198020102-5-17-2022-33-CC-BBAT-CEJ33Q-20220517175354

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 198020102
Report Date: 05/17/2022
Date Signed: 05/17/2022 05:54:00 PM

Document Has Been Signed on 05/17/2022 05:54 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:	ESCOBEDO FAMILY CHILD CARE		FACILITY NUMBER:	198020102
ADMINISTRATOR:	MARIA ESCOBEDO		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(626) 592-4795
CITY:	SAN GABRIEL	STATE: CA	ZIP CODE:	91776
CAPACITY:	14	CENSUS: 8	DATE:	05/17/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	02:45 PM
MET WITH:	Licensee, Maria Escobedo		TIME COMPLETED:	06:00 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	Licensing Program Analyst (LPA) Bardo Baluyot conducted an unannounced Required Annual Inspection today at 2:45pm. LPA met with Licensee, Maria Escobedo who guided analyst on a tour of the facility. Family members residing in the home are the Licensee and her minor aged child. LPA observed 8 children present/napping upon LPA's arrival with 3 staff including the Licensee. One additional staff arrived a short time after. Facility capacity is in compliance for a large Family Child Care Home. Per Licensee, hours of operation are Monday to Friday, 6:00am to 6:00pm. All areas identified on the facility sketch used for child care were inspected. This is a two story home that consists of 4 bedrooms, 3 restrooms, front living room, back living room, kitchen, garage, fenced front and back yards. LPA observed an inaccessible fireplace located in the front living room which Licensee confirmed does not work. LPA also observed access to the upstairs area made inaccessible by a security gate located at the bottom of the stairs. Areas used by children include the front living room, 1 bedroom, and a restroom. All areas used by children were inspected for safety, comfort, and cleanliness . Detergents, cleaning compounds, medicines, sharp objects and hazardous items that can pose a danger to children are inaccessible in areas designated for children. The Licensee was advised that any poisons must be kept locked and inaccessible to children in care. Areas off limits include 3 bedrooms, 2 restrooms, kitchen, back living room, garage, and front yard. There are toys and other age appropriate materials available for children. There is a working telephone service maintained in the home. All food items are prepared by the Licensee. Smoke and carbon monoxide detectors were tested and found to be operable. Fire extinguisher includes a receipt showing purchase date of 5/14/22. 1 of 3

SUPERVISOR'S NAME: Ana Chico	TELEPHONE: (323) 981-3351
LICENSING EVALUATOR NAME: Bardo Baluyot	TELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:	DATE: 05/17/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/17/2022

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: ESCOBEDO FAMILY CHILD CARE	FACILITY NUMBER: 198020102
	VISIT DATE: 05/17/2022

NARRATIVE

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Isolation area for sick children is the downstairs bedroom primarily used for infant napping adjacent to the front door and would be away from the other children. Per Licensee there are no firearms or weapons stored in the home.

Infant Care: Per Licensee, she is currently caring for 2 infants both of whom are over 12 months of age. LPA informed licensee of the new Safe sleep regulations, including LIC 9227 Infant Sleep Plan for infants under 12 months, 15-minute sleep check documentation for infants 0-24 months. LPA observed play yards to be in compliance with Title 22 regulations.

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). LPA observed all files to be complete.

Staff records were reviewed for approved Pediatric First Aid and CPR certification, LIC 508- Criminal Record Statement, Proof of immunization's 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, completed 12/03/2021. Licensee, Maria Escobedo Pediatric First Aid & CPR expires 01/24.

During inspection all children were observed to be treated with dignity and respect, they were observed to be receiving safe, healthful and comfortable accommodations, furnishings and equipment, and free from corporal and/or unusual punishment.

LPA observed that licensee is implementing COVID-19 precautions and procedures.

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SUPERVISOR'S NAME: Ana Chico	TELEPHONE: (323) 981-3351
LICENSING EVALUATOR NAME: Bardo Baluyot	TELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:	DATE: 05/17/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/17/2022

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: ESCOBEDO FAMILY CHILD CARE	FACILITY NUMBER: 198020102
	VISIT DATE: 05/17/2022

NARRATIVE

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Incidental Medical Services (IMS):
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

Based on the LPA's observations and records review no deficiencies will be cited today 05/17/22.

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.

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 web page 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.

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 the Licensee, Maria Escobedo.

SUPERVISOR'S NAME: Ana Chico	TELEPHONE: (323) 981-3351
LICENSING EVALUATOR NAME: Bardo Baluyot	TELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:	DATE: 05/17/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/17/2022

LIC809 (FAS) - (06/04)

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