198020212-8-26-2020-54-CC-MAYA-BSUVCA-20200826161848

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 198020212
Report Date: 08/13/2020
Date Signed: 08/26/2020 04:19:00 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:	VILLAGRAN FAMILY CHILD CARE		FACILITY NUMBER:	198020212
ADMINISTRATOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY:	8	CENSUS: 4	DATE:	08/13/2020
TYPE OF VISIT:	Case Management - Licensee Initiated	ANNOUNCED	TIME BEGAN:	03:00 PM
MET WITH:	Licensee, Guadalupe Villagran		TIME COMPLETED:	04:00 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	On August 13, 2020 at 3:00 PM, Licensing Program Analyst (LPA) Monique Ayala conducted an announced pre-licensing tele-inspection via Zoom Meeting with Licensee, Guadalupe Villagran. The inspection was conducted via Zoom Meeting due to the corona virus (COVID-19) pandemic. Licensee guided LPA on a tour of the facility. Members residing in the home are the Licensee, one other adult and two minor children. The Licensee is requesting for a Capacity Change (up to 14 children) to the family child care home license. The operating hours are Monday to Friday from 6:00 AM to 6:00 PM. The Licensee is applying to care for children ages, 3 months to 13 years old. All areas identified on the facility sketch were inspected. This facility is a single family home that consists of three (3) bedrooms, two (2) bathrooms, living room, dining room, family room, washroom, kitchen, front yard, backyard (fenced), swimming pool (secured and inaccessible to children) and garage. Areas that are accessible to children include: family room, living room, washroom, 1 bathroom (located near the washroom), hallway, front yard and backyard. Per Licensee, the children will utilize the backyard (fenced) for outdoor activity. Areas off limits to children include: kitchen, dining room, 3 bedrooms, one (1) bathroom (located near the hallway and bedroom), swimming pool and garage. LPA observed safety gates installed in the kitchen to make the off limit kitchen and dining room area inaccessible to children. Per Licensee, supervision will be provided when the children walk through the kitchen and dining room area. The applicant was advised that areas that are off limits must be made inaccessible during operating hours.

SUPERVISOR'S NAME: Brandi VanOosten	TELEPHONE: (323) 981-3365
LICENSING EVALUATOR NAME: Monique Ayala	TELEPHONE: (323) 246-2016
LICENSING EVALUATOR SIGNATURE:	DATE: 08/13/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/19/2020

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 CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME: VILLAGRAN FAMILY CHILD CARE	FACILITY NUMBER: 198020212
	VISIT DATE: 08/13/2020

NARRATIVE

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Areas that will be used by the children were virtually inspected for safety, comfort and cleanliness. Detergents, cleaning compounds, medicines, sharp objects and hazardous items that can pose a danger to children are inaccessible. The Licensee stated that there are no poisons in the home. The Licensee was advised that if any poisons are purchased, it is required to be locked with a key or combination lock. The Licensee was advised that if food is brought from the children’s home, all containers must be labeled with the child’s name and properly stored or refrigerated.

LPA observed a firearm securely locked and inaccessible to children and the ammunition was observed securely stored separately from the firearm and made inaccessible to the children. LPA observed the family dog isolated from the children in care. LPA observed the outdoor swimming pool secured and inaccessible to children. LPA observed the windows facing the swimming pool that are located in the family room had child safety locks and alarmed installed. LPA observed age appropriate toys and napping equipment for the children. The home has electrical outlet covers throughout the facility. The required fire extinguisher (2A-10BC) is fully charged. Smoke and carbon monoxide detectors were tested and are operable. A First Aid kit is available and is located in the family room.

The Licensee has proof of pediatric First Aid/CPR certification (expires: 12/2020). The Licensee has proof of immunization records for pertussis and measles. The Licensee completed the Preventative Health and Safety training, including the nutrition and lead components and Mandated Reporter (AB 1207) training (completed on: 02/27/2019. The Licensee was advised that the mandated reporter training must be completed every 2 years and is available at www.mandatedreporterca.com.

During the tele-inspection, LPA discussed Forms/Records to Keep in Your Family Child Care Home (LIC 311D) to the applicant. LPA also discussed reference material on the California Car Seat Law Changes (effective January 1, 2017), Effects of Lead Exposure, Shaken Baby Syndrome, Sudden Infant Death Syndrome (SIDS), safe sleep practices and COVID-19 precautionary measures and recommendations.

LPA observed the following information posted in the facility:
Emergency Disaster Plan (LIC 610A), Earthquake Preparedness Checklist (LIC 9148), Notification of Parents’ Rights Poster (PUB 394), and Facility License (LIC 203).

SUPERVISOR'S NAME: Brandi VanOosten	TELEPHONE: (323) 981-3365
LICENSING EVALUATOR NAME: Monique Ayala	TELEPHONE: (323) 246-2016
LICENSING EVALUATOR SIGNATURE:	DATE: 08/13/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/19/2020

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 CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME: VILLAGRAN FAMILY CHILD CARE	FACILITY NUMBER: 198020212
	VISIT DATE: 08/13/2020

NARRATIVE

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Facility Forms/Records to keep in your home:
1. Personnel Records as required in Title 22, Division 12, Chapter 3, Section 102416.1, including but not limited to, proof of current pediatric first aid, CPR, preventative health practices certificate, mandated reporter training certificate and criminal record information.
2. Unusual Incident/Injury Report (LIC 624B).
3. Child Care Facility Roster (LIC 9040).
4. Notice of Employee Rights (LIC 9052).
5. Statement Acknowledging Requirement to Report Suspected Child Abuse (LIC 9108).
6. Property Owner/Landlord Consent Form (LIC 9149).
7. Property Owner/Landlord Notification Form (LIC 9151).
8. A copy of your deed or lease/rental agreement.

The following was also discussed with the Licensee:
1. Individuals who are 18 years of age or older and 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 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.
2. In the absence of the license a qualified adult must be present, supervising the children; a qualified adult is an individual who has a valid and current adult/infant CPR and Pediatric First Aid certification and a valid criminal record clearance associated to the facility license.
3. A current roster of children enrolled must be available and maintained for a period of 3 years, even after children are no longer attending the facility.
4. 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.
5. The fire extinguisher type 2A-10BC must be serviced annually or as often as necessary and smoke and carbon monoxide detectors should be checked, and batteries replaced as needed.
6. 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.
7. Any unusual incidents or injuries must be reported to the Department within 24 hours via telephone and within seven (7) days in writing (refer to LIC 624B). Mandated reporter requirements were reviewed and explained.

SUPERVISOR'S NAME: Brandi VanOosten	TELEPHONE: (323) 981-3365
LICENSING EVALUATOR NAME: Monique Ayala	TELEPHONE: (323) 246-2016
LICENSING EVALUATOR SIGNATURE:	DATE: 08/13/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/19/2020

LIC809 (FAS) - (06/04)

Page: 3 of 4

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: VILLAGRAN FAMILY CHILD CARE	FACILITY NUMBER: 198020212
	VISIT DATE: 08/13/2020

NARRATIVE

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8. Fire and safety drills must be performed every six (6) months and documented for review by the Department.
9. Smoking is prohibited in the family child care home.
10. Children and staff records must be maintained and updated as needed and be available for review by the Department.
11. Dog(s) and/or pets are recommended to be isolated from children in care.
12. No baby bouncers, No infant walkers, No Johnny jumpers, No saucer chairs, No trampolines and any other item that falls into this category is not permitted in the facility.

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 Americans with Disabilities Act (ADA) was provided: U.S. 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 on how to access forms, regulations, quarterly updates, and Provider Information Notices (PINs) on the Department website at www.ccld.ca.gov.

A final review on the application for a Capacity Change will be completed prior to licensure. Once licensed, the applicant is required to adhere to the terms and limitations stated on the license.

An exit interview was conducted and a copy of this report was issued to the Licensee via registered mail and certified mail.

SUPERVISOR'S NAME: Brandi VanOosten	TELEPHONE: (323) 981-3365
LICENSING EVALUATOR NAME: Monique Ayala	TELEPHONE: (323) 246-2016
LICENSING EVALUATOR SIGNATURE:	DATE: 08/13/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/19/2020

LIC809 (FAS) - (06/04)

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