198020186-3-10-2020-33-CC-LGOZ-BMKMU7-20200310095441

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 198020186
Report Date: 03/10/2020
Date Signed: 03/10/2020 09:54:49 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:	FLORES DE RAFAEL FAMILY CHILD CARE		FACILITY NUMBER:	198020186
ADMINISTRATOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY:	8	CENSUS: 5	DATE:	03/10/2020
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	08:41 AM
MET WITH:	Marta Flores de Rafel		TIME COMPLETED:	10:10 AM

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	An unannounced Annual/Random Inspection was conducted today by Licensing Program Analysts (LPAs) Lissete Gonzalez and Jennifer Anguiano regarding a pending application for an increase in capacity. LPAs met with Licensee Marta Flores de Rafael who guided LPAs on an indoor and outdoor tour of the facility. Also present was Licensee’s Assistant, Milagro Flores. Additional adults residing in the home include the Licensee’s husband Licensee’s adult child (fingerprint clearances on file). There were 5 children present, 2 being infants. The Licensee is requesting an increase in capacity from 8 to 14 children. The Licensing Department received a granted Fire Clearance for a capacity of 14 children. During today's inspection, LPAs toured the facility and did not observe any deficiencies during today’s inspection. Children's roster was reviewed and is current. 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). Areas used for day-care: 1 bedroom, 1 indoor bathroom located in the hallway, the living room, 1 bathroom located outdoors, and the back yard (fenced). Off limit areas include: Dining room, kitchen, 2 bedrooms, 1 bathroom, and front yard. There is a door to the off limit rooms that is maintained closed by a latch lock when children are not using the bedroom for nap time. LPA will recommend approval of the increase in capacity as the home meets Title 22 Code of Regulations and a fire clearance has been approved for a maximum capacity of 14 children. Licensee states that there are no weapons or firearms on the premises. LPAs did not observe swimming pools or spas on the premises. The backyard is adequately fenced. There are age appropriate toys and equipment on the premises. The smoke detectors and carbon monoxide detectors are present in the facility and in operable condition. REPORT CONTINUES ON NEXT PAGE: 1 OF 3

SUPERVISOR'S NAME: Christina Gabelman	TELEPHONE: (323) 981-3380
LICENSING EVALUATOR NAME: Lissete Gonzalez	TELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:	DATE: 03/10/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/10/2020

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: 03/10/2020

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
26
27
28
29
30
31
32

—Licensee, Marta Flores de Rafael’s First Aid/CPR Card is valid through 7/31/2021.
—Child Care Roster, Disaster Plan, and Children's Records were reviewed and discussed.
—Children records and required licensing forms were discussed as well as mandated child abuse reporting and criminal record clearance requirement.

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

The following was discussed with the Licensee:
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.

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.
REPORT CONTINUES ON NEXT PAGE: 2 OF 3

SUPERVISOR'S NAME: Christina Gabelman	TELEPHONE: (323) 981-3380
LICENSING EVALUATOR NAME: Lissete Gonzalez	TELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:	DATE: 03/10/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/10/2020

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: 03/10/2020

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
26
27
28
29
30
31
32

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. Sudden Infant Death Syndrome (SIDS) and Never-Shake-a-Baby were discussed. A hard copy of A Child Care Provider’s Guide to Safe Sleep(SP) was provided.

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.

· A qualified Assistant must be present and actively involved in caring for children whenever nine (9) or more children are present at the facility in a large family child care home.
· Dog(s) and/or pets should be isolated from children in care.
· It is recommended that First-Aid kits be available on premises.
· Outdoor supervision required at all times. If outdoor area not adequately fenced, provider must be with children at all times when outdoors.

These forms may also be downloaded from our website: www.ccld.ca.gov

There were no deficiencies cited during today's visit in accordance to the California Code of Regulations Title 22, Division 12, Chapter 1

The report and the Notice of Site Visit shall be posted for 30 consecutive days. Failure to maintain posting as required, will result in an immediate $100 civil penalty.

Exit interview, copy of report was given. Appeal rights were issued and discussed.

END OF REPORT PAGE: 3 OF 3

SUPERVISOR'S NAME: Christina Gabelman	TELEPHONE: (323) 981-3380
LICENSING EVALUATOR NAME: Lissete Gonzalez	TELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:	DATE: 03/10/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/10/2020

LIC809 (FAS) - (06/04)

Page: 3 of 3