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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198020449
Report Date: 11/19/2019
Date Signed: 11/19/2019 11:13:28 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:SOTO & JONES FAMILY CHILD CAREFACILITY NUMBER:
198020449
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY:8CENSUS: 1DATE:
11/19/2019
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Daisy Soto & Rosaline Jones TIME COMPLETED:
11:15 AM
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Licensing Program Analyst (LPA) Seung Lee conducted a prelicensing inspection on this date. Upon arrival LPA Lee met with applicants Daisy Soto & Rosaline Jones. The applicants stated the home will provide care for children ages 4 months to 11 years old. Day care hours will be Monday-Friday 6:30AM-6:00PM. Residents that live at this home include the two applicant and 3 adults who are finger print cleared.

This is a one story home that consists of 4 bedrooms 2 bathrooms, kitchen, living room, dining area, and back yard with a detached garage .The day care will take place in the Living room, 1 bedroom, Dining room area, 1 bathroom, the detached garage, and the backyard. The kitchen, 3 bedrooms, 1 bathroom will be off limits. LPA observed the backyard had an AC unit that has been fenced off to prevent access. The detached garage has been converted to a room to provide care for children. Applicants stated that children will eat and nap in the living room of the home and not in the converted garage. The home was inspected for safety, comfort, cleanliness, telephone service, heating and ventilation, inaccessibility to poisons, detergents, cleaning compounds, medicines, and hazardous items that can pose a danger to children.

The back yard area is adequately fenced and there is NO swimming pool, spa or other bodies of water observed on the premises. There are age appropriate toys and napping equipment on the premises. The children will nap in the living room per applicant.

There are operational smoke and carbon monoxide detectors throughout the home. Applicant's CPR expires on 06/2021. Fire extinguisher was observed in the home with a purchase date of 11/19/2019 per receipt.

LPA advised applicant that infants should sleep mouth up, on their backs, and free of clutter surrounding their sleeping space (cribs). LPA reviewed SIDS, Never Shake a Baby, and safe sleeping practices.
SUPERVISOR'S NAME: Guangorena ClaudiaTELEPHONE: (323) 981-3417
LICENSING EVALUATOR NAME: Seung LeeTELEPHONE: (323) 981-3382
LICENSING EVALUATOR SIGNATURE:

DATE: 11/19/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/19/2019
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: SOTO & JONES FAMILY CHILD CARE
FACILITY NUMBER: 198020449
VISIT DATE: 11/19/2019
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 FORMS TO BE POSTED

LIC6101A Emergency Disaster Plan,

PUB394 Notification of Parents Rights Poster,

Facility License



Facility Records: LIC 624B Unusual Incident/Injury Report,LIC 9040 Child Care Facility Roster, LIC9052 Employee Rights,LIC9108 Statement Acknowledging Requirement to Report Child Abuse,
Staff Forms/Records - any assistant present must have the following on file: Proof of TB clearance (within one year), Immunization records. Notice of Employee Rights (LIC 9052), Criminal Record Statement (LIC 508), Statement Acknowledging Requirements to Report Suspected Child Abuse (LIC 9180).
Children’s records requirements: LIC 700 Identification And Emergency Information, LIC 627 Consent For Emergency Medical Treatment, LIC 282 Affidavit Regarding Liability Insurance, LIC 9150 Parent Notification Additional Children In Care, Immunization record, PUB 72- Family Child Care Consumer Guide, LIC 995A Notification of Parent’s Rights

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. 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, TB clearance, and a valid criminal record clearance associated to the facility license.
·A current roster of children enrolled LIC 9040 must be available and maintained for a period of three years, even after children no longer are attending the facility.
SUPERVISOR'S NAME: Guangorena ClaudiaTELEPHONE: (323) 981-3417
LICENSING EVALUATOR NAME: Seung LeeTELEPHONE: (323) 981-3382
LICENSING EVALUATOR SIGNATURE:

DATE: 11/19/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/19/2019
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: SOTO & JONES FAMILY CHILD CARE
FACILITY NUMBER: 198020449
VISIT DATE: 11/19/2019
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  • 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.
·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.
·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. Mandated reporter requirements was reviewed and explained.
·Fire and safety drills must be performed every 6 months and documented for review by the Department.
·Smoking is prohibited in a family child care home, 24/7.
·Children and Staff records must be maintained and updated as needed and must be available for review by the Department.
·No smoking, 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.
·All adults living and working in the home shall be made of aware of the Departments right to inspection authority.

Once licensed applicant was informed to contact the department 30 days prior to enrolling any child with IMS needs. LPA advised applicant to refer to Section 101173 and 101226 for further information on regulatory requirements. Regulation Interpretations and Procedures for Child Care Centers Section 102417. 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.

Applicants were told that this report along with the application will be submitted for review and approval. Care for children can begin after the License has been granted.

Exit interview was conducted with Daisy Soto & Rosaline Jones, applicant, who is in agreement with the above. A copy of this report and all other Licensing reports must be made available to the public for 3 years.
SUPERVISOR'S NAME: Guangorena ClaudiaTELEPHONE: (323) 981-3417
LICENSING EVALUATOR NAME: Seung LeeTELEPHONE: (323) 981-3382
LICENSING EVALUATOR SIGNATURE:

DATE: 11/19/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/19/2019
LIC809 (FAS) - (06/04)
Page: 3 of 3