198400004-5-21-2019-54-CC-WBIS-BCDULU-20190521154119

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 198400004
Report Date: 05/21/2019
Date Signed: 05/21/2019 03:41:32 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:	CASTRO MARTINEZ-GUEVARA FAMILY CHILD CARE		FACILITY NUMBER:	198400004
ADMINISTRATOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY:	8	CENSUS: 0	DATE:	05/21/2019
TYPE OF VISIT:	Prelicensing	ANNOUNCED	TIME BEGAN:	01:30 AM
MET WITH:	Fatima Castro/Yaricsa Martinez Guevara		TIME COMPLETED:	03:55 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) Warren Birks conducted an announced pre-licensing inspection today. LPA met with applicants Fatima Castro and Yaricsa Martinez Guevara who guided analyst on a tour of the facility. Adults and Family members residing in the home are both applicants, co-applicants spouse and minor child. All adults on the premises including the backhouse are fingerprint cleared. Operating hours will be Monday to Sunday 7:00am to 6:00am. Applicant Castro states they will care for children 0 to 13 years old. Applicant indicates she may upgrade to a large facility at a later date. All areas identified on the facility sketch were inspected. This is single family home with a separate one bedroom back house on the property (Same address). The front house consist of three bedrooms and one bathroom, living room, kitchen, front and backyard (fenced). The children will use the living room, two bedrooms, the bathroom and backyard for daycare. There is a section of the backyard area that is inaccessible by a large fence. Applicant Castro provided an affidavit indicating he backyard driveway will not be used for vehicles. The home was inspected for safety, comfort, cleanliness, telephone service, heating (central air), and ventilation. There is no accessibility to poisons, detergents, cleaning compounds, medicines, and hazardous items that can pose a danger to children. The applicant has installed child locks on cabinets in the kitchen and bathrooms. The applicant's smoke detector, carbon monoxide detector are in operable condition. The 2A10BC fire extinguisher is current and is due for service by November 12, 2019. LPA observed age appropriate toys, books and play equipment. Applicant Castro will have to purchase napping equipment for infants. Off limits areas include: One bedroom and Large fenced off backyard area. Areas used by children include: Living room activity area, front bedroom, backyard, one bathrooms. Per applicant there are no weapons, firearms or body of waters on the premises at this time. First Aid kit is available and is in the living room. Licensees have current Preventative Health and Safety and CPR/First Aid (valid until December, 2018).

SUPERVISOR'S NAME: Brandi VanOosten	TELEPHONE: (323) 981-3365
LICENSING EVALUATOR NAME: Warren Birks	TELEPHONE: 323-981-3373
LICENSING EVALUATOR SIGNATURE:	DATE: 05/21/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/21/2019

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 CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME: CASTRO MARTINEZ-GUEVARA FAMILY CHILD CARE	FACILITY NUMBER: 198400004
	VISIT DATE: 05/21/2019

NARRATIVE

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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. Currently the applicant implements IMS. All applicant immunization records are current.

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), 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

Smoking is prohibited in a family child care home.
·Children and Staff records must be maintained and updated and must be available for review.
·No baby bouncers, No infant walkers, No Johnny jumpers, No saucer chairs, No trampolines and any other item that falls into that category are permitted in the facility.

All adults living and working in the home shall be made of aware of the Departments inspection authority.

SUPERVISOR'S NAME: Brandi VanOosten	TELEPHONE: (323) 981-3365
LICENSING EVALUATOR NAME: Warren Birks	TELEPHONE: 323-981-3373
LICENSING EVALUATOR SIGNATURE:	DATE: 05/21/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/21/2019

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 CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME: CASTRO MARTINEZ-GUEVARA FAMILY CHILD CARE	FACILITY NUMBER: 198400004
	VISIT DATE: 05/21/2019

NARRATIVE

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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, mandated reporter certificate.
·A current roster of children enrolled must be available and maintained for a period of three years, even after children no longer are attending the facility.
·The fire extinguisher type 2A-10BC or higher 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 were reviewed and explained.
·Fire and safety drills must be performed every six months and documented for review by the Department.

Applicant indicated she may occasionally take children to the park for outdoor activities. Applicant was advised to provide 100% supervision for safety regarding any activities away from the daycare.

Note: Once the applicants provide evidence of infant napping equipment, the facility will be approved for a small family child care license. Once licensed, the applicant is required to adhere to the terms and limitations as stated on the license.

LPA advised the applicant how to access forms, regulations and quarterly updates on the Child Care Licensing Website at: www.ccld.ca.gov . Exit interview was conducted with Applicant Fatima Castro (who provided Spanish translation to Co-Applicant Yaricsa Martinez Guevara) . A copy of this report and all other Licensing reports must be made available to the public for 3 years.

SUPERVISOR'S NAME: Brandi VanOosten	TELEPHONE: (323) 981-3365
LICENSING EVALUATOR NAME: Warren Birks	TELEPHONE: 323-981-3373
LICENSING EVALUATOR SIGNATURE:	DATE: 05/21/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/21/2019

LIC809 (FAS) - (06/04)

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