section Cited

HSC

1597.622(a)(1)

General Provisions and Definitions

(1) Commencing September 1, 2016, a person shall not be employed or volunteer at a family day care home if he or she has not been immunized against influenza, pertussis, and measles. Each employee and volunteer shall receive an influenza vaccination between August 1 and December 1 of each year. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on record review], the licensee did not comply with the section cited above in 1 out of 2 staff files reviewed which did not contain proof of immunization record which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 06/28/2023
	Plan of Correction
1 2 3 4	Licensee will have assistant obtain copy of immunization record for measles, pertussis and flu. Proof will be provided via picture.

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: Valarie Cook	TELEPHONE: (323) 513-3828
LICENSING EVALUATOR NAME: Jeanette Estrada	TELEPHONE: (323) 229-6521
LICENSING EVALUATOR SIGNATURE:	DATE: 06/07/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/07/2023

LIC809 (FAS) - (06/04)

Page: 5 of 11

Document Has Been Signed on 06/07/2023 03:18 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 CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME: CALDERON FAMILY CHILD CARE	FACILITY NUMBER: 198016949
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 06/07/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

102421(a)

Child's Records

(a) The licensee shall maintain, in each child's record, the signed and dated notice form required in Section 102419(d). This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on record review, the licensee did not comply with the section cited above in 5 out of 5 children's records which did not contain the required documents which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 06/28/2023
	Plan of Correction
1 2 3 4	Licensee will have children's files completed. Proof of correction will be provided via picture.

Section Cited


	Deficient Practice Statement
1 2 3 4
	POC Due Date:
	Plan of Correction
1 2 3 4

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: Valarie Cook	TELEPHONE: (323) 513-3828
LICENSING EVALUATOR NAME: Jeanette Estrada	TELEPHONE: (323) 229-6521
LICENSING EVALUATOR SIGNATURE:	DATE: 06/07/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/07/2023

LIC809 (FAS) - (06/04)

Page: 6 of 11

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: CALDERON FAMILY CHILD CARE	FACILITY NUMBER: 198016949
	VISIT DATE: 06/07/2023

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.

The deficiencies listed on the following pages were observed by the LPA and are being cited in accordance with California Code of Regulations Title 22. Five type B deficiencies are being issued today. Please see attached LIC 809-Ds for citations. Deficiencies that are being cited need to be cleared to protect the children’s health & safety.

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

SUPERVISOR'S NAME: Valarie Cook	TELEPHONE: (323) 513-3828
LICENSING EVALUATOR NAME: Jeanette Estrada	TELEPHONE: (323) 229-6521
LICENSING EVALUATOR SIGNATURE:	DATE: 06/07/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/07/2023

LIC809 (FAS) - (06/04)

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