198400117-7-9-2021-54-CC-RNAO-C4RSRW-20210709140700

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 198400117
Report Date: 07/09/2021
Date Signed: 07/09/2021 02:07:14 PM

Document Has Been Signed on 07/09/2021 02:07 PM - It Cannot Be Edited

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:	PEREZ FAMILY CHILD CARE		FACILITY NUMBER:	198400117
ADMINISTRATOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY: 8	TOTAL ENROLLED CHILDREN: 0	CENSUS: 4	DATE:	07/09/2021
TYPE OF VISIT:	Case Management - Licensee Initiated	UNANNOUNCED	TIME BEGAN:	12:35 PM
MET WITH:	Teresa Perez		TIME COMPLETED:	02:20 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	A Case Management Inspection was conducted by Licensing Program Analyst (LPA) Raul Navarro for the purpose of increasing Licensee's capacity to 14 children. LPA arrived at the facility at 12:35pm and was guided on a tour of the facility by Licensee Teresa Perez. There were four children present during today’s inspection. Licensee states that there are currently seven children enrolled. The children's roster was reviewed and is current. Disaster drill log was also available during today’s inspection. Last drill conducted on July 2021. This is a one story home which consists of four bedrooms and three bathrooms. Areas used by the children were inspected as follows: living room, kitchen, dining room, one bedroom, one bathroom, and back yard. Per Licensee, areas off limits to children and parents include: three bedrooms, two bathrooms, front yard, and 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. Per Licensee, child care will be provided 7:00am to 6:00pm Monday through Friday. There is a working telephone maintained in the home. LPA confirmed with the Licensee that all adults residing/working in the home have obtained criminal record and TB clearance. Licensee has no pets. Detergents, cleaning compounds, medications, and other items which can pose a danger to children are inaccessible. Per Licensee, there are no weapons or firearms in the home. LPA did not observe any bodies of water on the premises. There are safe toys, play equipment and materials observed for children. Children’s records were reviewed to ensure that each child has an Identification and Emergency form. The valve on the required 2A 10BC fire extinguisher indicates fully charged last serviced on June 2021. Smoke and carbon monoxide detectors are in operable condition. Report Continues- Page 1 of 3

SUPERVISORS NAME: Karen Chambers
LICENSING EVALUATOR NAME: Raul Navarro
LICENSING EVALUATOR SIGNATURE:	DATE: 07/09/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/09/2021

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: PEREZ FAMILY CHILD CARE	FACILITY NUMBER: 198400117
	VISIT DATE: 07/09/2021

NARRATIVE

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The Licensee has current Pediatric First Aid and CPR, which will expire on 08/2022. Licensee has taken the Mandated Reporter Training. Proof of immunization against pertussis, measles, and influenza was readily available during today's inspection.

The Licensee was advised they shall be present in the home and shall ensure children in care are supervised at all times. Licensee was also advised children shall not be left in parked vehicles at any time.

The bathroom was observed to be free of hazards. The home has central air and heating. Children will nap on mats and cribs in the bedroom and living room. Licensee states that she is currently caring for one infant. Licensee states that infants sleep in the bedroom where they are constantly supervised. Appropriate sleeping arrangements and cribs were observed. The cribs did not hinder the entrance or exit from the sleeping space. The crib was observed to be free of loose articles and objects. No objects were observed to be hanging above or attached to the side of the crib. LPA did not observe any infants swaddled while in care.

LPA advised the Licensee that infants shall be placed on their backs for sleeping and shall be supervised. Infants shall be checked on every 15 minutes and the time of each 15-minute check shall be documented with child’s name and date. The LIC 9227 Individual Infant Sleeping Plan shall be completed for each infant up to 12 months of age. A copy of the LIC 9227 was provided to Licensee. LPA also provided the Licensee with a copy of the Child Care Provider’s Guide to Safe Sleep, by American Academy of Pediatrics.

The following was discussed with the Licensee/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 and a valid criminal record clearance associated to the facility license.

Report continues- Page 2 of 4

SUPERVISORS NAME: Karen Chambers
LICENSING EVALUATOR NAME: Raul Navarro
LICENSING EVALUATOR SIGNATURE:	DATE: 07/09/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/09/2021

LIC809 (FAS) - (06/04)

Page: 2 of 4

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: PEREZ FAMILY CHILD CARE	FACILITY NUMBER: 198400117
	VISIT DATE: 07/09/2021

NARRATIVE

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· 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. Each employee and volunteer shall receive an influenza vaccination between August 1 and December 1 of each year. The family day care home shall maintain documentation of the required immunization or exemptions from immunization in the person’s personnel record that is maintained by the family day care home.
· 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.
· 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.
· The fire extinguisher type 2A10BC must be serviced annually or as often as necessary and smoke and carbon monoxide detectors should 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.
· 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.
· 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.
· Saucer chairs, bouncers, walkers, or any similar items are prohibited.
· All adults living and working in the home shall be made of aware of the Departments right to inspection authority, which includes but not limited to the right to enter the home when children are being cared for, interview children and adults and review documentation.
· Emergency Disaster Plan, Parent’s Rights Poster and the Facility License are required to be posted.

Report continues Page 3 of 4

SUPERVISORS NAME: Karen Chambers
LICENSING EVALUATOR NAME: Raul Navarro
LICENSING EVALUATOR SIGNATURE:	DATE: 07/09/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/09/2021

LIC809 (FAS) - (06/04)

Page: 3 of 4

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: PEREZ FAMILY CHILD CARE	FACILITY NUMBER: 198400117
	VISIT DATE: 07/09/2021

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

LPA discussed self-assessment and answered question regarding COVID-19 procedures. Per Licensee parents will not be allowed inside the home. LPA observed sanitizer, masks and gloves. Per Applicant they will ask screening questions and take children's temperatures daily. LPA observed Posters for parents and children informing about COVID-19 and hand washing posted in the facility. Children have their own cubby for their personal belongings. Per Licensee children and staff wear face coverings during day care hours. Per Licensee, they encourage 20 second hand washing with children multiple times during the day. LPA observed soap and paper towels in the bathroom. Licensee has a supply of cleaning and sanitizing products. Per Licensee high touched areas will be cleaned throughout the day as needed. LPA observed space in the main care area to socially distance children during nap time. If a child becomes ill, Licensee will utilize the master bedroom as an isolations area. LPA observed an outdoor area where child have space to play. Per Licensee, they will utilize the outdoor area for ventilation. A large family child care can have no more than 14 children at one time.

LPA advised the Licensee how to access forms, regulations and quarterly updates on the Child Care Licensing website at: www.ccld.ca.gov. After further review by the department, Licensee will be notified if and when License is granted. Once licensed, the Licensee is required to adhere to the terms and limitation as stated on the license.

Exit interview was conducted with Licensee. The Licensee was provided a copy of their appeal rights (LIC 9058) and their signature on this form acknowledges receipt of these forms. The Notice of Site Visit (LIC 9213) must remain posted for 30 days during the hours of operation after each site inspection by a licensing representative. Failure to maintain posting as required will result in a civil penalty of $100.00.

Report ends Page 4 of 4

SUPERVISORS NAME: Karen Chambers
LICENSING EVALUATOR NAME: Raul Navarro
LICENSING EVALUATOR SIGNATURE:	DATE: 07/09/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/09/2021

LIC809 (FAS) - (06/04)

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