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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198020186
Report Date: 10/16/2019
Date Signed: 10/16/2019 03:52:01 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 CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME:FLORES DE RAFAEL FAMILY CHILD CAREFACILITY NUMBER:
198020186
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY:8CENSUS: 3DATE:
10/16/2019
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
02:20 PM
MET WITH:Marta Flores de RafaelTIME COMPLETED:
04:08 PM
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Licensing Program Analyst (LPA) Lissete Gonzalez conducted an unannounced annual random site inspection in Spanish to ensure the health & safety standards as required by regulations governing family child care homes. Upon arrival, LPA met with Licensee, Marta Flores de Rafael, who provided LPA on a tour of the facility indoors and outdoors. Also present was Licensee’s Assistant, Milagro Flores Barrera. There were 4 children present, 3 being infants. Licensee states there are 5 children enrolled. The children’s roster was reviewed and is current. Licensee’s operating hours are from 7:00 a.m. to 6:00 p.m. from Monday through Friday.

This is a one story home which consists of 3 bedrooms, 3 bathrooms, kitchen, dining room, living room (primary day care area), front & back yard (fenced). The children will use the small bathroom in the hallway, the living room, the bathroom located outdoors and the back yard will be used for outside play. Areas off limits to children and parents include: Dining room, kitchen, 3 bedrooms, and 1 bathroom. There is a door to these areas that is locked with a latch lock.

During today’s visit, Licensee, Martha, provided LPA with an updated indoor facility sketch. Licensee would like to use 1 bedroom for infants in care during nap time. LPA advised Licensee to supervise the infants during nap time. LPA Gonzalez observed no children in the bedroom. The bedroom is located in the South/East rear part of the home and is the last bedroom to the left of the hallway. LPA observed the bedroom to be safe of any hazards and furnished with age appropriate equipment. LPA will update facility file with indoor sketch to include the bedroom to be used by children in care.

LPA inspected the living room used by the children. There are adequate age appropriate toys, books, and games. No hazards or violations were observed. There is proper ventilation through the home provided by a ceiling fan and air conditioning units. Knives and sharp objects are stored in the kitchen cabinet located above

REPORT CONTINUES ON NEXT PAGE: 1 OF 3

SUPERVISOR'S NAME: Christina GabelmanTELEPHONE: (323) 981-3380
LICENSING EVALUATOR NAME: Lissete GonzalezTELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:

DATE: 10/16/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/16/2019
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 3
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: FLORES DE RAFAEL FAMILY CHILD CARE
FACILITY NUMBER: 198020186
VISIT DATE: 10/16/2019
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the sink which is inaccessible to children. Cleaning compounds and detergents are stored in a latched kitchen cabinet located underneath the sink. The bathrooms were inspected for safety and cleanliness. No hazards or violations were observed. There are electrical outlet covers throughout and a First Aid Kit is available.

The outdoor yard was inspected by LPA. The outdoor yard is fenced and there is shade available to the children.

Licensee has the Parent’s Rights poster and other appropriate forms posted on a board in the living room. Licensee, Marta Flores de Rafael’s First Aid/Infant CPR certificates are valid through 07/31/2021. Licensee’s Assistant, Milagro Flores Barrera’s First Aid/Infant CPR certificates are valid through 07/31/2021. Licensee's disaster drill log notes last drill conducted on 07/14/19. Licensee has a working telephone.

LPA observed the 2A10BC fire extinguisher located in the living room is fully charged and was serviced on 1/08/2019. There is an operational smoke detector and an operational carbon monoxide detector in the home. There are no firearms or poisons present on the premises as stated by Licensee. Currently there are no pets.

Staff files were reviewed and found to be complete. Children’s files were reviewed for proper documentation and found to be complete.

The following were discussed: Individuals who are 18 years of age or older living in the home must be finger print cleared prior to being in the presence of the children in care. Individuals within one month of their 18th birthday must be fingerprinted immediately. No smoking, No infant walkers, No baby bouncers, No Johnny jumpers, No exersaucers and any other item that falls into that category. LPA discussed disaster drills, posting requirements, children records requirements, mandated child abuse and injury/death reporting. LPA reviewed LIC 311D with licensee, reminding her of required forms. LPA reviewed SIDs, Never Shake A Baby, and safe sleeping practices. Infants should sleep mouth up, on their backs, free of clutter surrounding their sleeping space.

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 REPORT CONTINUES ON NEXT PAGE: 2 OF 3
SUPERVISOR'S NAME: Christina GabelmanTELEPHONE: (323) 981-3380
LICENSING EVALUATOR NAME: Lissete GonzalezTELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:

DATE: 10/16/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/16/2019
LIC809 (FAS) - (06/04)
Page: 2 of 3
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: FLORES DE RAFAEL FAMILY CHILD CARE
FACILITY NUMBER: 198020186
VISIT DATE: 10/16/2019
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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

LPA advised the licensee how to access forms, regulations and quarterly updates on the Child Care Licensing
website at: www.ccld.ca.gov

There were no deficiencies cited during today’s inspection

Exit interview was conducted with Licensee, Marta Flores de Rafael. The Licensee was provided a copy of the appeal rights (LIC 9058) and their signature on this form acknowledges receipt of these forms.

A copy of the LIC 9213 was given to licensee—Notice of Site Visit. 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.

END OF REPORT: PAGE 3 OF 3
SUPERVISOR'S NAME: Christina GabelmanTELEPHONE: (323) 981-3380
LICENSING EVALUATOR NAME: Lissete GonzalezTELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:

DATE: 10/16/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/16/2019
LIC809 (FAS) - (06/04)
Page: 3 of 3