198400022-4-13-2021-54-CC-MAYA-C22P4P-20210413105927

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 198400022
Report Date: 04/12/2021
Date Signed: 04/13/2021 10:59:41 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 CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME:	BELTRAN FAMILY CHILD CARE		FACILITY NUMBER:	198400022
ADMINISTRATOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY:	8	CENSUS: 1	DATE:	04/12/2021
TYPE OF VISIT:	Case Management - Licensee Initiated	ANNOUNCED	TIME BEGAN:	01:30 PM
MET WITH:	Licensee/Applicant, Monica Beltran		TIME COMPLETED:	03:20 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	On April 12, 2021 at 1:30 PM, Licensing Program Analyst (LPA) Monique Ayala conducted a Prelicensing tele-inspection via Zoom Meeting with Licensee/Applicant, Monica Beltran. The inspection was conducted via Zoom Meeting due to the Coronavirus Disease 2019 (COVID-19) pandemic. The Licensee/Applicant is requesting a Capacity Change to be licensed as a Large Family Day Care Home (up to 14 children). A fire clearance for the requested capacity was granted on March 2, 2021. At the time of the inspection, individuals residing in the home was discussed and assessed. The operating hours are Monday through Friday from 7:00 AM to 6:00 PM. The applicant is applying to care for children ages, newborn to 13 years old. All areas identified on the facility sketch were virtually inspected. This facility is a single family home that consists of three (3) bedrooms, two (2) bathrooms, living room, dining room, kitchen, garage and outdoor shed. Areas that are accessible to children include: one bathroom, living room, dining room, and fenced backyard. Per applicant, the children will utilize the fenced backyard for outdoor activity. Areas off limits to children include: 3 bedrooms, 1 bathroom, kitchen, outdoor shed, and garage. LPA observed the bedroom doors, garage door and outdoor shed door closed and locked, making the areas inaccessible to children. LPA also observed child safety gates installed in the kitchen, making the area inaccessible to children. Per Licensee/Applicant, children are escorted through the kitchen to and from the front entrance and to use the restroom. The Licensee/Applicant was advised that off-limit areas must be made inaccessible during operating hours.

SUPERVISOR'S NAME: Brandi VanOosten	TELEPHONE: (323) 981-3365
LICENSING EVALUATOR NAME: Monique Ayala	TELEPHONE: (323) 246-2016
LICENSING EVALUATOR SIGNATURE:	DATE: 04/12/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/12/2021

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: BELTRAN FAMILY CHILD CARE	FACILITY NUMBER: 198400022
	VISIT DATE: 04/12/2021

NARRATIVE

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Areas used by children were inspected for safety, comfort, cleanliness and telephone service. The home does not have a fire place. LPA observed the wall heaters securely barricaded, making the wall heaters inaccessible to children. Detergents, cleaning compounds, medicines, sharp objects and hazardous items that can pose a danger to children are inaccessible. Licensee/Applicant stated that there are no poisons in the home. Licensee/Applicant was advised that if any poisons are purchased, it is required to be locked with a key or combination lock.

Per Licensee/Applicant, the home does not have any pets, firearms, weapons, or bodies of water. LPA observed age appropriate toys and napping equipment. LPA observed electrical outlet covers throughout the facility. LPA observed the required fire extinguisher (2A-10BC) that is fully charged. Smoke and carbon monoxide detectors were tested by the Licensee/Applicant and are operable. First Aid kits are available and located in the kitchen and dining room. The Licensee/Applicant has a no-touch thermometer readily available. The Licensee/Applicant was advised that if food is brought from the children’s home, all containers must be labeled with the child’s name and properly stored or refrigerated.

The Licensee/Applicant has proof of Pediatric First Aid/CPR certification (expires 03/2023). Licensee/Applicant has proof of immunization against influenza, pertussis, and measles. Licensee/Applicant completed the Preventative Health and Safety training, including the Nutrition on 03/16/2019, Lead Poisoning Prevention Training on 03/21/2021, and Mandated Reporter training (AB 1207) on 03/13/2021. Licensee/Applicant was advised that the mandated reporter training must be completed every 2 years and is available at www.mandatedreporterca.com.

During the tele-inspection, LPA discussed Forms/Records to Keep in Your Family Child Care Home (LIC 311D). LPA also discussed reference material on the California Car Seat Law Changes (effective January 1, 2017), Effects of Lead Exposure, Shaken Baby Syndrome, Sudden Infant Death Syndrome (SIDS), and recently approved safe sleep regulations in effect (Provider Information Notice (PIN) 20-22-CCP, dated 09/15/2020).

LPA observed the following forms posted in the facility: License (203A), Emergency Disaster Plan (LIC 610A), Earthquake Preparedness Checklist (LIC 9148), Notification of Parents’ Rights Poster (PUB 394), and COVID-19 related posters.

SUPERVISOR'S NAME: Brandi VanOosten	TELEPHONE: (323) 981-3365
LICENSING EVALUATOR NAME: Monique Ayala	TELEPHONE: (323) 246-2016
LICENSING EVALUATOR SIGNATURE:	DATE: 04/12/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/12/2021

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: BELTRAN FAMILY CHILD CARE	FACILITY NUMBER: 198400022
	VISIT DATE: 04/12/2021

NARRATIVE

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Facility Forms/Records to keep in your home:
1. Personnel Records as required in Title 22, Division 12, Chapter 3, Section 102416.1, including but not limited to, proof of current pediatric first aid, CPR, preventative health practices certificate, mandated reporter training certificate and criminal record information.
2. Unusual Incident/Injury Report (LIC 624B).
3. Child Care Facility Roster (LIC 9040).
4. Notice of Employee Rights (LIC 9052).
5. Statement Acknowledging Requirement to Report Suspected Child Abuse (LIC 9108).
6. Property Owner/Landlord Consent Form (LIC 9149).
7. Property Owner/Landlord Notification Form (LIC 9151).
8. A copy of your deed or lease/rental agreement.
9. Affidavit Regarding Liability Insurance (LIC 282).

The following was also discussed with the Licensee/Applicant:
1. Individuals who are 18 years of age or older and 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.
2. 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 and Pediatric First Aid certification and a valid criminal record clearance associated to the facility license.
3. A current roster of children enrolled must be available and maintained for a period of 3 years, even after children are no longer attending the facility.
4. Annual fees must be paid promptly and by the due date or a late fee shall be assessed and/or the license shall be terminated.
5. 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.
6. 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.
7. Any unusual incidents or injuries must be reported to the Department within 24 hours and within seven (7) days in writing (refer to LIC 624B). Mandated reporter requirements were reviewed and explained.

SUPERVISOR'S NAME: Brandi VanOosten	TELEPHONE: (323) 981-3365
LICENSING EVALUATOR NAME: Monique Ayala	TELEPHONE: (323) 246-2016
LICENSING EVALUATOR SIGNATURE:	DATE: 04/12/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/12/2021

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: BELTRAN FAMILY CHILD CARE	FACILITY NUMBER: 198400022
	VISIT DATE: 04/12/2021

NARRATIVE

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8. Fire and safety drills must be performed every six (6) months and documented for review by the Department.
9. Smoking is prohibited in the family child care home.
10. Children and staff records must be maintained and updated as needed and be available for review by the Department.
11. Dog(s) and/or pets are recommended to be isolated from children in care.
12. No baby bouncers, No infant walkers, No Johnny jumpers, No saucer chairs, No trampolines and any other item that falls into this category is not permitted in the facility.

On April 12, 2021, the Licensee/Applicant submitted the completed Child Care Program COVID-19 Self-Assessment. During the tele-inspection, LPA reviewed the implementations noted on the guide and discussed plans to ensure that the applicant will meet COVID-19 guidance for a child care setting.

LPA observed that the Licensee/Applicant has hand sanitizer, cleaning solutions, and gloves readily available. Licensee/Applicant was advised that children may use hand sanitizer but only under adult supervision and hand sanitizer must be kept out of children's reach.

The Licensee/Applicant requires all staff and children over the age of 2 to wear cloth face coverings. Licensee/Applicant trains staff and communicates with families on the following: enhanced sanitation practices, physical distancing guidelines, use of face coverings, screening practices, COVID-19 specific exclusion criteria, and arrangements for back up child care should a family member or their child exhibit COVID-19 symptoms or test positive.

Licensee/Applicant introduces outdoor air as much as possible. Licensee/Applicant has all personal items labeled and kept in a separate space to ensure personal items are separate from others. Licensee/Applicant stated that personal toys and blankets are washed daily by the provider.

The parents/caregivers sign their children in and out outside of the home. Licensee/Applicant has sanitized pens readily available. Upon arrival, the Licensee/Applicant conducts a health screening of the children by taking the child's temperature and asking the child's parent/caregiver questions regarding any confirmed cases of COVID-19, COVID-19 exposure or COVID-19 symptoms.

SUPERVISOR'S NAME: Brandi VanOosten	TELEPHONE: (323) 981-3365
LICENSING EVALUATOR NAME: Monique Ayala	TELEPHONE: (323) 246-2016
LICENSING EVALUATOR SIGNATURE:	DATE: 04/12/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/12/2021

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: BELTRAN FAMILY CHILD CARE	FACILITY NUMBER: 198400022
	VISIT DATE: 04/12/2021

NARRATIVE

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Licensee/Applicant disinfects and sanitizes high touched areas after each use. Licensee/Applicant teaches the children to avoid contact with one's eyes, nose and mouth, and uses tissues to wipe their nose and to cough or sneeze inside their elbow. The Licensee/Applicant models and practices hand washing before and after eating, after coughing or sneezing, after playing outside, and after using the restroom. When a child becomes ill, the Licensee/Applicant will have the child be separated from other children.

The Licensee/Applicant was advised to report any possible exposures and/or positive cases of COVID-19 to the Regional Office. The Licensee/Applicant was also advised that staff and families must be notified immediately of any possible cases of COVID-19 while maintaining confidentiality.

Incidental Medical Services (IMS) policy was also 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 Americans with Disabilities Act (ADA) was provided: U.S. 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/Applicant on how to access forms, regulations, quarterly updates, and Provider Information Notices (PINs) on the Department website at www.ccld.ca.gov.

The following document is required for further processing:

Updated Facility Sketch (Floor Plan) (LIC 999A) listing the off-limit areas observed and discussed during the inspection.

A final review of the application will be conducted by the Department. Once licensed for a capacity change, the Licensee is required to adhere to the terms and limitations stated on the license.

An exit interview was conducted and a copy of this report will be issued via email with a read receipt as confirmation of receipt. LPA requested the report to be signed and returned to the Monterey Park South West Child Care Regional Office located at 1000 Corporate Center Dr., Suite 200B, Monterey Park, CA 91754.

SUPERVISOR'S NAME: Brandi VanOosten	TELEPHONE: (323) 981-3365
LICENSING EVALUATOR NAME: Monique Ayala	TELEPHONE: (323) 246-2016
LICENSING EVALUATOR SIGNATURE:	DATE: 04/12/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/12/2021

LIC809 (FAS) - (06/04)

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