198020326-10-8-2019-33-CC-MGAA-BGRTHU-20191008144519

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 198020326
Report Date: 10/08/2019
Date Signed: 10/08/2019 02:45:37 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:	CANCHOLA & GUILLEN FAMILY CHILD CARE		FACILITY NUMBER:	198020326
ADMINISTRATOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY:	8	CENSUS: 0	DATE:	10/08/2019
TYPE OF VISIT:	Prelicensing	ANNOUNCED	TIME BEGAN:	09:20 AM
MET WITH:	Juan Gerardo Canchola & Gerardo Guillen, Applicants		TIME COMPLETED:	02:50 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) M. García conducted a pre-licensing inspection today. LPA met with Juan Canchola & Gerardo Guillen, Applicants who guided analyst on a tour of the facility. Per applicants, family members residing in the home are 2 adults and 6 children. The applicants are requesting a small family child care home license. Per applicants, operation hours will be Monday to Friday, 6:00 AM to 6:00 PM. Applicants state that they will care for children 0-12 years of age. All areas identified on the facility sketch were inspected, including but not limited to, off limit areas. This is a two- story home that consists of 4 bedrooms, 3 restrooms, living room, dining room, family room, kitchen and garage. Per applicants, the children will use the living room, dinning room, family room, kitchen and the restroom located on the first floor near the living room. Areas that will be used by children were inspected for safety, comfort, cleanliness, telephone service, ventilation and heating (central). Detergents, cleaning compounds, medicines, sharp objects and hazardous items that can pose a danger to children are inaccessible in areas designated for children. The applicant states poisons are locked in the shed with a pad lock. The shed is located on the side of the outdoor area of the home. The applicants were advised that any poisons must be locked with a key or combination lock. Based on the Facility Sketch submitted, areas off limits to children and parents are: Second floor which consist of: Four (4) bedrooms and two (2) bathrooms. There is two (2) safety gates installed one (1) is in the bottom of the stairs and one (1) is located at the top of the stairs. Applicants state that the safety gates will remain and kept closed during the hours of operation. The applicant understands that licensing staff may have access to off-limit areas during inspection visit if necessary. REPORT CONTINUES ON NEXT PAGE - 1 of 6

SUPERVISOR'S NAME: Christina Gabelman	TELEPHONE: (323) 981-3380
LICENSING EVALUATOR NAME: Mireya Garcia	TELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:	DATE: 10/08/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/08/2019

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: CANCHOLA & GUILLEN FAMILY CHILD CARE	FACILITY NUMBER: 198020326
	VISIT DATE: 10/08/2019

NARRATIVE

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Infant Care: Applicants state that they will care for infants. LPA advised the applicants to sleep infants where they can be directly supervised at all times and advised against sleeping infants in a separate room. The applicant states the following as a supervision plan for infants: Applicants state that infants will sleep in the family room where they will be providing supervision. LPA provided the applicant with a copy of the Spanish and English version of the Child Care Provider’s Guide to Safe Sleep, by American Academy of Pediatrics. Online copy can be downloaded at: https://www.cdph.ca.gov/programs/SIDS/Documents/SIDSchildcaresafesleep.pdf

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

LPA advised the applicants how to access forms, regulations and quarterly updates on the Child Care Licensing website at: www.ccld.ca.gov. LPA reviewed and issued the Forms/Records to Keep in Your Family Child Care Home (LIC 311D) and provided the following forms:

CHILDREN FORMS/RECORDS - Children’s files must contain the following documents/information:
Identification and Emergency Information (LIC 700), Consent for Emergency Medical Treatment (LIC 627), Notification of Parent’s Rights (LIC 995A), Caregiver Background Check Process (LIC 995E), Family Child Care Consumer Awareness Information (LIC 9212), Consent/Verification for Nebulizer Care (LIC 9166), California School Immunization Record, Parent Notification for Additional Children in Care (LIC 9150), Affidavit Regarding Liability Insurance (LIC 282), Acknowledgment of Receipt of Licensing Reports (LIC 9224).
FACILITY FORMS/RECORDS - Facility files must contain the following documents/information:
Personnel Records: As required in Title 22 Regulations 102416.1, Unusual incident/Injury Report (LIC 624B): Child Care Facility Roster (LIC 9040), Notice of Employee Rights (LIC 9052), Statement Acknowledging Requirement to Report Suspected Child Abuse (LIC 9108), Property Owner/Landlord Consent (LIC 9149), Property Owner/Landlord Notification Form (LIC 9149). REPORT CONTINUES ON NEXT PAGE - 4 of 6

SUPERVISOR'S NAME: Christina Gabelman	TELEPHONE: (323) 981-3380
LICENSING EVALUATOR NAME: Mireya Garcia	TELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:	DATE: 10/08/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/08/2019

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: CANCHOLA & GUILLEN FAMILY CHILD CARE	FACILITY NUMBER: 198020326
	VISIT DATE: 10/08/2019

NARRATIVE

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INFORMATION TO BE POSTED IN YOU FAMILY CHILD CARE HOME – You are required by Law to post the following: Facility License (LIC 203), Emergency Disaster Plan (LIC 610A), Earthquake Preparedness Checklist (LIC 9148), Notification of Parent’s Rights (PUB 394). A Notice of Site Visit (LIC 9213): Must be posted for 30 days after each site inspection by a Licensing Representative. Any Licensing Report documenting a Type “A” deficiency must be posted for 30 days during the hours that children are in care. Any Licensing Report or other document verifying compliance or non-compliance with the Department’s order to correct a Type “A” deficiency must be posted for 30 days during the hours that children are in care.
OTHER INFORMATION AND FORMS PROVIDED:
· Handouts provided for Never Shake a Baby, Sudden Infant Death Syndrome (SIDS) and Safe Sleeping practices
· Capacity Handout for a Small Family Child Care Home and Large Family Child Care Home was provided.
Per applicants, there is a current foster family license at this address.

LPA also discussed Section 10 of the Application for a Family Child Care Home License that the applicant has signed which states the following:
A. I/We live in the home to be licensed.
B. I/We have money to maintain the level of service required by law in a Family Child Care Home.
C. I/We have both State Fire Marshal approved fire extinguisher (rated 2A, 10BC) and smoke detector in operating condition.
D. I/We shall stay current and in compliance with the law and regulations governing standards for Family Child Care Homes.
E. I/We shall obtain approval from the licensing agency before making changes in our license capacity or to our home.
F. I/We shall notify the licensing agency when we want to discontinue our license.
G. I/We have informed the property owner, if leased or rented, that we will be operating a Family Child Care Home on the premises. The owner/landlord has been sent the Property Owner/Landlord Notification (LIC 9151).
H. I/We have written consent from the property owner, if leased or rented, when I plan to expand my Small Family Child Care Home capacity from 6 to 8 children, or to expand my Large Family Child Care Home capacity to 12 to 14 children. Property Owner/Landlord Consent Form (LIC 9149) has been signed.
I. I/We understand the requirements to report known or suspected child abuse (LIC 9108).
REPORT CONTINUES ON NEXT PAGE - 5 of 6

SUPERVISOR'S NAME: Christina Gabelman	TELEPHONE: (323) 981-3380
LICENSING EVALUATOR NAME: Mireya Garcia	TELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:	DATE: 10/08/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/08/2019

LIC809 (FAS) - (06/04)

Page: 5 of 6

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: CANCHOLA & GUILLEN FAMILY CHILD CARE	FACILITY NUMBER: 198020326
	VISIT DATE: 10/08/2019

NARRATIVE

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· Reporting Requirements: 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.
· No infant walkers, No Johnny jumpers, No saucer chairs, No trampolines and any other item that falls into that category are not permitted in the facility.
· Inspection Authority: All adults living and working in the home shall be made of aware of the Department’s right to inspection the home, which includes, but is not limited to the right to enter the home when children are being cared for, interview children and adults and review documentation.
· The facility license number must be on all advertisements, publications or announcements with the intent to attract clients.
· Isolation for Ill children: When a child is ill he/she shall be separated from other children (reference 102417(e) Operation of a Family Child Care Home).
· Liability Insurance was discussed; LPA advised applicant to review Title 22 Regulation 102417(m)(1) for additional information.

· Immunization Requirement: H&S 1597.622: Commencing September 1, 2016, a person shall not be employed or volunteer at a family day care home if he or she has not been immunized against influenza, pertussis, and measles. The licensee and all adults working with children have proof of immunizations.

· Mandated Reporter Training: H&S 1596.8662: Beginning January 1, 2018, all licensed providers, applicants, directors and employees to complete training as specified on mandated reporter duties. Training is available at: www.mandatedreporterca.com

REPORT CONTINUES ON NEXT PAGE - 3 of 6

SUPERVISOR'S NAME: Christina Gabelman	TELEPHONE: (323) 981-3380
LICENSING EVALUATOR NAME: Mireya Garcia	TELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:	DATE: 10/08/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/08/2019

LIC809 (FAS) - (06/04)

Page: 3 of 6

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: CANCHOLA & GUILLEN FAMILY CHILD CARE	FACILITY NUMBER: 198020326
	VISIT DATE: 10/08/2019

NARRATIVE

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The applicant’s signature on this report acknowledges that they have signed the Application for a Family Child Care Home License (LIC 279) under the penalty of perjury that the statements on the application and any attachments are correct.

Based on the LPA’s observation, the following corrections need to be corrected prior to obtaining a small family child care license. Corrections are due by 11/08/2019.

· Applicants state that they will make the back yard safe for children by covering the water pipes. Applicants state that they will submit a picture by due date as proof of correction.
· Applicants state that they will make the backyard safe for children by making the Air Conditioner Condenser inaccessible to children. Applicants state that they will submit a picture by due date as proof of correction.

A small family child care licensee will be granted upon receipt of proof of corrections for the above. Once licensed, the applicant is required to comply with the terms and limitations stated on the license. A copy of this report was reviewed and provided to the applicants.

Exit interview was conducted with Gerardo Guillen, Applicant who acknowledges receipt of report.

REPORT END - PAGE 6 of 6

SUPERVISOR'S NAME: Christina Gabelman	TELEPHONE: (323) 981-3380
LICENSING EVALUATOR NAME: Mireya Garcia	TELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:	DATE: 10/08/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/08/2019

LIC809 (FAS) - (06/04)

Page: 6 of 6

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: CANCHOLA & GUILLEN FAMILY CHILD CARE	FACILITY NUMBER: 198020326
	VISIT DATE: 10/08/2019

NARRATIVE

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OUTDOOR PLAY AREA
The children will use the back yard for outdoor play, which was observed to be fenced. Per applicant, there are no pets, firearms, weapons or bodies of water on the premises.

The value on the 2A10BC fire extinguisher indicates fully charged, and was serviced on 06/25/19, as indicated on service tag.

There are toys available for children.

The applicants state that they will provide food for children in care. If food is not provided and food is brought from the children’s homes; container shall be labeled with child’s name and properly stored or refrigerated.

The applicants have completed the required Health and Safety Training, Nutrition Training and Pediatric First Aid and CPR which expires 07/2021. There are first aid supplies available.

The following was discussed with the applicant:

· 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. Civil Penalties will be assessed if not in compliance.
· 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 Pediatric First Aid and CPR training, Immunizations (TDAP, MMR, Influenza), mandated reporter training and a valid criminal record clearance associated to the facility license.
· Annual fees must be paid promptly and by the due date or a late fee shall be assessed and/or the License may 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.
· Reporting Requirements: 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 6

SUPERVISOR'S NAME: Christina Gabelman	TELEPHONE: (323) 981-3380
LICENSING EVALUATOR NAME: Mireya Garcia	TELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:	DATE: 10/08/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/08/2019

LIC809 (FAS) - (06/04)

Page: 2 of 6