198019145-6-15-2023-54-CC-AESA-CSTW54-20230615165832

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 198019145
Report Date: 06/15/2023
Date Signed: 06/15/2023 04:58:39 PM

Document Has Been Signed on 06/15/2023 04:58 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 S WEST, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME:	RODRIGUEZ FAMILY CHILD CARE		FACILITY NUMBER:	198019145
ADMINISTRATOR:	ROXANA R. & JACQUELINE G.		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(562) 281-9027
CITY:	BELLFLOWER	STATE: CA	ZIP CODE:	90706
CAPACITY:	14	CENSUS: 7	DATE:	06/15/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	02:50 PM
MET WITH:	Licensee Roxana Rodriguez & Co- Licensee Jacqueline Gonzalez		TIME COMPLETED:	05:15 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) Austin Estrada conducted an unannounced required 1-year inspection at the above facility. LPA met with the Licensee Roxana Rodriguez and informed her of the purpose for the visit. LPA provided the inspection Entrance Checklist (LIC 126). Licensee guided LPA on a tour of the facility. There were 7 children present during the inspection. All adults present during the inspection have obtained a criminal record clearance or exemption. Individuals residing in the home have been discussed and noted. Licensee provides care to children ages newborn to 12 years old and operation days/ hours are Monday through Friday 7:00 AM to 5:30 PM. Co- Licensee Jacqueline Gonzalez arrived at a later time. This is a single-story home which consists of 3 bedrooms, 1 bathroom, kitchen, laundry room, living room, front yard, backyard (fenced), and 2 detached garages. Areas on limits to children in care include the living room, back yard (fenced), and bathroom. The children use the bathroom located in the hallway. The restroom was observed safe and sanitary. Per Licensee, areas off limits to children include 3 bedrooms, kitchen, laundry room, 2 detached garages and front yard. 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 reviewed required posted documentation for Facility License, Publication (PUB) 394- Notification of Parent Rights and Licensing Form (LIC) 9148- Earthquake Preparedness form. All documents were observed to be posted in the living room. Facility records were reviewed for LIC 9040- Facility Roster, LIC 610A- Emergency Disaster Plan and Verification of Disaster and Fire Drills. The last drill was conducted on 6/8/23. All documents were observed during the inspection. There is an operable carbon monoxide detector and a smoke detector in the home. A fully charged Fire extinguisher (2A10BC) was observed and last serviced on 2/3/23. The home maintains telephone service (landline/mobile). LPA observed cleaning compounds and sharp objects such as knives located in the off-limits kitchen area inaccessible to children in care. Per Licensee, no children require medication. Per Licensee there are no poisons stored in the home. LPA advised Licensee that all poisons must be

SUPERVISOR'S NAME: Valarie Cook	TELEPHONE: (323) 9813362
LICENSING EVALUATOR NAME: Austin Estrada	TELEPHONE: (323) 981-3350
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
MONTEREY PARK S WEST, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME: RODRIGUEZ FAMILY CHILD CARE	FACILITY NUMBER: 198019145
	VISIT DATE: 06/15/2023

NARRATIVE

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locked away, not only inaccessible. Isolation area for sick children waiting to be picked up is in the living room, away from the other children. Per Licensee there are no firearms or weapons stored in the home.
Food is provided by Licensee. LPA advised Licensee if children bring food from home it must be labeled with the child’s name and properly stored or refrigerated.
The home is observed to be clean and orderly. There are toys and other age-appropriate materials available for children. LPA observed sleeping cots available for children to use. Per Licensee, children bring their own bedding sheets, but the bedding sheets are stored and washed at the facility weekly. LPA observed a fireplace in the living room. Cubbies have been placed in front of the fireplace making it inaccessible to children in care.
The outdoor play area was observed to be fenced and contain toys and other age- appropriate materials available for children. Per Licensee, children are supervised while playing outside. LPA observed 2 detached garages located in the backyard. Both Garages were observed to be locked. Per Licensee, children use part of the backyard for outdoor play. LPA observed a detachable fence that separates the on limits areas from the off-limits areas from in the backyard. LPA did not observe any pools, spas, or other bodies of water. During the inspection, children present was observed to be treated with dignity and respect, observed to be receiving safe, healthful, and comfortable accommodations, furnishings, and equipment, and free from corporal and/or unusual punishment.
Children’s records were reviewed for (LIC) 282- Affidavit Regarding Liability Insurance, Immunization Records, LIC 700- Identification and Emergency Information, LIC 627- Consent for Medical Treatment, LIC 995A Notification of Parents’ Rights, LIC 9227- Infant sleep form (0-12 months, and documentation of 15-minute Infant Sleep Check (0-24 months). All records were observed to be complete.
Personnel 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, and LIC 9108- Statement of Child and Mandated Reporter Training Certificate. LPA observed Licensee’s and Co-Licensee’s CPR/First Aid and Mandated Reporter Training Certificate to be current. All records were observed to be complete.
Infant Care: Licensees do not care for any infants currently. LPAs observed one crib in the living room. LPA reviewed Safe sleep regulations with Licensee, including LIC 9227 (Infant Sleep Plan) for infants under 12 months and 15-minute sleep check documentation for infants 0-24 months. LPA 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

SUPERVISOR'S NAME: Valarie Cook	TELEPHONE: (323) 9813362
LICENSING EVALUATOR NAME: Austin Estrada	TELEPHONE: (323) 981-3350
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
MONTEREY PARK S WEST, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME: RODRIGUEZ FAMILY CHILD CARE	FACILITY NUMBER: 198019145
	VISIT DATE: 06/15/2023

NARRATIVE

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an additional resource. LPA provided a copy of PIN 20-24-CCP: Recently Approved Safe Sleep Regulations in Effect.
Overnight Care: Per Licensee, there is no overnight care is not provided at the moment.
Incidental Medical Services (IMS): 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 Center and the ADA, available at: http://www.ada.gov/childqanda.htm
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.
LPA advised Licensee that all adults age 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.
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.
Based on the LPA’s observation and record review, the Licensee is in compliance with the California Title 22 Regulations. Therefore, there are no deficiencies being issued today, 6/15/23.
An exit interview was conducted, and report was reviewed with Co-Licensee, Jacqueline Gonzalez.
A notice of site visit was given and must remain posted for 30 days. Failure to maintain posting as required will result in a $100.00 civil penalty. Appeal rights were discussed and provided to the Licensee.

SUPERVISOR'S NAME: Valarie Cook	TELEPHONE: (323) 9813362
LICENSING EVALUATOR NAME: Austin Estrada	TELEPHONE: (323) 981-3350
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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