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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198019958
Report Date: 06/21/2019
Date Signed: 06/21/2019 09:26:58 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:ALCANTAR FAMILY CHILD CAREFACILITY NUMBER:
198019958
ADMINISTRATOR:JOSE ALCANTARFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(626) 622-9857
CITY:EL MONTESTATE: CAZIP CODE:
91732
CAPACITY:14CENSUS: 0DATE:
06/21/2019
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
08:40 AM
MET WITH:Jose Alcantar, ApplicantTIME COMPLETED:
09:40 AM
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Licensing Program Analyst (LPA) A. Lucero conducted an Announced Pre-Licensing Inspection to inspect the facility for initial licensure. Upon arrival, LPA met with Applicant Jose Alcantar who guided LPA on an indoor and outdoor tour of the facility. There were no children or other adults present at the time of inspection. The facility is a two bedroom and a two bathroom home.

Individuals residing in the home are the applicant and brother-in-law and no minors. Applicant stated to LPA that brother-in-law is living with him. LPA confirmed that brother-in-law is fingerprint cleared; however, is not associated to this facility. LPA informed Applicant that he must submit the proper documentation to have his brother-in-law associated to his facility. LPA also determined that brother-in-law does not have a current TB clearance and Applicant will need to obtain a TB clearance for brother-in-law.

Per Applicant, the following areas will be used for day-care: living room, dining area, small den area that is converted into a day care area, two bathrooms, back yard and detached garage.

Per Applicant, Off-limits areas include: Kitchen, two bedrooms, front yard.

There is an operational smoke and carbon monoxide detector and required 2-A10BC fire extinguisher maintained in the home. The home has electrical outlet covers throughout and maintains a First Aid Kit. There are some age appropriate materials available for children to be enrolled in care. The department has received the granted fire clearance for a Large Family Child Care Home.

The Applicant was advised he shall be present in the home and shall ensure children in care are visually supervised at all times. Applicant also advised once Licensure is granted, when temporarily absent from the home, Licensee shall arrange for a criminally record cleared substitute adult to care for and supervise children in her absence. Applicant advised children shall not be left in parked vehicles at any time.

SUPERVISOR'S NAME: Brandi VanOostenTELEPHONE: (323) 981-3365
LICENSING EVALUATOR NAME: Armando J LuceroTELEPHONE: (323) 981-3435
LICENSING EVALUATOR SIGNATURE:

DATE: 06/21/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/21/2019
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 CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME: ALCANTAR FAMILY CHILD CARE
FACILITY NUMBER: 198019958
VISIT DATE: 06/21/2019
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A current roster of children enrolled must be available and maintained for a period of three years, even after children no longer are attending the facility. 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.

The fire extinguisher type 2A-10BC must be serviced annually or as often as necessary. Smoke and Carbon Monoxide detectors should be checked and batteries replaced as needed. 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.

Any unusual incidents or injuries must be reported to the Department within 24 hours via telephone and within seven (7) days in writing. Fire and safety drills must be performed every six months and documented for review by the Department. Smoking is prohibited in a family child care home. Children and Staff records must be maintained and updated as needed and must be available for review by the Department.

Baby walkers, saucer chairs, bouncers or any similar items are prohibited. All adults living and working in the home shall be made of aware of the Departments right to inspection authority, which includes but not limited to the right to enter the home when children are being cared for, interview children and adults and review documentation. LPA also provided Applicant with a complete packet of the Provider Information Network (PIN) 10-02-CCP dated February 20, 2019 regarding Safe Sleep Awareness Campaign.

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

LPA advised Applicant how to access forms and regulations on line at: www.ccld.ca.gov

Exit interview was conducted with Applicant Jose Alcantar.

SUPERVISOR'S NAME: Brandi VanOostenTELEPHONE: (323) 981-3365
LICENSING EVALUATOR NAME: Armando J LuceroTELEPHONE: (323) 981-3435
LICENSING EVALUATOR SIGNATURE:

DATE: 06/21/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/21/2019
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: ALCANTAR FAMILY CHILD CARE
FACILITY NUMBER: 198019958
VISIT DATE: 06/21/2019
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Per Applicant, there are no firearms, ammunition, or weapons present on the premises. Furthermore, there are no bodies of water or spas on the premises. The outdoor play area is a fenced backyard, which is free of hazards.

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

After a tour and review of this home and review of records, the following corrections need to be made prior to licensure in accordance with California Code of Regulations Title 22 to protect the Health & Safety of child that will be in care:

1. Applicant's brother-in-law who is now living in the home must transfer his criminal record clearance so that he may be associated to facility.

2. Applicant must submit TB clearance for brother-in-law and must be current within one year.

The above corrections must be completed on or before Friday, July 19, 2019 by end of business day. LPA advised Applicant to contact LPA by phone or E-mail to inform LPA that the above corrections have been completed. Once the above items have been corrected, and all application documents approved, the department will make its determination on whether or not to approve the Applicant for a large license.

The following was discussed with the applicant:

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 a 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.

SUPERVISOR'S NAME: Brandi VanOostenTELEPHONE: (323) 981-3365
LICENSING EVALUATOR NAME: Armando J LuceroTELEPHONE: (323) 981-3435
LICENSING EVALUATOR SIGNATURE:

DATE: 06/21/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/21/2019
LIC809 (FAS) - (06/04)
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