198020500-5-11-2020-33-CC-RLOZ-BPHR7D-20200511124609

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 198020500
Report Date: 05/11/2020
Date Signed: 05/11/2020 12:46:38 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:	ACEVEDO FAMILY CHILD CARE		FACILITY NUMBER:	198020500
ADMINISTRATOR:	MARIA ACEVEDO		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(323) 440-1276
CITY:	MONTEBELLO	STATE: CA	ZIP CODE:	90640
CAPACITY:	14	CENSUS: 0	DATE:	05/11/2020
TYPE OF VISIT:	Prelicensing	ANNOUNCED	TIME BEGAN:	09:00 AM
MET WITH:	Applicant, Maria Leticia Acevedo		TIME COMPLETED:	12:45 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	An announced Pre- Licensing Inspection was conducted by Licensing Program Analyst (LPA) Roxana Lopez. Due to COVID-19 and precautionary measures this Pre- Licensing Inspection was conducted with Maria Leticia Acevedo, Applicant via a tele-inspection by the use of face-time. The purpose of today's visit is to inspect and evaluate facility for initial licensure, Applicant is applying for a Large Family Child Care Home. Present during this inspection was Licensee, her father and her daughter. Per applicant, family members residing in the home are 2 adults. Per applicant, operation hours will be Monday to Sunday, 7:00 AM to 6:00 PM. Applicant states that she will care for children 3 mos -13 years of age. During this tele-inspection the Applicant took the LPA on a tour of the home. During this tour the following was observed: All areas identified on the facility sketch were inspected, including but not limited to, off limit areas. This is a one story home that consists of 3 bedrooms, 2 bathrooms, kitchen, family room, living room, laundry room, garage, front yard and backyard. Per applicant, the children will use the restroom in the hallway, the family room, one bedroom/playroom and backyard fence. Areas that will be used by children were inspected for safety, comfort, cleanliness, telephone service cell phone and landline, ventilation and heating LPA did observed cleaning compounds and other hazardous items that can pose a danger to children accessible to children in a cabinet located next to the bathroom the children will be using. During the inspection the applicant’s daughter removed the items and placed them in the laundry room which is inaccessible for children in care. --------------------------------------------------------- Pg.1 of 5 ---------------------------------------------------------------------------

SUPERVISOR'S NAME: Valarie Cook	TELEPHONE: (323) 981-3362
LICENSING EVALUATOR NAME: Roxana Lopez	TELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:	DATE: 05/11/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/11/2020

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: ACEVEDO FAMILY CHILD CARE	FACILITY NUMBER: 198020500
	VISIT DATE: 05/11/2020

NARRATIVE

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The applicant states that there are poisons on the premises and are locked in the garage. Lpa observed a fireplace in the living room which is inaccessible for children. Per applicant, the living room is off limits for children and the door remains locked during day-care hours.

Based on the Facility Sketch submitted, areas off limits to children and parents are: The front yard, kitchen, laundry room, 2 bedrooms, one bathroom and garage. All areas inaccessible for children were observed to have a lock or security knob making them inaccessible for children in care. The applicant understands that licensing staff may have access to off-limit areas during inspection visit if necessary.

LPA Lopez observed two fire extinguishers- one in the laundry room and the other in the family room. The valves on the 2A10BC fire extinguishers indicates fully charged and were purchased on 1/25/2020 as indicated in the receipt. Applicant’s daughter tested the smoke and carbon monoxide detectors during the inspection. LPA Lopez observed and heard them to be operable.

There are toys available for children. LPA observed sleeping arrangements in forms of cots, mats and a playpen. LPA advised applicant that when infant is sleeping in playpen, the playpen should be clear of any toys or stuff animals.

The applicant states that they will provide food for children in care and is planning to apply for the food program.
The applicant has completed the required Health and Safety Training, Nutrition Training and Pediatric First Aid and CPR. There are first aid supplies available.

Per applicant, she has no firearms, weapons or bodies of water on the premises. LPA did not observed any bodies of water.

OUTDOOR PLAY AREA
The children will use the back yard for outdoor play, which was observed to be fenced and safe of any hazards. Per applicant parents and children will be coming in through the back yard. LPA observed a door in the backyard leading into the play room. Per applicant, there are two dogs in the facility. LPA observed the dogs to be outside behind a gate.
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SUPERVISOR'S NAME: Valarie Cook	TELEPHONE: (323) 981-3362
LICENSING EVALUATOR NAME: Roxana Lopez	TELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:	DATE: 05/11/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/11/2020

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: ACEVEDO FAMILY CHILD CARE	FACILITY NUMBER: 198020500
	VISIT DATE: 05/11/2020

NARRATIVE

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Per applicant the dogs will remain gated during day care hours.

Infant Care: Applicant states that they will care for infants. LPA advised the applicant 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: Applicant states that infants will sleep in the bedroom/play-room where she will be providing supervision. LPA provided the applicant with a copy 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. 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

At 9:35 AM 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.
· 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.
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SUPERVISOR'S NAME: Valarie Cook	TELEPHONE: (323) 981-3362
LICENSING EVALUATOR NAME: Roxana Lopez	TELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:	DATE: 05/11/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/11/2020

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: ACEVEDO FAMILY CHILD CARE	FACILITY NUMBER: 198020500
	VISIT DATE: 05/11/2020

NARRATIVE

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· 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; Per Applicant she does have liability insurance. 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

At 9:45 am LPA reviewed and issued the LIC 311D - Forms/Records to Keep in Your Family Child Care Home. All required forms listed were explained and provided via email to the applicant during this visit.

LPA advised the applicant how to access forms, regulations and quarterly updates on the Child Care Licensing website at: www.ccld.ca.gov.

OTHER INFORMATION AND FORMS PROVIDED:
· Handouts provided for Never Shake a Baby, Sudden Infant Death Syndrome (SIDS) and Safe Sleeping
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SUPERVISOR'S NAME: Valarie Cook	TELEPHONE: (323) 981-3362
LICENSING EVALUATOR NAME: Roxana Lopez	TELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:	DATE: 05/11/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/11/2020

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: ACEVEDO FAMILY CHILD CARE	FACILITY NUMBER: 198020500
	VISIT DATE: 05/11/2020

NARRATIVE

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practices
· Capacity Handout for a Large Family Child Care Home and Large Family Child Care Home was provided.

Per applicant, there are no dual licenses at this address. Applicant’s email address was obtained during this inspection. The applicant was advised that email may be public information.

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.

Licensee is seeking to provide care for 14 children 3 mos-13 years old. A fire clearance has been granted as of 2/6/2020. Based upon today’s inspection, there are no corrections pending at this time. The Family Child Care Home appears to meet Title 22 requirements. The application will be submitted for final review to the department. Once licensed, the applicant is required to adhere to the terms and limitations stated on the license.

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 Maria Leticia Acevedo, Licensee via tele-inspection (face-time), during which appeal rights were explained. This report along with a copy of appeal rights will be sent to the Licensee via email with a read receipt or confirmation of receipt of email, which will act as the Applicants signature

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SUPERVISOR'S NAME: Valarie Cook	TELEPHONE: (323) 981-3362
LICENSING EVALUATOR NAME: Roxana Lopez	TELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:	DATE: 05/11/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/11/2020

LIC809 (FAS) - (06/04)

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