198018312-10-19-2023-54-CC-WBIS-CWRRL4-20231019130631

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 198018312
Report Date: 10/19/2023
Date Signed: 10/19/2023 01:06:53 PM

Document Has Been Signed on 10/19/2023 01:06 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:	CIBRIAN FAMILY CHILD CARE		FACILITY NUMBER:	198018312
ADMINISTRATOR:	MARIA CIBRIAN		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(323) 835-6575
CITY:	HUNTINGTON PARK	STATE: CA	ZIP CODE:	90255
CAPACITY: 14	TOTAL ENROLLED CHILDREN: 14	CENSUS: 11	DATE:	10/19/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	10:55 AM
MET WITH:	Maria Cibrian		TIME COMPLETED:	01:20 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) Warren Birks conducted an unannounced Required - 1 Year inspection. LPA met with Licensee Maria Cibrian who guided LPA on a tour of the facility. Upon arrival, LPA observed Licensee and three cleared assistants providing care for 10 preschool children and one infant. Per Licensee there are 17 children enrolled attending at various times. Individuals residing in the home were noted. The children's roster is current. At Approximately 11:15am LPA conducted an inspection of all areas of the facility sketch. This is a one story home which consists of four bedrooms, four bathrooms, living room, kitchen, dining area, front yard, small den room, family room, Back room and garage. The Licensee uses the small den room, family room one bathroom and and backyard for child care. Areas accessible to children were inspected to ensure that they are clean and orderly with ventilation and heating for the safety of the children. There is a working telephone maintained in the home. Licensee has no pets at this time. LPA advised Licensee to provide extra care if she gets a pet as animals may be unpredictable. Detergents, cleaning compounds, medications, and other items which can pose a danger to children are inaccessible. LPA reminded Licensee to provide extra care and supervision for outdoor play. Licensee was also reminded to ensure that all medicines, chemicals, cleaners, paints, sharp objects, grills, propane, and similar hazardous items must be inaccessible at all times. Poisons must also be locked with a key or combination lock. Fire arms and pool regulations were discussed. Per Licensee there are no bodies of water and LPA did not observe any on the premises. The License, Parents Rights Poster, and Earthquake Preparedness was posted. The valve on the required 2A 10BC fire extinguisher indicates fully charged and is due for service in April 2024. Smoke and carbon monoxide detectors family room were tested and are in operable

SUPERVISORS NAME: Karen Chambers
LICENSING EVALUATOR NAME: Warren Birks
LICENSING EVALUATOR SIGNATURE:	DATE: 10/19/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/19/2023

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: CIBRIAN FAMILY CHILD CARE	FACILITY NUMBER: 198018312
	VISIT DATE: 10/19/2023

NARRATIVE

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condition. LPA observed the Licensee and staff has the current Mandated Reporter training which expires in 2025. LPA observed the Licensee and staff also have documentation indicating immunization regarding measles, pertussis and tuberculosis on file.

At approximately 12:00pm LPA reviewed five children's files which include the documentation such as: Parent's Rights, Personal, Affidavit for Liability insurance, Identification and Emergency, Consent for Emergency Treatment, Additional Children in Care and Immunization records. The Licensee also has 15 minute check safe sleep documents for one child under two.

The following was discussed: 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. LPA advised to ensure all adults that come into the home are fingerprint cleared and associated.

No smoking, No infant walkers, No Johnny jumpers, No saucer chairs, 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. Licensee's CPR expires in 2025.

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

LPA advised the Licensee that infants shall be placed on their backs for sleeping and shall be supervised. Infants shall be checked on every 15 minutes and document the child's condition. The LIC 9227 Individual Infant Sleeping The plan shall be completed for each infant up to 12 months of age. LPA discussed the form and explained that the LIC 9227 form that is available on CCLD website.

SUPERVISORS NAME: Karen Chambers
LICENSING EVALUATOR NAME: Warren Birks
LICENSING EVALUATOR SIGNATURE:	DATE: 10/19/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/19/2023

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: CIBRIAN FAMILY CHILD CARE	FACILITY NUMBER: 198018312
	VISIT DATE: 10/19/2023

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The Licensee was advised on the inaccessibility of hazards, Sudden Infant Death Syndrome (SIDS) and Never-Shake-a-Baby were discussed. LPA informed Licensee regarding PIN 20-24-CCP. LPA discussed LIC 311D - Forms/Records to Keep in Your Family Child Care Home. Mandatory Forms for the children’s files and staff files, requirements for fire drills, earthquake drills and documentation were discussed. Role and responsibilities of being a Mandated Reporter were reviewed. The Licensee was advised how to access forms and Regulations online at www.ccld.ca.gov. Licensee was made aware that it is his/her responsibility to know the regulations as well as anyone who assists in providing care.

LPA consulted and explained Child Abuse Reporting, Updated Parent’s Rights Poster with Complaint Hotline information, Never Shake a Baby, Sudden Infant Death Syndrome (SIDS), and Safe Sleeping practices which always Baby is sleeping on his/her back. Capacity Handout (Small & Large) was provided during this inspection. Any unusual incidents or injuries must be reported to the Department within 24 hours via telephone and within seven (7) days in writing (use LIC624B for written report). Mandated reporter training must be completed every 2 years. www.mandatedreporterca.com. Licensee and staff have the required Mandated Reporter training.

LPA informed Licensee information regarding with Safe Sleep PIN 20-24-CCP. LPA also discussed Entrance Checklist form, Capacity and Ratio, and Items not Permitted. LPA explained these regulations and advised Licensee to ensure that she provides care and supervision adhering to the information provided.

The Notice of Site Visit (LIC 9213) – 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. This report along with a copy of the appeal rights was provided. Exit interview was conducted with Licensee Maria Cibrian.

SUPERVISORS NAME: Karen Chambers
LICENSING EVALUATOR NAME: Warren Birks
LICENSING EVALUATOR SIGNATURE:	DATE: 10/19/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/19/2023

LIC809 (FAS) - (06/04)

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