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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198400129
Report Date: 08/13/2021
Date Signed: 08/13/2021 03:17:39 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:SANDOVAL FAMILY CHILD CAREFACILITY NUMBER:
198400129
ADMINISTRATOR:SUSANNA SANDOVALFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(424) 215-6263
CITY:CARSONSTATE: CAZIP CODE:
90745
CAPACITY:14CENSUS: 14DATE:
08/13/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:28 PM
MET WITH:Susanna SandovalTIME COMPLETED:
03:36 PM
NARRATIVE
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Licensing Program Analyst (LPA) Raul Navarro conducted an unannounced random annual inspection. LPA arrived at 1:28pm and met with Licensee Susanna Sandoval who guided this LPA on a tour of the facility. Also present was Licensee's spouse. Upon arrival LPA observed 14 children present during today’s inspection. Licensee states that there are currently 19 children enrolled. The children's roster was reviewed and is current.

This is a one story home which consists of three bedrooms and two bathrooms. Areas used by the children include the living room, den, dining room and backyard. These areas were inspected for safety, comfort, cleanliness, telephone service, ventilation and heating. LPA observed children's bathroom clean with detergents inaccessible. Per Licensee, areas off limits to children and parents include: three bedrooms, one bathroom, kitchen, and garage. Outdoor play area is fenced. Licensee and or assistants maintains visual supervision at all times while children are outside. The Licensee uses the front yard as the designated ill isolation area.

Areas accessible to children were inspected to ensure that they are clean and orderly with ventilation and heating for the safety of the children. There is a working telephone service maintained in the home. At 1:50pm LPA observed Licensee's son in the home. Per Licensee, son just turned 18. Son does not have a fingerprint clearance. Licensee has two pet dogs. Detergents, cleaning compounds, medications, and other items which can pose a danger to children are inaccessible. Poisons are locked, as required. The Licensee does understand that poison must be locked with a key or combination lock.

Per Licensee, there are no weapons, firearms. There is a pool in the backyard which is fenced denying access to the children in care. The fence is in good repair and openings do not exceed 4 inches. There are safe toys, play equipment and materials observed for children.
Report continues- Page 1 of 3
SUPERVISOR'S NAME: Karen ChambersTELEPHONE: (323) 980-4934
LICENSING EVALUATOR NAME: Raul NavarroTELEPHONE: 323-981-3388
LICENSING EVALUATOR SIGNATURE:

DATE: 08/13/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/13/2021
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 CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME: SANDOVAL FAMILY CHILD CARE
FACILITY NUMBER: 198400129
VISIT DATE: 08/13/2021
NARRATIVE
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Emergency Disaster Plan was posted at the time of inspection. 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 purchased on 05/31/21. Smoke and carbon monoxide detectors in the were tested and are in operable condition. The Licensee has current EMS approved Pediatric First Aid and CPR, which will expire on 03/2023. Proof of immunization against influenza, pertussis, and measles for the Licensee was readily available during today’s inspection. The Licensee has also taken the Mandated Reporter Training.

Licensee states that she is currently caring for one infant. Licensee states that infants sleep in the living room where they are constantly supervised. Appropriate sleeping arrangements and cribs were observed. Play yard did not hinder the entrance or exit from the sleeping space. Play yards were observed to be free of loose articles and objects. No objects were observed to be hanging above or attached to the side of the play yard. LPA did/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.

The following was discussed: 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. When temporarily absent from the home, the licensee shall arrange for a substitute adult to care for and supervise children in their absence.

Rooms that are off-limits need to be made inaccessible during operating hours. Smoking is prohibited in a licensed Family Child Care Home. Per Licensee, no one smokes in the home. Infant walkers, johnny jumpers, saucer chairs, trampolines and any other item that falls into that category are not permitted in the facility.
Report continues- Page 2 of 3
SUPERVISOR'S NAME: Karen ChambersTELEPHONE: (323) 980-4934
LICENSING EVALUATOR NAME: Raul NavarroTELEPHONE: 323-981-3388
LICENSING EVALUATOR SIGNATURE:

DATE: 08/13/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/13/2021
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 CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME: SANDOVAL FAMILY CHILD CARE
FACILITY NUMBER: 198400129
VISIT DATE: 08/13/2021
NARRATIVE
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 Car seats shall only be used for transportation purposes and shall not be used for sleeping. Effective January 1, 2010, licensees of family child care homes are required to ensure that at least one staff member with current training in pediatric first aid and pediatric CPR is on site at all times when children are present.

LPA reviewed the LIC 311D - Forms/Records to Keep in Your Family Child Care Home. The Licensee was advised how to access forms and Regulations online at www.ccld.ca.gov. Licensee was made aware that it is his/her responsibility to know the regulations as well as anyone who assists in providing care.

The Licensee was advised that inaccessibility of hazards must be constantly reassessed depending on the children in care. Sudden Infant Death Syndrome (SIDS) and Never-Shake-a-Baby were discussed. A hard copy of A Child Care Provider’s Guide to Safe Sleep was provided.

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
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LPA issued the Confidential Names List (LIC 811) to the licensee during this visit. The Confidential Names List documents the children’s files that were reviewed during this inspection.

The deficiency listed on the following pages were observed by the LPA and are being cited in accordance with California Code of Regulations Title 22. Please see attached LIC 809-D. The deficiency that is being cited need to be cleared to protect the children’s health & safety.

Upon receipt of this report, the Licensee shall post the Notice of Site visit and any licensing report documenting a type “A” deficiency. The report and the Notice of Site visit shall be posted for 30 consecutive days. Failure to maintain posting as required, will result in an immediate $100 civil penalty. A copy of this report shall be provided to the parent/guardian of children currently enrolled by the next business day or immediately upon return.
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SUPERVISOR'S NAME: Karen ChambersTELEPHONE: (323) 980-4934
LICENSING EVALUATOR NAME: Raul NavarroTELEPHONE: 323-981-3388
LICENSING EVALUATOR SIGNATURE:

DATE: 08/13/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/13/2021
LIC809 (FAS) - (06/04)
Page: 5 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 CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME: SANDOVAL FAMILY CHILD CARE
FACILITY NUMBER: 198400129
VISIT DATE: 08/13/2021
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A copy of this report shall also be provided to the parent/guardian of any newly enrolled children for the next 12 months (1 year). The Acknowledgement form must be maintained in each child’s file immediately upon receipt from parent. Licensee was provided with a copy of the parent Acknowledgement of Receipt of Licensing Reports Form during this visit. A copy of the Parent Notification Requirements was also provided to the licensee.

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
SUPERVISOR'S NAME: Karen ChambersTELEPHONE: (323) 980-4934
LICENSING EVALUATOR NAME: Raul NavarroTELEPHONE: 323-981-3388
LICENSING EVALUATOR SIGNATURE:

DATE: 08/13/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/13/2021
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 CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME: SANDOVAL FAMILY CHILD CARE
FACILITY NUMBER: 198400129
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/13/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
08/13/2021
Section Cited

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Criminal Record Clearance- (a) Prior to the Department issuing a license, the applicant(s) and all adults residing in the home shall obtain a California criminal record clearance or exemption. This requirement was not met as evidenced by LPA's observations and file review.
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 Licensee's son was present in the facility and has not obtained fingerprint clearance. Per Licensee, son just turned 18. This is an immediate risk to the health and safety of the children in care. A civil penalty of $100.00 was assessed during today's inspection.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Karen ChambersTELEPHONE: (323) 980-4934
LICENSING EVALUATOR NAME: Raul NavarroTELEPHONE: 323-981-3388
LICENSING EVALUATOR SIGNATURE:
DATE: 08/13/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/13/2021
LIC809 (FAS) - (06/04)
Page: 4 of 5