198019786-10-8-2020-54-CC-MAYA-BU7L72-20201008082933

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 198019786
Report Date: 08/19/2020
Date Signed: 10/08/2020 08:30:07 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 CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME:	SANDOVAL FAMILY CHILD CARE		FACILITY NUMBER:	198019786
ADMINISTRATOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY:	8	CENSUS: 0	DATE:	08/19/2020
TYPE OF VISIT:	Case Management - Licensee Initiated	ANNOUNCED	TIME BEGAN:	05:15 PM
MET WITH:	Licensee, Janet Sandoval		TIME COMPLETED:	06:30 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	On August 19, 2020 at 5:15 PM, Licensing Program Analyst (LPA) Monique Ayala conducted an announced case management tele-inspection via Zoom Meeting with Licensee, Janet Sandoval. The purpose of the tele-inspection is due to a pending application for a capacity change. The inspection was conducted via Zoom Meeting due to the coronavirus (COVID-19) pandemic. The Licensee is requesting an increase in capacity from 8 to 14 children. The Department received a granted Fire Clearance for a capacity of 14 children. Members residing in the home are the Licensee, one other adult and three minor children. The operating hours are Monday to Friday from 7:30 AM to 5:30 PM. The Licensee is applying to care for children ages, 3 months to 12 years old. All areas identified on the facility sketch were virtually inspected. This facility is a single family home with a detached studio located in the backyard. The main house consists of two (2) bedrooms, one (1) bathroom, living room, dining room, kitchen, front yard, backyard (fenced), shed (located in the backyard) and garage. The detached studio located in the backyard consists of a playroom area, kitchen area and 1 bathroom. Above the studio and garage, there is a second floor house. LPA observed a child safety gate installed, making the stairs leading to the second floor house inaccessible to children. Per Licensee, the second floor house has a separate address to the family child care home. Per the Facility Sketch (LIC 999A), areas that are accessible to children include: the kitchen, living room, dining room and bathroom located inside the main house; the playroom area, kitchen area and bathroom located in the detached studio. Per Licensee, the children utilize the backyard (fenced) for outdoor activity. Per the LIC 999A, areas that are off limits to children include: 2 bedrooms located in the main house, shed (located in the backyard) and garage. Licensee was advised that areas that are off limits must be made inaccessible during operating hours.

SUPERVISOR'S NAME: Brandi VanOosten	TELEPHONE: (323) 981-3365
LICENSING EVALUATOR NAME: Monique Ayala	TELEPHONE: (323) 246-2016
LICENSING EVALUATOR SIGNATURE:	DATE: 08/19/2020

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/24/2020

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
CCLD Regional Office, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME: SANDOVAL FAMILY CHILD CARE	FACILITY NUMBER: 198019786
	VISIT DATE: 08/19/2020

NARRATIVE

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During the tele-inspection, LPA discussed Forms/Records to Keep in Your Family Child Care Home (LIC 311D) to the applicant. LPA also discussed reference material on the California Car Seat Law Changes (effective January 1, 2017), Effects of Lead Exposure, Shaken Baby Syndrome, Sudden Infant Death Syndrome (SIDS), safe sleep practices and COVID-19 guidance.

LPA observed the following information posted in the facility:
Emergency Disaster Plan (LIC 610A), Earthquake Preparedness Checklist (LIC 9148), Notification of Parents’ Rights Poster (PUB 394), and Facility License (LIC 203).

Facility Forms/Records to keep in your home:
1. Personnel Records as required in Title 22, Division 12, Chapter 3, Section 102416.1, including but not limited to, proof of current pediatric first aid, CPR, preventative health practices certificate, mandated reporter training certificate and criminal record information.
2. Unusual Incident/Injury Report (LIC 624B).
3. Child Care Facility Roster (LIC 9040).
4. Notice of Employee Rights (LIC 9052).
5. Statement Acknowledging Requirement to Report Suspected Child Abuse (LIC 9108).
6. Property Owner/Landlord Consent Form (LIC 9149).
7. Property Owner/Landlord Notification Form (LIC 9151).
8. A copy of your deed or lease/rental agreement.

The following was also discussed with the Licensee:
1. Individuals who are 18 years of age or older and 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.
2. 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 and Pediatric First Aid certification and a valid criminal record clearance associated to the facility license.
3. A current roster of children enrolled must be available and maintained for a period of 3 years, even after children are no longer attending the facility.

SUPERVISOR'S NAME: Brandi VanOosten	TELEPHONE: (323) 981-3365
LICENSING EVALUATOR NAME: Monique Ayala	TELEPHONE: (323) 246-2016
LICENSING EVALUATOR SIGNATURE:	DATE: 08/19/2020

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/24/2020

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 CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME: SANDOVAL FAMILY CHILD CARE	FACILITY NUMBER: 198019786
	VISIT DATE: 08/19/2020

NARRATIVE

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During the tele-inspection, Licensee disclosed that the main home is not used and is inaccessible to the children in care. Per Licensee, child care is only provided in the detached studio. Licensee noted that the Fire Department only inspected the detached studio. Licensee stated that the families enter the child care home through the side gate to access the detached studio that is located in the backyard.

LPA observed the kitchen in the main home is currently being renovated. LPA observed cleaning solutions on the floor of the dining room in the main home. LPA also observed shampoos and soaps inside the shower of the bathroom located in the main home. The smoke detector located in the dining room area of the main home was inoperable. Per Licensee, there were no other operable smoke detectors located in the main home. Licensee stated that batteries would be replaced for the smoke detector located in the main home. The main home did not appear to being utilized for child care as there were no toys and/or napping equipment for children observed.

Areas that are used by the children (detached studio) were virtually inspected for safety, comfort and cleanliness. Detergents, cleaning compounds, medicines, sharp objects and hazardous items that can pose a danger to children were inaccessible. The Licensee stated that there are no poisons in the home. The Licensee was advised that if any poisons are purchased, it is required to be locked with a key or combination lock. The Licensee was advised that if food is brought from the children’s home, all containers must be labeled with the child’s name and properly stored or refrigerated.

Per Licensee, there are no firearms or weapons on the premises. LPA did not observe any bodies of water. LPA observed age appropriate toys and napping equipment for the children. The required fire extinguisher (2A-10BC) is fully charged. Smoke and carbon monoxide detectors were tested and are operable. A First Aid kit is available and is located in the kitchen area of the detached studio.

The Licensee has proof of pediatric First Aid/CPR certification (expires: 01/2022). The Licensee completed the Preventative Health and Safety training, including the nutrition component on 09/25/2016. The Licensee was advised that the mandated reporter training must be completed every 2 years and is available at www.mandatedreporterca.com.

SUPERVISOR'S NAME: Brandi VanOosten	TELEPHONE: (323) 981-3365
LICENSING EVALUATOR NAME: Monique Ayala	TELEPHONE: (323) 246-2016
LICENSING EVALUATOR SIGNATURE:	DATE: 08/19/2020

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/24/2020

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 CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME: SANDOVAL FAMILY CHILD CARE	FACILITY NUMBER: 198019786
	VISIT DATE: 08/19/2020

NARRATIVE

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4. Annual fees must be paid promptly and by the due date or a late fee shall be assessed and/or the license shall be terminated.
5. The fire extinguisher type 2A-10BC must be serviced annually or as often as necessary and smoke and carbon monoxide detectors should be checked, and batteries replaced as needed.
6. Changes should be reported to the Department as soon as they occur such as construction, remodeling, telephone number changes and/or if you move from your home.
7. Any unusual incidents or injuries must be reported to the Department within 24 hours via telephone and within seven (7) days in writing (refer to LIC 624B). Mandated reporter requirements were reviewed and explained.
8. Fire and safety drills must be performed every six (6) months and documented for review by the Department.
9. Smoking is prohibited in the family child care home.
10. Children and staff records must be maintained and updated as needed and be available for review by the Department.
11. Dog(s) and/or pets are recommended to be isolated from children in care.
12. No baby bouncers, No infant walkers, No Johnny jumpers, No saucer chairs, No trampolines and any other item that falls into this category is not permitted in the facility.

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 Americans with Disabilities Act (ADA) was provided: U.S. 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 on how to access forms, regulations, quarterly updates, and Provider Information Notices (PINs) on the Department website at www.ccld.ca.gov.

There were no deficiencies cited during today's inspection in accordance to the California Code of Regulations Title 22, Division 12, Chapter 1.

SUPERVISOR'S NAME: Brandi VanOosten	TELEPHONE: (323) 981-3365
LICENSING EVALUATOR NAME: Monique Ayala	TELEPHONE: (323) 246-2016
LICENSING EVALUATOR SIGNATURE:	DATE: 08/19/2020

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/24/2020

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 CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME: SANDOVAL FAMILY CHILD CARE	FACILITY NUMBER: 198019786
	VISIT DATE: 08/19/2020

NARRATIVE

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The following forms must be submitted to the Monterey Park South West Child Care Regional Office within 30 days from the date of this tele-inspection for further processing:

1. The updated original signed copy of the Application (LIC 279), dated 08/11/2020.
2. The original signed copy of the Pre-Licensing Readiness Guide (LIC 9217), dated 08/17/2020.
3. Emergency Disaster Plan for Family Child Care Homes (LIC 610A), including the Major Crossroads and Home Direction from Crossroad filled out.
4. Revised Facility Sketch (LIC 999A) for the main home, identifying the off-limit areas for children.
5. Facility Sketch (LIC 999A) of the detached studio where child care is provided, including the dimensions.
6. The original signed copy of the Criminal Record Statement (LIC 508), dated 08/11/2020 for the other adult residing in the home.
7. Lead Component Training certificate for the Licensee.
8. Mandated Reporter Training certificate for the Licensee.
9. Immunization record: Influenza for the Licensee.
10. Immunization record: TB Clearance and Influenza for the other adult residing in the home.
11. Valid permit for the detached studio on the residence.
12. Proof of address for the second floor house that is attached to the garage and studio.
13. Written declaration of how the Licensee will ensure the safety of the children in care with utilizing the detached studio and during outdoor activity time.

A final review on the application for a capacity change will be completed prior to licensure. Once licensed, the applicant is required to adhere to the terms and limitations stated on the license.

Upon receipt of this report, the Licensee shall post the Notice of Site Visit. The report and the Notice of Site Visit shall be posted for 30 consecutive days. Failure to maintain posting as required, will result in an immediate $100 civil penalty.

An exit interview was conducted and a copy of this report was issued to the Licensee via registered mail and certified mail.

SUPERVISOR'S NAME: Brandi VanOosten	TELEPHONE: (323) 981-3365
LICENSING EVALUATOR NAME: Monique Ayala	TELEPHONE: (323) 246-2016
LICENSING EVALUATOR SIGNATURE:	DATE: 08/19/2020

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/24/2020

LIC809 (FAS) - (06/04)

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