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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198018715
Report Date: 08/01/2024
Date Signed: 08/01/2024 02:23:47 PM


Document Has Been Signed on 08/01/2024 02:23 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
MONTEREY PARK SW RO, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754



FACILITY NAME:PEREZ-OLIVERA FAMILY CHILD CAREFACILITY NUMBER:
198018715
ADMINISTRATOR:PEREZ, DAVID & OLIVERA, KFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(562) 291-0243
CITY:BELL GARDENSSTATE: CAZIP CODE:
90201
CAPACITY:14CENSUS: 8DATE:
08/01/2024
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
12:10 PM
MET WITH:Licensee Kendra Olivera & Licensee David PerezTIME COMPLETED:
02:43 PM
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Licensing Program Analyst (LPA) Anthony Padilla conducted a unannounced Annual Inspection on 8/1/24. Upon arrival at 12:10 PM LPA met with co-licensee Kendra Olivera and co-licensee David Perez, who provided tour of facility. LPA explained the purpose of inspection and provided the inspection Entrance Checklist, LIC 126. LPA inspected rooms/areas on the facility sketch in which child-care services are provided and to which children have access, as well as off limit area. Per licensee, the hours of operation are Monday-Friday 7:00am - 6:00pm. There were 8 children present, including 1 infant.

All adults present have obtained the required background clearance. Individuals residing in the home were discussed and noted. The home maintains telephone service via cell phone.

This is a two-story home consisting of 3 bedrooms and 1 1/2 baths. Care is provided in the living and dining room. There is a half bathroom adjacent to the dining area that is used by day care children.

Area off limits to children are: The 2nd floor (consists of three bedrooms and one bathroom), kitchen, laundry room and living room accessible through door in the kitchen. The second floor and kitchen are off limits. The home has air conditioning and heating. LPA did not observed any wall heaters or fire places during time of inspection.

All areas identified on the facility sketch that are accessible for children to use were inspected for safety, comfort, and cleanliness. The following was observed and reviewed during this inspection:



LPA observed the facility license, Publication (PUB) 394- Notification of Parent Rights and Licensing Form (LIC) 9148- Earthquake Preparedness form posted in the hallway leading to the main day care space for children. LPA observed completed facility records including; LIC 9040- Facility Roster, LIC 610- Facility Disaster Plan.

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SUPERVISOR'S NAME: Karen ChambersTELEPHONE: (323) 981-3368
LICENSING EVALUATOR NAME: Anthony PadillaTELEPHONE: 323-981-3350
LICENSING EVALUATOR SIGNATURE:
DATE: 08/01/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/01/2024
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
MONTEREY PARK SW RO, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME: PEREZ-OLIVERA FAMILY CHILD CARE
FACILITY NUMBER: 198018715
VISIT DATE: 08/01/2024
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Smoke and carbon monoxide detectors were tested and are operable. Fire extinguisher indicated fully charged and a receipt attached dated 7/28/23. at 1:00PM LPA issued a Technical Assistance (TA) for fire extinguisher. Licensee was reminded that fire extinguisher needs to be serviced yearly. Licensee states she will purchase a new fire extinguisher on the weekend and submit proof of purchase to LPA via email. The home is observed to be clean and orderly. There are toys and other age appropriate material available for children. LPA observed that kitchen and bathroom cabinets have safety locks making items inside inaccessible to children in care. The bathroom that children use is observed to be clean and free of hazards.
Licensee states that there are no poisons stored in the home and understands that all poisons must be lock, not only inaccessible to children.
Per Licensee there are no firearms or weapons stored in the home. Licensee states that there are no pets at the facility. LPA did not observe any weapons, fire arms, or pets during time of inspection.
Isolation area for sick children waiting to be picked up is in the area used for lunch time away from the other children.
Infant Care: 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, and provided PIN 20-24-CCP. Licensee states infants sleep in the living room where they are supervised by licensees, a play yard is available for infant under 12 months old.

Per licensee, they are not using the outdoor play area, all childcare activities take place indoors. Licensee states that weather permitting they will take the children to the local park (Hannon Park) for some outdoor play time. Facility does not have a pool or similar bodies of water. LPA did not observe any of these items during time of inspection.

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


Staff records were reviewed for approved Pediatric First Aid and CPR certification, LIC-501: Personnel
Record, LIC 508-Criminal Record Statement, LIC 9052- Employee Rights, Proof of immunizations against measles, pertussis and influenza or influenza declination, TB clearance or risk assessment, LIC 9108- Statement Acknowledging Requirement to Report Child Abuse and current Mandated Reporter Training Certificate which are indicated on LIC 859 report

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SUPERVISOR'S NAME: Karen ChambersTELEPHONE: (323) 981-3368
LICENSING EVALUATOR NAME: Anthony PadillaTELEPHONE: 323-981-3350
LICENSING EVALUATOR SIGNATURE:

DATE: 08/01/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/01/2024
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
MONTEREY PARK SW RO, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME: PEREZ-OLIVERA FAMILY CHILD CARE
FACILITY NUMBER: 198018715
VISIT DATE: 08/01/2024
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To improve the quality and value of the new inspection process, a survey may 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 CARE tools, please send email inquiries 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/inspection-process.

Licensee was reminded that all adults 18 and over living or working in the home, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, 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 for a maximum of 5 days or, if the penalty is for a repeat violation, for a maximum of 30 days 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-andresources/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.

Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02- CCP. 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: https://www.ada.gov/resources/child-care-centers/.

Licensee was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain child care by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.

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SUPERVISOR'S NAME: Karen ChambersTELEPHONE: (323) 981-3368
LICENSING EVALUATOR NAME: Anthony PadillaTELEPHONE: 323-981-3350
LICENSING EVALUATOR SIGNATURE:

DATE: 08/01/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/01/2024
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
MONTEREY PARK SW RO, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME: PEREZ-OLIVERA FAMILY CHILD CARE
FACILITY NUMBER: 198018715
VISIT DATE: 08/01/2024
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During the exit interview, the LICENSEE KENDRA OLIVERA, confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS.

LPA provided a copy of local Resource and Referral agencies with in the area to seek information with contracting families for enrollment.

At this time, the licensee is in compliance with California Title 22 Regulations. Therefore, there are no citations being issued today.

A notice of site visit was given and must remain posted for 30 days.

Exit interview conducted and report was reviewed with the licensee Kendra Olivera

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SUPERVISOR'S NAME: Karen ChambersTELEPHONE: (323) 981-3368
LICENSING EVALUATOR NAME: Anthony PadillaTELEPHONE: 323-981-3350
LICENSING EVALUATOR SIGNATURE:

DATE: 08/01/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/01/2024
LIC809 (FAS) - (06/04)
Page: 4 of 4