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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198019988
Report Date: 06/18/2024
Date Signed: 06/18/2024 03:26:40 PM


Document Has Been Signed on 06/18/2024 03:26 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
MONTEREY PARK CC RO, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754



FACILITY NAME:PEREZ FAMILY CHILD CAREFACILITY NUMBER:
198019988
ADMINISTRATOR:NORMA PEREZFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(909) 753-5251
CITY:POMONASTATE: CAZIP CODE:
91768
CAPACITY:14CENSUS: 12DATE:
06/18/2024
TYPE OF VISIT:Required - 3 YearUNANNOUNCEDTIME BEGAN:
01:15 PM
MET WITH:Licensee Norma PerezTIME COMPLETED:
03:45 PM
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At 1:15pm, Licensing Program Analyst (LPA) Stephanie Li conducted an unannounced required annual inspection to the above facility. A risk assessment was conducted upon entry. Upon arrival, licensee was not home. Her mother and assistant opened the door. Licensee was called by her teenage son and spoke with LPA. Licensee is returning from a doctor’s appointment. Licensee returned home by 1:55pm. Licensee Norma Perez, guided analysts on a tour of the facility. Per Licensee, there are currently 21 children enrolled. A current children’s roster was available for review. There were 2 adults, licensee’s mother and assistant, licensee’s teenage son, and 12 children present upon arrival. Facility capacity is in compliance for a Large Family Child Care Home. Hours of operation are Monday-Friday, 7:00am-6:00pm.

This is a one story home which consists of 4 bedrooms, 2 bathrooms, living room, play room, laundry room, storage room, kitchen, garage (outdoor), front yard, side and backyard (fenced). Currently residing in the home are 3 adults and 1 minor (teenage) child. 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.

Areas accessible to children were inspected as follows: kitchen, living room, 1 bathroom, play room, side and back yard.

Per licensee, areas off limits to children and parents, 4 bedrooms, 1 bathrooms, front yard, and garage. The LPA toured all areas used by children during this visit. Per Licensee, there are no weapons or fire arms on the property. No bodies of water were observed. LPA observed an empty inflatable pool turned upside down in the back yard. Per licensee, she empties it immediately after each use.



All areas identified on the facility sketch that are accessible for children to use were inspected for safety, comfort, and cleanliness. There is central ventilation and heating. There is telephone service via a cellphone that stays at the facility during operation hours.
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SUPERVISOR'S NAME: Christina GabelmanTELEPHONE: (323) 981-3380
LICENSING EVALUATOR NAME: Stephanie LiTELEPHONE: (626) 366-3362
LICENSING EVALUATOR SIGNATURE:
DATE: 06/18/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/18/2024
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 4


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MONTEREY PARK CC RO, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME: PEREZ FAMILY CHILD CARE
FACILITY NUMBER: 198019988
VISIT DATE: 06/18/2024
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The following was observed and reviewed during this inspection:

LPA observed the following required posted documentation in the main entry way 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- Facility Disaster Plan. All homes shall conduct fire and disaster drills at least once every six months, and document the date and time of each drill. LPA’s observed the last drill logged was on 5/3/24.

The home is observed to be clean and orderly, with central air and heating. There are toys available for children. Play pens and cots were observed. LPA observed the required 2A 10BC fire extinguisher, but no receipt was available to verify purchase date. LPA discussed with licensee, requirements for servicing fire extinguishers yearly and advised to keep receipt with purchase yearly. Smoke and carbon monoxide detectors were tested and are operable. Detergents, cleaning compounds, and medications were observed to be inaccessible to children. Per Licensee, there are no poisons in the home and understands that all poisons must be locked, to be made inaccessible to children. Licensing staff reminded licensee smoking is not allowed in a family child care home. The restroom that children use was observed to be safe and sanitary.

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-andresources/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.



Currently, children are using the side patio and back 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 in the outdoor yard.


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SUPERVISOR'S NAME: Christina GabelmanTELEPHONE: (323) 981-3380
LICENSING EVALUATOR NAME: Stephanie LiTELEPHONE: (626) 366-3362
LICENSING EVALUATOR SIGNATURE:

DATE: 06/18/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/18/2024
LIC809 (FAS) - (06/04)
Page: 2 of 4
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MONTEREY PARK CC RO, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME: PEREZ FAMILY CHILD CARE
FACILITY NUMBER: 198019988
VISIT DATE: 06/18/2024
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The licensee is observed to be operating within the license capacity limitations.

Children’s records were reviewed, including emergency information and were observed to be complete.

The licensee has completed training on preventive health practices including Pediatric First Aid and CPR. The licensee’s Pediatric First Aid and CPR expires on 11/2024. Licensee and her mother have current Mandated Reporter AB 1207 compliant Child Care Training Certificate on file expires on 05/05/2025.

LPA observed that the Licensee and her mother do have proof of immunization. LPA observed that newly hire assistant (this month) does not have proof of mandated reporter or TB, TDAP and MMR. Per licensee, she is in the process of obtaining mandated reporter training from the union conducted in Spanish. Per licensee, assistant has her immunization and TB but is acquiring the records from her medical provider.

Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02- CCP. 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: https://www.ada.gov/resources/child-care-centers/.


Licensee was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain child care by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.



LPA advised the licensee to access forms, regulations and quarterly updates on line at: www.ccld.ca.gov.

To improve the quality and value of the new inspection process, a survey may 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 CARE tools, please send email inquiries 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: Christina GabelmanTELEPHONE: (323) 981-3380
LICENSING EVALUATOR NAME: Stephanie LiTELEPHONE: (626) 366-3362
LICENSING EVALUATOR SIGNATURE:

DATE: 06/18/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/18/2024
LIC809 (FAS) - (06/04)
Page: 3 of 4
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MONTEREY PARK CC RO, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME: PEREZ FAMILY CHILD CARE
FACILITY NUMBER: 198019988
VISIT DATE: 06/18/2024
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Licensee was reminded that all adults 18 and over living or working in the home, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, 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 for a maximum of 5 days or, if the penalty is for a repeat violation, for a maximum of 30 days per person will be assessed if this regulation is violated.

Currently, the licensee is in compliance with California Title 22 Regulations. There are no citations being issued today.

During the exit interview, the Licensee Norma Perez, confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS.

A notice of site visit was given and must remain posted for 30 days.

Exit interview conducted, report provided and appeal rights was reviewed with Licensee Norma Perez.

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SUPERVISOR'S NAME: Christina GabelmanTELEPHONE: (323) 981-3380
LICENSING EVALUATOR NAME: Stephanie LiTELEPHONE: (626) 366-3362
LICENSING EVALUATOR SIGNATURE:

DATE: 06/18/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/18/2024
LIC809 (FAS) - (06/04)
Page: 4 of 4