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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198019269
Report Date: 11/19/2019
Date Signed: 11/19/2019 04:35:44 PM

COMPREHENSIVE INSPECTION
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:NEVAREZ FAMILY CHILD CAREFACILITY NUMBER:
198019269
ADMINISTRATOR:MARYANA NEVAREZFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(562) 704-2487
CITY:LONG BEACHSTATE: CAZIP CODE:
90815
CAPACITY:14CENSUS: 11DATE:
11/19/2019
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
02:38 PM
MET WITH:Maryana NevarezTIME COMPLETED:
04:49 PM
NARRATIVE
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ANNUAL RANDOM INSPECTION CONDUCTED IN ENGLISH

An Annual Random inspection was conducted by Licensing Program Analyst (LPA), Timothy Fields and Jose Guzman. LPA was guided on a tour of the facility by Maryana Nevarez. This is a single story home with three bedrooms and two bathrooms. Residing in the home are two adults and two children. Upon arrival LPAs observed licensee's assistant present with 11 day care children in the accessible outdoor activity space. A second adult and licensee's child arrived shortly after LPAs.

Care is mainly provided in the converted garage and accessible front yard. Children do not eat or sleep in the activity space. The kitchen and dining room is accessible for eating and all three bedrooms are accessible for sleeping. Graco and Even grow pack-and-plays are used for napping. The living room is accessible through passing otherwise off limits to children in care.

LPAs observed an fire place and wall heater in the living room and dining area that does not have a barricade. The master bathroom is off limits. Children use the guest bathroom located in the hallway. Licensee's two dogs are isolated in the backyard which is inaccessible. There were no detached sheds observed. All rooms that are off-limits need to be made inaccessible during operating hours. Licensee complied with inspection authority.

Per licensee there are no weapons or firearms in the home. Telephone service was in operable condition. There are no *swimming pool or spa on the premises. The front yard is adequately fenced. There are age appropriate toys and equipment on the premises.The smoke detectors, carbon monoxide detector, and fire extinguisher (2A 10BC) are in operable condition.
SUPERVISOR'S NAME: Trevino CochranTELEPHONE: (323) 981-3350
LICENSING EVALUATOR NAME: Timothy FieldsTELEPHONE: (323) 981-3431
LICENSING EVALUATOR SIGNATURE:

DATE: 11/19/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/19/2019
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 6
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: NEVAREZ FAMILY CHILD CARE
FACILITY NUMBER: 198019269
VISIT DATE: 11/19/2019
NARRATIVE
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-Pediatric CPR and First Aid expires: Assistant 10/17/2020. Licensee's certification expired: 5/2019
-Child Care Roster, Disaster Plan, and Children's Records were discussed.
-Children records and required licensing forms were discussed as well as mandated child abuse reporting and criminal records clearance (finger prints and child abuse clearance) requirement. Licensee states she does not carry liability insurance.

The following was discussed: Individuals who are 18 years of age or older living or working in the home must be finger print cleared prior to licensure or living/working in the facility. Individuals within one month of their 18th birthday must be fingerprinted immediately. An immediate $100 per day Civil Penalty for a maximum of five days for the first violation and a maximum of 30 days for subsequent violations per individual will be issued. If an individual has a clearance with the Department, a criminal record clearance may be transferred. LIC 9182 Criminal Background Clearance Transfer Request may be used.

During operating hours no smoking, no infant walkers, Johnny jumpers, Exersaucers and any other item that falls into that category are allowed in the facility. Earthquake, fire disaster, and safety drill posting requirement were explained in detail on this date.

Licensee has been advised of the following:
· Dog(s) and or pets should be isolated from children in care.
· It is recommended that a First Aid kit be available on premises.
· Outdoor supervision required at all times. If outdoor area not adequately fenced provider must be with children at all times when outdoors.

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. Required measles, pertussis, and influenza vaccinations were discussed.
SUPERVISOR'S NAME: Trevino CochranTELEPHONE: (323) 981-3350
LICENSING EVALUATOR NAME: Timothy FieldsTELEPHONE: (323) 981-3431
LICENSING EVALUATOR SIGNATURE:

DATE: 11/19/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/19/2019
LIC809 (FAS) - (06/04)
Page: 6 of 6
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: NEVAREZ FAMILY CHILD CARE
FACILITY NUMBER: 198019269
VISIT DATE: 11/19/2019
NARRATIVE
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The following deficiencies are cited in accordance with Title 22 of California Code of Regulations and discussed with licensee:
  1. LPAs observed rodent pesticides underneath unlocked kitchen sink as well as accessible bleach and laundry detergent in the laundry area adjacent to the kitchen.
  2. Licensee had five infants in care at the time of arrival.
  3. Licensee wall heater and fire place were not barricaded.
  4. Licensee and licensee's assistant does not have proof of completing the mandated reporter training. www.mandatedreporterca.com.
  5. Licensee nor her assistant have records of their vaccination.

See 809 D attached.
The licensee shall require each recipient (Parent/guardian) of a licensing report documenting a
Type A citation resulting from a compliant investigation and any licensing document pertaining to a conference, and any summary of an accusation indicating the Department’s intent to revoke a license, to sign LIC 9224 form, indicating that he or she has received the documents and the date they were received. The licensee shall keep verification of receipt in each child’s file.

Online copy of the Child Care Provider’s Guide to Safe Sleep, by American Academy of Pediatrics can be downloaded at: https://www.cdph.ca.gov/programs/SIDS/Documents/SIDSchildcaresafesleep.pdf

Exit interview conducted with licensee. Appeal Rights provided and explained. Notice of Site Visit must be posted for (30) days. Failure to do so may result in a $100.00 civil penalty.

Web site address to order forms: http://www.dss.cahwnet.gov/cdssweb/On-lineFor_293.htm#l
INTERNET ADDRESS: http://www.ccld.ca.gov – To access licensing forms, updates and Title 22.
SUPERVISOR'S NAME: Trevino CochranTELEPHONE: (323) 981-3350
LICENSING EVALUATOR NAME: Timothy FieldsTELEPHONE: (323) 981-3431
LICENSING EVALUATOR SIGNATURE:

DATE: 11/19/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/19/2019
LIC809 (FAS) - (06/04)
Page: 2 of 6
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: NEVAREZ FAMILY CHILD CARE
FACILITY NUMBER: 198019269
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/19/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
11/19/2019
Section Cited

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Operation of a Family Child Care Home:

Poisons, detergents, cleaning compounds, medicines, firearms and other items which could pose a danger if readily available to children shall be stored where they are inaccessible to children.
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The requirement is not met as evidenced by LPAs observing rodent pesticides underneath unlocked kitchen sink as well as accessible bleach and laundry detergent in the laundry area adjacent to the kitchen. This poses an immediate risk to the health and safety of children in care.
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Type A
11/21/2019
Section Cited

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Staffing Ratio and Capacity
Twelve children, no more than four of whom may be infants;

The requirement is not met as evidenced by Licensee having five infants in care at the time of arrival. This poses an immediate risk to the health and safety of children in care.
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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: Trevino CochranTELEPHONE: (323) 981-3350
LICENSING EVALUATOR NAME: Timothy FieldsTELEPHONE: (323) 981-3431
LICENSING EVALUATOR SIGNATURE:
DATE: 11/19/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/19/2019
LIC809 (FAS) - (06/04)
Page: 3 of 6
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: NEVAREZ FAMILY CHILD CARE
FACILITY NUMBER: 198019269
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/19/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
11/26/2019
Section Cited

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Operation of a Family Child Care Home:

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 Marshal.
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The requirement is not met as evidenced by Licensee's wall heater and fire place were not barricaded. This poses a potential risk to the health and safety of children in care.
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Type B
11/26/2019
Section Cited

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Availability of information regarding detecting and reporting child abuse and neglect; training for mandated reporter who is licensed day care provider, administrator, or employee of a licensed child day care facility; proof of completion.

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The requirement is not met as evidenced by Licensee and licensee's assistant not having proof of completing the mandated reporter training. This poses a potential risk to the health and safety of children in care.
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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: Trevino CochranTELEPHONE: (323) 981-3350
LICENSING EVALUATOR NAME: Timothy FieldsTELEPHONE: (323) 981-3431
LICENSING EVALUATOR SIGNATURE:
DATE: 11/19/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/19/2019
LIC809 (FAS) - (06/04)
Page: 4 of 6
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: NEVAREZ FAMILY CHILD CARE
FACILITY NUMBER: 198019269
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/19/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
11/26/2019
Section Cited

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Employees or volunteers at family day care home; immunization requirements; records; exemptions
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
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and volunteer shall receive an influenza vaccination between August 1 and December 1 of each year. The requirement is not met as evidenced by Licensee nor her assistant having records of their vaccination. This poses an immediate risk to the health and safety of children in care.
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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: Trevino CochranTELEPHONE: (323) 981-3350
LICENSING EVALUATOR NAME: Timothy FieldsTELEPHONE: (323) 981-3431
LICENSING EVALUATOR SIGNATURE:
DATE: 11/19/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/19/2019
LIC809 (FAS) - (06/04)
Page: 5 of 6