198017665-7-28-2021-33-CC-TRAO-C5CSM7-20210728135929

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 198017665
Report Date: 07/28/2021
Date Signed: 07/28/2021 01:59:34 PM

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:	ESQUEDA FAMILY CHILD CARE		FACILITY NUMBER:	198017665
ADMINISTRATOR:	ESQUEDA, MICHELLE		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(626) 332-3270
CITY:	WEST COVINA	STATE: CA	ZIP CODE:	91791
CAPACITY:	14	CENSUS: 10	DATE:	07/28/2021
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	12:00 PM
MET WITH:	Michelle Esqueda, Licensee		TIME COMPLETED:	02:00 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 Analyst (LPA) Thelma Razo conducted a Required - 1 Year inspection and met with Licensee Michelle Esqueda. LPA stated the purpose of the inspection and together with Licensee, guided analyst on a tour of the facility. Also present was Licensee's assistant, Fabiola Ortega. Per Licensee, there were two adult family members living in the home with one minor. LPA observed ten children in care, one of whom is an infant. All areas identified on the Facility Sketch were inspected: Off limit areas: Master bedroom with private bathroom, 2 bedrooms, garage. Day care areas: Living room, dining area, kitchen, common bathroom located in between the bedrooms and outdoor play area in the backyard. The home was inspected for safety, comfort, cleanliness, telephone service (land line available), heating and ventilation, inaccessibility to poisons, detergents, cleaning compounds, medicines, and hazardous items that can pose a danger to children. Per licensee, there are no weapons, firearms or bodies of water on the premises. There were safe toys, play equipment and materials observed for children. The valve on the required 2A 10BC fire extinguisher indicates it was fully charged, last serviced on 1/6/2021. Smoke and carbon monoxide detectors are combined and in operable condition. Licensee and assistant have current Pediatric First Aid and CPR which expires on 11/14/22. Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Family Child Care Homes Section. When any IMS is Page 1 of 3

SUPERVISOR'S NAME: Brandi VanOosten	TELEPHONE: (323) 981-3365
LICENSING EVALUATOR NAME: Thelma Razo	TELEPHONE: (323) 981-3387
LICENSING EVALUATOR SIGNATURE:	DATE: 07/28/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/28/2021

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 3

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: ESQUEDA FAMILY CHILD CARE	FACILITY NUMBER: 198017665
	VISIT DATE: 07/28/2021

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

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

SB792 (Immunization Requirements for Staff and Employees) was discussed with the Licensee. The Licensee and staff have required immunization documentation on file.

Individuals who are 18 years of age or older living in the home must obtain a criminal record clearance. Individuals within one month of their 18th birthday must be fingerprinted immediately. Failure to obtain a criminal record background check clearances prior to initial presence in the home will result in an immediate $100.00 dollar or more per day Civil Penalty.

No smoking, No infant walkers, No Johnny jumpers, No saucer chairs, No trampolines and any other item that falls into that category are not permitted in the facility. Effective January 1, 2010, licensees of family child care homes are required to ensure that at least one staff member with current training in pediatric first aid and pediatric CPR is on site at all times when children are present. Mandated Reporter Training was taken on 1/3/2020.by Licensee and assistant.

LPA reviewed and issued the LIC 311 - Forms/Records to Keep in Your Family Child Care Home.
CHILDREN’S FORMS/RECORDS, FACILITY FORMS/RECORDS and INFORMATION TO BE POSTED, Disaster drills, posting requirements, children records requirements, mandated child abuse and injury/ death reporting, criminal record transfer requirements, criminal record and child abuse clearances were also discussed during this visit.

LPA discussed and provided a copy of PIN 20-24-CCP Recently Approved Safe Sleep Regulations in Effect and LIC 9227 Individual Infant Sleeping Plan.

During this visit, LPA obtained an updated LIC279 and and LIC279B to reflect one additional adult family member living in the home with one minor. Child Care Facility Roster that lists all children enrolled in the day care was provided by Licensee.

Page 2 of 3

SUPERVISOR'S NAME: Brandi VanOosten	TELEPHONE: (323) 981-3365
LICENSING EVALUATOR NAME: Thelma Razo	TELEPHONE: (323) 981-3387
LICENSING EVALUATOR SIGNATURE:	DATE: 07/28/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/28/2021

LIC809 (FAS) - (06/04)

Page: 2 of 3

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: ESQUEDA FAMILY CHILD CARE	FACILITY NUMBER: 198017665
	VISIT DATE: 07/28/2021

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	No deficiencies were cited during this inspection. The Notice of Site Visit (LIC 9213) was posted – 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. An exit interview was held with Licensee, copy of this report provided. Page 3 of 3

SUPERVISOR'S NAME: Brandi VanOosten	TELEPHONE: (323) 981-3365
LICENSING EVALUATOR NAME: Thelma Razo	TELEPHONE: (323) 981-3387
LICENSING EVALUATOR SIGNATURE:	DATE: 07/28/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/28/2021

LIC809 (FAS) - (06/04)

Page: 3 of 3