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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198019446
Report Date: 06/16/2023
Date Signed: 06/16/2023 01:22:31 PM


Document Has Been Signed on 06/16/2023 01:22 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 CNTR DR. 200-B
MONTEREY PARK, CA 91754



FACILITY NAME:CUERVO & ESCAMILLA FAMILY CHILD CAREFACILITY NUMBER:
198019446
ADMINISTRATOR:G. CUERVO & L. ESCAMILLAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(818) 397-4038
CITY:MONTEBELLOSTATE: CAZIP CODE:
90640
CAPACITY:14CENSUS: 6DATE:
06/16/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
08:40 AM
MET WITH:Licensee Lorena Valentina Escamilla TIME COMPLETED:
01:35 PM
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 This inspection was conducted in Spanish
Licensing Program Analyst (LPA) Veronica Martinez Garza conducted an unannounced 1-year required inspection at the above facility on 06/16/23 at 08:40 a.m. A COVID risk assessment was conducted upon entry- appropriate PPE was used. LPA met with Lorena Valentina Escamilla, Licensee who guided analyst on a tour of the facility. There were 06 children present during this inspection. Per licensee, 16 children are enrolled. Present during the inspection was the Licensee’s husband (Licensee), licensee’s assistant, Licensee’s mother-in-law, Licensee’s son and Licensee’s cousin.

Operation hours are Monday – Saturday 06:00 a.m. – 06:00 p.m.

This is a two-story home which consists of 4 bedrooms, 3 bathrooms, living room, dining room, playroom #1, playroom #2, kitchen, garage, and back yard (fenced). Per Licensee, family members residing in the home are 6 adults and 0 minors. Individuals living in the home are identified on the attached LIC811.

Areas accessible to children include playroom #1 and playroom #2, 1 bathroom located in playroom #1, and back yard (fenced) for play. The bathroom children use was observed to be safe and sanitary.
Per licensee, areas off limits to children and parents include 4 bedrooms, 2 bathrooms, kitchen, living room, dining room, and garage. Per licensee, there are no pets on the premises.

LPA toured all areas identified on the facility sketch used by children during this visit and were inspected for safety, comfort, and cleanliness. LPA observed safe toys, play equipment and materials for children. Napping: LPA observed appropriate napping equipment: cribs located in playroom #1. LPA observed that cribs are free from loose articles and objects. There are no objects hanging above or attached to the side of the cribs. LPA observed that the cribs do not hinder the entrance or exit to and from the space they are sleeping in. Mattresses were observed to be firm and covered with a fitted sheet that is appropriate to the mattress size. Per licensee, children nap in the playroom #2. The licensee does understand that licensing staff may have access to off-limit areas during inspection visit if necessary.
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SUPERVISOR'S NAME: Ana ChicoTELEPHONE: (323) 981-3374
LICENSING EVALUATOR NAME: Veronica Martinez-GarzaTELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:
DATE: 06/16/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/16/2023
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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Document Has Been Signed on 06/16/2023 01:22 PM - It Cannot Be Edited

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: CUERVO & ESCAMILLA FAMILY CHILD CARE
FACILITY NUMBER: 198019446

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/16/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
102370(d)(1)
Criminal Record Clearance
(d) All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1596.871 shall prior to working, residing or volunteering in a licensed facility: (1) Obtain a California clearance or a criminal record exemption as required by the Department or

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, interview, and record review, the licensee did not comply with the section cited above in Licensee did not ensure that her adult son received a fingerprint clearance. LPA determined through Guardian and Licensing Information System (LIS) that Licensee's son does not have a fingerprint clearance status is which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 06/16/2023
Plan of Correction
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Per Licensee, she will ensure that all adults receive a fingerprint clearance prior to being present in the home. Licensee stated that her son will submit a new request for fingerprints and will ensure that he is fingerprinted for a Family Day Care
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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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: Ana ChicoTELEPHONE: (323) 981-3374
LICENSING EVALUATOR NAME: Veronica Martinez-GarzaTELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:
DATE: 06/16/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/16/2023
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 06/16/2023 01:22 PM - It Cannot Be Edited

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: CUERVO & ESCAMILLA FAMILY CHILD CARE
FACILITY NUMBER: 198019446

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/16/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102416(c)
Personnel Requirements
(c) The licensee and other personnel as specified shall complete training on preventive health practices, including pediatric cardiopulmonary resuscitation and pediatric first aid, pursuant to Health and Safety Code Section 1596.866.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation and record review, the licensee did not comply with the section cited above in Both Licensee's and assistant have an expired Pediatric CPR/FA, which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 07/14/2023
Plan of Correction
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Per licensee, assistant and husband/licensee will renew Pediatric CPR/FA and will submit proof to LPA by POC due date
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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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: Ana ChicoTELEPHONE: (323) 981-3374
LICENSING EVALUATOR NAME: Veronica Martinez-GarzaTELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:
DATE: 06/16/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/16/2023
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 CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME: CUERVO & ESCAMILLA FAMILY CHILD CARE
FACILITY NUMBER: 198019446
VISIT DATE: 06/16/2023
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**Rooms that are off-limits need to be made inaccessible during operating hours**

Per licensee, food is provided to all children in care. There is telephone service via a cell phone. There is central ventilation and heating.

Detergents, cleaning compounds, medications, and other items which could pose a danger to children were observed to be inaccessible to children. The licensee states that there are no poisons in the home and understands that storage areas for poisons must be locked with a key or combination lock.

At 08:57 a.m., combined smoke and carbon monoxide detector were tested and are operable. The valve on the required 2A 10BC fire extinguisher indicates fully charged and was serviced on 06/08/23, as indicated on service tag. Per State Fire Marshall standards, fire extinguishers shall be serviced annually.

LPA observed a first aid kit readily available in the closet located by the entrance. Isolation area for sick children waiting to be picked up is in the playroom #2 of the home with supervision.

Per Licensee, there are no firearms or weapons stored in the home.

LPA observed the following required posted documentation in playroom #1 of the facility: Facility License, Publication (PUB) 394- Notification of Parent Rights and Licensing Form (LIC) 9148- Earthquake Preparedness form. LPA reviewed facility records for LIC 9040- Facility Roster, LIC 610- Emergency Disaster Plan and Disaster drill log. 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 12/22/22. Children's roster was reviewed and is current.

Currently children use the back yard for outdoor play with adequate shade and age-appropriate play equipment for children in care. LPA did not observe any objects that could be hazardous to children in care. Licensee understands that children should be supervised at all times.

LPA did not observe any pools, spas, hot tubs, fishponds, or similar bodies of water during the inspection.

Smoking is prohibited in a licensed Family Child Care Home. Per Licensee, no one smokes in the home.
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SUPERVISOR'S NAME: Ana ChicoTELEPHONE: (323) 981-3374
LICENSING EVALUATOR NAME: Veronica Martinez-GarzaTELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:

DATE: 06/16/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/16/2023
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 CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME: CUERVO & ESCAMILLA FAMILY CHILD CARE
FACILITY NUMBER: 198019446
VISIT DATE: 06/16/2023
NARRATIVE
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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, LIC 9227- Infant sleep form (0-12 months, and documentation of 15-minute Infant Sleep Check (0-24 months). Children's Child #1 thru 6 records were observed to be complete. LPA observed Child #6 (C6) was missing LIC 9227.

Staff records were reviewed for approved Pediatric First Aid and CPR certification, expires 06/15/2023. LPA observed both Licensee’s and assistant have an expired Pediatric CPR/FA. 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 are on file. Licensee's mandated reporter training expires 01/13/24.

AB1207 Mandated Child Abuse Reporting – On or before March 30, 2018, any person who works in a child care facility shall complete the training and renew the training every 2 years. Website provided: https://www.mandatedreporterca.com/training/child-care-providers

The licensee is operating within proper capacity and ratios. LPA observed licensee to be present at the home and providing adequate care and supervision.

Currently licensee does care for infants. 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-and-resources/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. LPA provided PIN 20-24-CCP SP, LIC 9227- Infant sleep form (0-12 months, and documentation of 15-minute Infant Sleep Check (0-24 months), and PUB 217 Never Shake a Baby Brochure. LPA provided consultation on LIC 9227.

No infant walkers, No baby bouncers, No Johnny jumpers, No exersaucers and any other item that falls into that category.
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SUPERVISOR'S NAME: Ana ChicoTELEPHONE: (323) 981-3374
LICENSING EVALUATOR NAME: Veronica Martinez-GarzaTELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:

DATE: 06/16/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/16/2023
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 CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME: CUERVO & ESCAMILLA FAMILY CHILD CARE
FACILITY NUMBER: 198019446
VISIT DATE: 06/16/2023
NARRATIVE
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Incidental Medical Services (IMS) policy was discussed. Per Licensee, there are no children on medications. 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

Licensee was reminded that all adults 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. LPA observed Licensee’ son does not have a fingerprint clearance. Licensee stated that her son turned 18 years old last year on 05/06/2022 and obtained his liveScan on 05/20/22 (Per Guardian). Licensee does not have proof of Request for LiveScan Service-Community Care Licensing LIC 9163 but did provide LPA with a letter from Department of Justice. LPA observed through Guardian that Licensee’s son’s fingerprints have not been cleared and have been “In Process” since 05/20/22. After LPM review of Department of Justice letter, it was determined that Licensee’s son obtained a liveScan for an adult program instead of Family Child Care. Per Licensee, son has been present in the home for only (1) day.

Community Care Licensing Division (CCLD) regularly sends information to licensed facilities, providers, and stakeholders by way of Provider Information Notices (PIN), Program Quarterly Update Newsletters and other important information communication platform. To receive important licensed-related information to licensed facilities, visit the CCLD Important Information website at https://www.cdss.ca.gov/inforesources/community-care-licensing/subscribe and select the Child Care option to receive email communication.

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
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SUPERVISOR'S NAME: Ana ChicoTELEPHONE: (323) 981-3374
LICENSING EVALUATOR NAME: Veronica Martinez-GarzaTELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:

DATE: 06/16/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/16/2023
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 CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME: CUERVO & ESCAMILLA FAMILY CHILD CARE
FACILITY NUMBER: 198019446
VISIT DATE: 06/16/2023
NARRATIVE
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LPA advised the licensee to access forms, regulations, and quarterly updates on the Child Care Licensing website at: www.ccld.ca.gov

The following deficiencies were cited in accordance with Title 22 of the California Code of Regulations and Health & Safety Codes. Please see 809D for documentation of deficiencies.

LPA Veronica MartinezGarza informed Licensee Lorena Valentina Escamilla that this report dated 06/16/23 document(s) 1 Type A citation(s) which shall be posted for 30 consecutive days as there is/are immediate risk(s) to the health, safety, or personal rights of children in care.

Also, LPA Veronica MartinezGarza informed the Licensee Lorena Valentina Escamilla to provide a copy of this licensing report dated 06/16/23 that documents any Type A citation(s) to parents/guardians of all children currently enrolled by the next business day or the next day the children are in care, and to any newly enrolled parents/guardians for 12 months from the date of this report. A signed Acknowledgement of Receipt of Licensing Report (LIC 9224), or other written statement, must be placed in the child's file for verification.

A notice of site visit was given and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.



Exit interview conducted and report was reviewed with Licensee Lorena Valentina Escamilla and provided Appeal Rights.


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SUPERVISOR'S NAME: Ana ChicoTELEPHONE: (323) 981-3374
LICENSING EVALUATOR NAME: Veronica Martinez-GarzaTELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:

DATE: 06/16/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/16/2023
LIC809 (FAS) - (06/04)
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