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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198020326
Report Date: 09/14/2021
Date Signed: 09/14/2021 11:21:24 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:CANCHOLA & GUILLEN FAMILY CHILD CAREFACILITY NUMBER:
198020326
ADMINISTRATOR:J CANCHOLA & G. GUILLENFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(909) 802-6239
CITY:PICO RIVERASTATE: CAZIP CODE:
90660
CAPACITY:14CENSUS: 7DATE:
09/14/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
08:25 AM
MET WITH:Gerardo Guillen TIME COMPLETED:
11:25 AM
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At 8:25 am Licensing Program Analysts (LPA) Roxana Lopez conducted an unannounced required 1 year inspection to the above facility. A risk assessment was conducted upon entry- appropriate PPE was used. LPA met with Gerardo Guillen, Licensee who guided analysts on a tour of the facility. Per Licensee, there are 23 children currently 23 enrolled. A current children’s roster was available for review. There were 7 children present upon arrival- two being infants. The 8th child arrived at 8:45am, assistant Breanna Avellanadena arrived at 9:05 am.

The licensee states that 2 adults and 6 children currently live in the home. Per Licensee, he currently has 3 assistants. All adults present in the home have obtained a criminal record clearance or exemption prior to working, residing or volunteering in the licensed child care home. Licensee states that there are no firearms stored in the home.

This is a two story home which consists of 4 bedrooms, 3 restrooms, living room, dining room, family room, kitchen, garage and backyard (fenced). The children have access to living room, dining room, family room, kitchen, the restroom located on the first floor near the living room and backyard fenced.

Per licensee, areas off limits to children and parents include entire second floor, 4 bedrooms, 2 bathrooms and garage. The LPA toured all areas used by children during this visit. LPA observed a baby gate at the bottom and at the top of the stairs making the second floor inaccessible.

All areas identified on the facility sketch that are accessible for children to use were inspected for safety, comfort, and cleanliness. There is telephone service via a landline and a cellphone that stays at the facility during operation hours. There is ventilation and heating (central). The following was observed and reviewed during this inspection.
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SUPERVISOR'S NAME: Brandi VanOostenTELEPHONE: (323) 981-3365
LICENSING EVALUATOR NAME: Roxana LopezTELEPHONE: (323) 854-5073
LICENSING EVALUATOR SIGNATURE:

DATE: 09/14/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/14/2021
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 5
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: 09/14/2021
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Detergents, cleaning compounds, and medications were observed to be inaccessible to children. At 8:40 am LPA Lopez observed 2 knifes in an unlocked drawer. During inspection License placed the knifes in a high cabinet above the refrigerator. Poisons are locked in a high cabinet above the refrigerator in the kitchen. The restroom that children use was observed to be safe and sanitary.

LPA Lopez did observed a fireplace in the family room which was barricaded and inaccessible for children in care. The valve on the required 2A10BC fire extinguisher indicates fully charged and was serviced on 08/9/2021, as indicated on service tag. Smoke and carbon monoxide detectors were tested and are operable. All homes shall conduct fire and disaster drills at least once every six months, and document the date and time of each drill. Last drill documented was conducted on 8/1/2021

Emergency Disaster Plan, Parent’s Rights Poster and the Facility License were observed to be posted in the entrance of the facility.

The home is observed to be clean and orderly. There are toys available for children. Appropriate sleeping arrangements in forms of cots and play pens were observed.

Licensee states that he is currently caring for infants. LPA Lopez discussed the Sleeping Regulation- Sleeping Log and Individual Sleeping Plan was observed To be on file. Per Licensee, infants sleep in the family room.

LPA did not observe the following items during the inspection: Infant Walkers, Johnny Jumpers, Saucer Chairs, Trampolines and/or any other item that fall into these categories are not permitted in a family child care facility.

Smoking is prohibited in a licensed Family Child Care Home. Per Licensee, no one smokes in the home.

Currently, children are using the back yard for outdoor play time. 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 can pose a danger to children on the outdoor yard.

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SUPERVISOR'S NAME: Brandi VanOostenTELEPHONE: (323) 981-3365
LICENSING EVALUATOR NAME: Roxana LopezTELEPHONE: (323) 854-5073
LICENSING EVALUATOR SIGNATURE:

DATE: 09/14/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/14/2021
LIC809 (FAS) - (06/04)
Page: 2 of 5
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: 09/14/2021
NARRATIVE
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There are birds on the premises. LPA observed birds to be caged out in the backyard.

The licensee is observed to be operating within the license capacity limitations.

At 9:55 am children’s records were reviewed, including emergency information and were observed to be complete.

The licensee and other personnel have completed training on preventive health practices including Pediatric First Aid and CPR. The licensee's Pediatric First Aid and CPR expires on 7/2023. There are first aid supplies available.

LPA observed that the Licensee and assistant do have proof of immunization record and the Mandated Reporter AB 1207 compliant Child Care Training Certificate on file.


LPA issued a Confidential Names List (LIC 811) to the licensee which documents staff and children’s files reviewed during this inspection.

Incidental Medical Services (IMS):
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 licensee to access forms, regulations and quarterly updates on line at: www.ccld.ca.gov

Licensing staff consulted with licensing regarding COVID-19 health and safety guidelines on this date, Licensing staff observed COVID- 19 postings posted in the day care on this date. A RAST inspection is on file-


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SUPERVISOR'S NAME: Brandi VanOostenTELEPHONE: (323) 981-3365
LICENSING EVALUATOR NAME: Roxana LopezTELEPHONE: (323) 854-5073
LICENSING EVALUATOR SIGNATURE:

DATE: 09/14/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/14/2021
LIC809 (FAS) - (06/04)
Page: 3 of 5
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: 09/14/2021
NARRATIVE
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On this date LPA Lopez observed that Licensee, was not wearing a mask and did not ensure that children over the age of 2 wore masks while in the facility, as required by the CA Dept. of Public Health Guidance on the Use of Face Coverings issued June 18, 2020 and Updated November 16. 2020. Licensee, put a mask on when LPA came into the facility but there were no children’s mask available. LPA informed Licensee, that the usage of mask is a mandate and that every adult and child over the age of two should be wearing a mask. Per Licensee he will inform the parents during pick up- so they can bring mask for the children.

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 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.

Based on the LPA’s observations and records review, the following deficiencies listed on the attached LIC 809D (deficiency page) are being cited in accordance with California Code of Regulations Title 22. Deficiencies that are being cited need to be cleared to protect the children’s health & safety.

The Notice of Site Visit (LIC 9213) – must remain posted for 30 days during the hours of operation after each site visit made by a licensing representative. Failure to maintain posting as required will result in a civil penalty of $100.00.

Exit interview was conducted with Gerardo Guillen, Licensee including, but not limited to Provider Rights, Appeal Procedures and Agencies Consultative Role and their signature on this form acknowledges receipt of these forms.
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SUPERVISOR'S NAME: Brandi VanOostenTELEPHONE: (323) 981-3365
LICENSING EVALUATOR NAME: Roxana LopezTELEPHONE: (323) 854-5073
LICENSING EVALUATOR SIGNATURE:

DATE: 09/14/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/14/2021
LIC809 (FAS) - (06/04)
Page: 4 of 5
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
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/14/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
09/21/2021
Section Cited

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102417 Operation of a Family Child Care Home; (g)The home shall be free from defects or conditions which might endanger a child. Safety precautions shall include but not be limited to:(4) Poisons, detergents, cleaning compounds, medicines, firearms and other items which could pose a danger
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if readily available to children shall be stored where they are inaccessible to children.This requirement was not met as evidenced by LPA observing 2 knifes in an unlocked drawer in the kitchen. This poses a potential a risk for the health and safety of children in care.
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Type B
09/21/2021
Section Cited

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102423 Personal Rights- (2) To receive safe, healthful, and comfortable accommodations, furnishings, and equipment.. This requirement was not met as evidence by LPA's observation Licensee, did not ensure that children over the age of 2 wore masks while in the facility, as required by the CA Dept. of Public Health
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Guidance on the Use of Face Coverings issued June 18, 2020 and Updated November 16. 2020. This poses a potential risk for the health and safety of the children in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Brandi VanOostenTELEPHONE: (323) 981-3365
LICENSING EVALUATOR NAME: Roxana LopezTELEPHONE: (323) 854-5073
LICENSING EVALUATOR SIGNATURE:
DATE: 09/14/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/14/2021
LIC809 (FAS) - (06/04)
Page: 5 of 5