198020044-11-16-2021-54-CC-AMOY-C8U378-20211116165932

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 198020044
Report Date: 11/16/2021
Date Signed: 11/16/2021 07:41:14 PM

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:	ALVAREZ LEIVA FAMILY CHILD CARE		FACILITY NUMBER:	198020044
ADMINISTRATOR:	ALVAREZ LEIVA,S & CARLOS		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(562) 448-4169
CITY:	DOWNEY	STATE: CA	ZIP CODE:	90240
CAPACITY:	14	CENSUS: 5	DATE:	11/16/2021
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	10:19 AM
MET WITH:	Siomara Alvarez Leiva, Licensee		TIME COMPLETED:	05:05 PM

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Licensing Program Analyst (LPA) Alicia Moooberry conducted an unannounced Annual Inspection in Spanish and English. Upon arrival LPA met with licensee Siomara Alvarez provided tour of the facility. Also present is licensee's spouse and co-licensee Carlos Alvarez. The facility is a two story, five bedroom and three bathroom home. All adults present in the home have obtained a fingerprint clearance.

Licensee guided LPA on a tour of the facility indoors and outdoors. The home was inspected for safety, comfort, cleanliness, heating and ventilation, inaccessibility to poisons, detergents, cleaning compounds, medicines, and hazardous items that can pose a danger to children. Per Licensee, hours of operation are Monday through Saturday 24 hours a day. Licensee understands that care for a child should not exceed 24 hours. Licensee stated no overnight care is currently provided.

Per Licensee, the following areas will be used for day-care: Family room/Day care room (front of home), Living room/Dining room back of home, restroom located next to the living room, fenced front yard.

Per licensee, Off-limits areas include: Entire Second floor (three bedrooms, two bathrooms), Downstairs two (2) bedrooms, kitchen, pantry (by bathroom), backyard, garage, and pool. There is a baby gate to prevent access to the second floor and also the kitchen. The doors to the bedrooms and bathrooms will remain closed and have a child proof knobs on them. The kitchen cabinets have latches for added security.

LPA inspected the pool area in the back yard. LPA observed that the pool is accessible from the sliding glass doors located on the side by dining room, another in the back by living room, another from sliding glass door located in downstairs off limits bedroom. All of the doors have a working alarm that sound when opened. There is a mesh fence that surrounds the pool. Fence is in good repair and designed so children could not remove any portion of it. Fence is at least 5 feet high. Fence cannot be climbed. The gate on the fence swings away from the pool and is self latching. Mesh fence is strong enough to withstand the impact of toys and does not readily bend upon impact. Licensee understand that the fence has to be maintained in good repair. Page 1 of 4

SUPERVISOR'S NAME: Valarie Cook	TELEPHONE: (323) 513-3858
LICENSING EVALUATOR NAME: Alicia Mooberry	TELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:	DATE: 11/16/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/16/2021

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 CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME: ALVAREZ LEIVA FAMILY CHILD CARE	FACILITY NUMBER: 198020044
	VISIT DATE: 11/16/2021

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The front yard is used for outdoor play, the yard is enclosed and no hazards were observed. There are locked gates on either side of the home that lead to the backyard pool. Licensee was reminded to ensure doors are maintained closed and locked at all times. There is a dog, that is kept in the backyard and away from the children in care.

At 10:56am LPA observed the required 2A10BC fire extinguisher has not been serviced in the last year as required, the service tag is dated 11/25/19. This poses a potential risk to the health and safety of children in care.
The required Emergency drill was conducted and logged on 6/14/21. There is an operational smoke and carbon monoxide detector. The licensee maintains a completed First Aid Kit in the daycare area.

At 10:58am LPA observed that the crib used for 15 month old infant does not have a mattress. Per licensee,

Licensee retrieved the appropriate mattress and placed it in the crib. Licensee was issued a Technical Violation and LPA discussed and provided PIN 20-21-24 New Safe Sleep Regulations (Spanish) with licensee. Licensee has no infants under 12 months in care and understands that the LIC 9227 should be completed for all infants up to 12 months of age. Licensee completed the Sleeping Log for the 15 month old infant in care during this inspection.

Licensee CPR/1st Aid Expires on 03/14/2022. LPA confirmed with the Licensee that all adults residing/working in the home have obtained criminal record clearance. The Licensee has a working home telephone but will use her personal cell phone as the day care phone. Proof of immunization against influenza, pertussis, and measles for the licensee and assistant were readily available during today's inspection. Licensee and assistant have also completed the Mandated Reporter Training.

Per Licensee, there are no firearms, ammunition, or weapons present on the premises. The facility provides transportation for children. Licensee was reminded that children shall not be left in parked vehicles at any time.

The following was discussed with the applicant:

· LPA advised the applicant how to access forms, regulations and quarterly updates on the Child Care Licensing website at: www.ccld.ca.gov
· Any unusual incidents or injuries must be reported to the Department within 24 hours via telephone and within seven (7) days in writing. Including COVID-19 Positive or Exposure cases
· 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. Report continues- Page 2 of 4

SUPERVISOR'S NAME: Valarie Cook	TELEPHONE: (323) 513-3858
LICENSING EVALUATOR NAME: Alicia Mooberry	TELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:	DATE: 11/16/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/16/2021

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 CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME: ALVAREZ LEIVA FAMILY CHILD CARE	FACILITY NUMBER: 198020044
	VISIT DATE: 11/16/2021

NARRATIVE

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· 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.
· Commencing September 1, 2016, a person shall not be employed or volunteer at a family day care home if he or she has not been immunized against influenza, pertussis, and measles. Each employee and volunteer shall receive an influenza vaccination between August 1 and December 1 of each year. The family day care home shall maintain documentation of the required immunization or exemptions from immunization, as set forth in this section, in the person’s personnel record that is maintained by the family day care
· 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.
· 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.
· Saucer chairs, bouncers, walkers, 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.
· Emergency Disaster Plan, Parent’s Rights Poster and the Facility License are required to be posted.

COVID-19 DPH Exposure Management Guidelines discussed and provided. Licensee was reminded to clean frequently touched areas and make sure cleaning product are always inaccessible to children in care. Licensee and staff were wearing the proper face coverings. LPA observed the COVID posters visible to parents. The facility will isolate any child that is ill in area by the front door, where they are safe and will be supervised.

Report Continues - Page 3 of 4

SUPERVISOR'S NAME: Valarie Cook	TELEPHONE: (323) 513-3858
LICENSING EVALUATOR NAME: Alicia Mooberry	TELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:	DATE: 11/16/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/16/2021

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 CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME: ALVAREZ LEIVA FAMILY CHILD CARE	FACILITY NUMBER: 198020044
	VISIT DATE: 11/16/2021

NARRATIVE

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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

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/inspection-process.

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 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.

Licensee's email was verified correct during inspection.

Deficiency was cited during this inspection per Title 22 Regulatons (See attached LIC809D)

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

Exit interview conducted and report was reviewed with the licensee, Siomara Alvarez Leiva.

End of Report - Page 4 of 4

SUPERVISOR'S NAME: Valarie Cook	TELEPHONE: (323) 513-3858
LICENSING EVALUATOR NAME: Alicia Mooberry	TELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:	DATE: 11/16/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/16/2021

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 CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME: ALVAREZ LEIVA FAMILY CHILD CARE	FACILITY NUMBER: 198020044
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 11/16/2021

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

102417(g)(1)

Operation of A Family Child Care Home

(g) The home shall be free from defects or conditions which might endanger a child. Safety precautions shall include but not limited to: (1) Fireplaces and open face heaters shall be screened to prevent access by children. The home shall contain a fire extinguisher and smoke detector device which meet standards established by the State Fire Marshall. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on LPA observation of the Fire Extinguished service tag indicated that the last service date was 11/25/19. The licensee did not comply with the above requirements which poses a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 11/23/2021
	Plan of Correction
1 2 3 4	Per licensee, the fire extinguisher will be serviced and a copy of the service tag will be provided to the department via email be POC due date.

Section Cited

Infant Safe Sleep


	Deficient Practice Statement
1 2 3 4
	POC Due Date:
	Plan of Correction
1 2 3 4

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: Valarie Cook	TELEPHONE: (323) 513-3858
LICENSING EVALUATOR NAME: Alicia Mooberry	TELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:	DATE: 11/16/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/16/2021

LIC809 (FAS) - (06/04)

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