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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198019425
Report Date: 08/24/2021
Date Signed: 08/24/2021 11:52:37 AM

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:RIVERA GUERRA FAMILY CHILD CAREFACILITY NUMBER:
198019425
ADMINISTRATOR:ANA MARGARITA RIVERAGUERRAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(323) 738-9706
CITY:LOS ANGELESSTATE: CAZIP CODE:
90063
CAPACITY:14CENSUS: 4DATE:
08/24/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Ana Rivera Licensee TIME COMPLETED:
12:00 PM
NARRATIVE
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At 9:00 am Licensing Program Analysts (LPA) Roxana Lopez conducted an unannounced required 1 year inspection to the above facility. An attempted visit was made on 8/17/2021. A risk assessment was conducted and appropriate PPE was used. LPA met with Ana Rivera, Licensee who guided analysts on a tour of the facility. Also present during this inspection, was Destiny Guerra, Licensee’s daughter and assistant. Per Licensee, there are 10 children that are currently enrolled. A current children’s roster was available for review. There were 4 children present upon arrival.

The licensee states that 3 adults and no children currently live in the home. Per Licensee, she currently has one assistant. All adults present in the home have obtained a criminal record clearance or exemption prior to working, residing or volunteering in the licensed child care home. Licensee states that there are no firearms stored in the home.

This is a one story back home which consists of 3 bedrooms, 1 bathroom, kitchen, living room, front yard,back yard fence and garage. The children have access to 1 bedroom, 1 bathroom, living room, and fenced front yard for play. Per licensee, areas off limits to children and parents include: two bedrooms, kitchen, garage and back yard. All areas off limits were observed to lock and inaccessible to children in care. The LPA toured all areas used by children during this visit. The licensee provides food for children in care.

All areas identified on the facility sketch that are accessible for children to use were inspected for safety, comfort, and cleanliness. There is telephone service via a landline and a cellphone that is used. There is ventilation and heating. The following was observed and reviewed during this inspection.

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SUPERVISOR'S NAME: Brandi VanOostenTELEPHONE: (323) 981-3365
LICENSING EVALUATOR NAME: Roxana LopezTELEPHONE: (323) 854-5073
LICENSING EVALUATOR SIGNATURE:

DATE: 08/17/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/17/2021
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 5
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: RIVERA GUERRA FAMILY CHILD CARE
FACILITY NUMBER: 198019425
VISIT DATE: 08/24/2021
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Detergents, cleaning compounds, medications, and other items which could pose a danger to children were not observed to be accessible to children. Poisons are locked in a cabinet in the laundry room located in the off limits backyard. The restroom that children use was observed to be safe and sanitary.

LPA observed an open face heater in the living room inaccessible to children. The valve on the required 2A 10BC fire extinguisher was last serviced on 6/21/2018, as indicated on service tag. Smoke and carbon monoxide detectors were tested and are operable. All homes shall conduct fire and disaster drills at least once every six months, and document the date and time of each drill. Last drill documented was conducted on 08/24/2021.

Emergency Disaster Plan, Parent’s Rights Poster and the Facility License were observed to be posted in the living room and entrance of the facility.

The home is observed to be clean and orderly. There are toys available for children. Appropriate sleeping arrangements in form of mats and playpens were observed.

Licensee states that she is not currently caring for infants. LPA advised the licensee and assistant about the new sleeping regulation and discussed the LIC 9227 Individual Sleep Plan in case she enrolls infants.

LPA did not observe the following items during the inspection: Infant Walkers, Johnny Jumpers, Saucer Chairs, Trampolines and/or any other item that fall into these categories are not permitted in a family child care facility.

Smoking is prohibited in a licensed Family Child Care Home. Per Licensee, no one smokes in the home.

Currently, children are using the front yard for outdoor play time. The outdoor play area was observed to be fenced. LPA observed that the outdoor yard has toys and other materials for children to play with. LPA did not observe any objects that can pose a danger to children on the outdoor yard.

There are 3 dogs on the premises. Licensee states that the dogs remained in the off limits backyard during operating hours.
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SUPERVISOR'S NAME: Brandi VanOostenTELEPHONE: (323) 981-3365
LICENSING EVALUATOR NAME: Roxana LopezTELEPHONE: (323) 854-5073
LICENSING EVALUATOR SIGNATURE:

DATE: 08/24/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/24/2021
LIC809 (FAS) - (06/04)
Page: 2 of 5
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: RIVERA GUERRA FAMILY CHILD CARE
FACILITY NUMBER: 198019425
VISIT DATE: 08/24/2021
NARRATIVE
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The licensee is observed to be operating within the license capacity limitations.

At 10:00 am children’s records were reviewed, including emergency information and were observed to be complete.

The licensee and other personnel have completed training on preventive health practices including Pediatric First Aid and CPR. The licensee's and assistants Pediatric First Aid and CPR expired on 4/14/2018. There are first aid supplies available. The licensee does have proof of immunization against influenza, pertussis, and measles.

LPA did not observed the Mandated Reporter AB 1207 compliant Child Care Training Certificate on file.

LPA issued a Confidential Names List (LIC 811) to the licensee which documents staff and children’s files reviewed during this inspection.

Incidental Medical Services (IMS):
The licensee states that she will provide IMS. Per licensee, there are no children enrolled that require IMS at this time. 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 to access forms, regulations and quarterly updates on line at: www.ccld.ca.gov.

LPA consulted with Licensee and assistant regarding COVID-19 health and safety guidelines on this date. LPA observed COVID- 19 postings posted in the day care on this date. During this inspection LPA discussed Social and Physical Distancing Guidance And Healthy Practices For Child Care Facilities In Response To The Global Coronavirus (COVID-19) Pandemic Written In Collaboration With The California Department Of Education.
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SUPERVISOR'S NAME: Brandi VanOostenTELEPHONE: (323) 981-3365
LICENSING EVALUATOR NAME: Roxana LopezTELEPHONE: (323) 854-5073
LICENSING EVALUATOR SIGNATURE:

DATE: 08/24/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/24/2021
LIC809 (FAS) - (06/04)
Page: 3 of 5
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: RIVERA GUERRA FAMILY CHILD CARE
FACILITY NUMBER: 198019425
VISIT DATE: 08/24/2021
NARRATIVE
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The following was discussed with the Licensee:

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 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.

In the absence of the Licensee, a qualified adult must be present supervising the children; a qualified adult is an individual who has a valid and current adult/infant CPR & Pediatric First Aid certification and a valid criminal record clearance associated to the facility license.

Based on the LPA’s observations and records review, the following deficiencies listed on the attached LIC 809D (deficiency page) are being cited in accordance with California Code of Regulations Title 22. Deficiencies that are being cited need to be cleared to protect the children’s health & safety.



The Notice of Site Visit (LIC 9213) – must remain posted for 30 days during the hours of operation after each site visit made by a licensing representative. Failure to maintain posting as required will result in a civil penalty of $100.00.

Exit interview was conducted with Ana Rivera, Licensee and Destiny Guerra Daughter and Assistant, including, but not limited to Provider Rights, Appeal Procedures and Agencies Consultative Role and their signature on this form acknowledges receipt of these forms.

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SUPERVISOR'S NAME: Brandi VanOostenTELEPHONE: (323) 981-3365
LICENSING EVALUATOR NAME: Roxana LopezTELEPHONE: (323) 854-5073
LICENSING EVALUATOR SIGNATURE:

DATE: 08/24/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/24/2021
LIC809 (FAS) - (06/04)
Page: 4 of 5
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: RIVERA GUERRA FAMILY CHILD CARE
FACILITY NUMBER: 198019425
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/24/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
09/07/2021
Section Cited

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102417:(g)(1) Operation of a Family Child Care Home- The home shall be free from defects or conditions which might endanger a child. Safety precautions shall include but not be limited to:The home shall contain a fire extinguisher... which meet standards established by the State Fire Marshal.
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This requirement was not met as evidenced by: Lpa's observation the required 2A10BC Fire Extingusiher was las service on
6/21/2018 as indicated on the tag. This poses a potential risk to the health and safety of children in care.
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Type B
09/07/2021
Section Cited

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1596.8662(4)(b)(1) On or before March 30, 2018, a person who is a licensed child care provider or employee of a licensed child day care facility shall complete the mandated reporter training... (2) and (3) of subdivision (a), and shall complete renewal mandated reporter training every two years
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This requirement is not met as evidence by: LPA's observations and interviews Both Licensee and assistant did not have proof of the required AB1207 certificate
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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: Brandi VanOostenTELEPHONE: (323) 981-3365
LICENSING EVALUATOR NAME: Roxana LopezTELEPHONE: (323) 854-5073
LICENSING EVALUATOR SIGNATURE:
DATE: 08/24/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/24/2021
LIC809 (FAS) - (06/04)
Page: 5 of 5