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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198020186
Report Date: 03/02/2023
Date Signed: 03/02/2023 10:05:41 AM


Document Has Been Signed on 03/02/2023 10:05 AM - 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:FLORES DE RAFAEL FAMILY CHILD CAREFACILITY NUMBER:
198020186
ADMINISTRATOR:MARTA FLORES DE RAFAELFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(323) 979-6205
CITY:LOS ANGELESSTATE: CAZIP CODE:
90026
CAPACITY:14CENSUS: 5DATE:
03/02/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
08:05 AM
MET WITH:Marta Flores De Rafael, LicenseeTIME COMPLETED:
10:20 AM
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Licensing Program Analyst (LPA) Monique Ayala conducted an unannounced required 1 year inspection at the above facility on 03/02/2023. Visit was conducted in Spanish. A COVID-19 risk assessment was conducted prior to entering the facility. LPA met with Licensee Marta Flores De Rafael, who guided analyst on a tour of the facility. The Licensee's assistant, Milagro Flores, was present in the home. There were 5 children present during this inspection, per licensee there are 12 children enrolled. Facility capacity is in compliance for a large Family Child Care Home. Per Licensee hours of operation are Mon-Fri 7:00 AM - 6:00 PM.

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, dinning 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 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 and Disaster drill log, last drill documented was 03/02/2023.

Areas accessible to children were inspected to ensure that they are clean and orderly with ventilation and heating for safety and comfort. The home is free from defects or conditions which may endanger a child. LPA observed toys, play equipment and materials that are safe and age appropriate. There is a wall ac. There is a working telephone service maintained in the home.
SUPERVISOR'S NAME: Ana ChicoTELEPHONE: (323) 981-3374
LICENSING EVALUATOR NAME: Monique Jessica AyalaTELEPHONE: 323-981-3350
LICENSING EVALUATOR SIGNATURE:
DATE: 03/02/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/02/2023
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: FLORES DE RAFAEL FAMILY CHILD CARE
FACILITY NUMBER: 198020186
VISIT DATE: 03/02/2023
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Detergents, cleaning compounds, medications, and other items which can pose a danger to children are inaccessible in all areas of the home. All food items are prepared by the Licensee. Smoke and carbon monoxide detectors located in the living room were tested and are operable. Fire extinguisher indicates fully charged.

Licensee states that there are no poisons stored in the home and understands that all poisons must be lock, not only inaccessible to children. Isolation area for sick children waiting to be picked up is in one of the bedrooms, away from the other children. Per Licensee there are no firearms or weapons stored in the home.

Infant Care: Per Licensee, they have one infant enrolled that is under 12 months at this time. Per licensee, the infant naps in bedroom 1 with the door open and licensee has a baby monitor. Per licensee, there is always a staff in the napping room with the infant. LPA verified that licensee and assistant are documenting infants sleep every 15 minutes. LPA also verified that infant has LIC9227 completed in their file.

Currently children use rear yard for outdoor play. 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 could be hazardous to children in care.

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).



Staff records were reviewed for approved Pediatric First Aid and CPR certification, expires 01/07/2025, LIC 508- Criminal Record Statement, LIC 9052 Notice of Employee's Rights, 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, dated 04/28/2021. Licensee's assistant has require documents on file.

Incidental Medical Services (IMS):
Incidental Medical Services (IMS) policy was discussed. Per Licensee there are no children on medications.
SUPERVISOR'S NAME: Ana ChicoTELEPHONE: (323) 981-3374
LICENSING EVALUATOR NAME: Monique Jessica AyalaTELEPHONE: 323-981-3350
LICENSING EVALUATOR SIGNATURE:

DATE: 03/02/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/02/2023
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: FLORES DE RAFAEL FAMILY CHILD CARE
FACILITY NUMBER: 198020186
VISIT DATE: 03/02/2023
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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

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 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.

Based on the LPA's observations and records review no deficiencies will be cited today 03/02/2023.

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, Marta Flores De Rafael.

SUPERVISOR'S NAME: Ana ChicoTELEPHONE: (323) 981-3374
LICENSING EVALUATOR NAME: Monique Jessica AyalaTELEPHONE: 323-981-3350
LICENSING EVALUATOR SIGNATURE:

DATE: 03/02/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/02/2023
LIC809 (FAS) - (06/04)
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