198400182-9-28-2021-54-CC-ECHZ-C7ATXR-20210928150733

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 198400182
Report Date: 09/28/2021
Date Signed: 09/28/2021 03:20:02 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:	PACHECO FAMILY CHILD CARE		FACILITY NUMBER:	198400182
ADMINISTRATOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY:	8	CENSUS: 0	DATE:	09/28/2021
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	11:15 AM
MET WITH:	Maricela Pacheco		TIME COMPLETED:	03:30 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) Elka Chavez conducted an unannounced annual inspection to the above facility in Spanish on 09/28/2021. LPA arrived at the facility at 11:15 AM and met with Licensee, Maricela Pacheco, Licensee who guided analyst on a tour of the facility. Entrance Checklist for Family Child Care Homes was provided to the licensee upon entry. Per Licensee, there are no children currently enrolled. This is a single-story home. The home consists of 2 bedrooms, 1 restroom, living room, den, kitchen, pantry, laundry room, room next to the front door, front yard (fenced), side yard (fenced) back yard (fenced) and attached garage. Areas accessible to children are: Room next to the front door, living room, den, bathroom, kitchen, dining room and front yard (fenced). Areas off limits to children and parents are: Bedrooms, garage located next to the front door, pantry, laundry room, side yard and back yard (fenced). LPA observed child safety door knobs in the bedroom doors. LPA observed a fence in the side yard and backyard making the area inaccessible to children in care. The licensee understands that licensing staff may have access to off-limit areas during inspection visit if necessary. Rooms that are off-limits need to be made inaccessible during operating hours Individuals who reside in the home were noted and discussed. All adults present in the home have obtained a criminal record clearance. Licensee states that there are no firearms stored in the home. All areas identified on the facility sketch that are accessible for children to use were inspected for safety, comfort, and cleanliness. There is telephone service via a cell phone that is used, and the cellphone stays at the facility during hours of operation. Safe toys play equipment and materials were observed. Detergents, cleaning compounds, medications, and other items which could pose a danger to children were observed to be inaccessible to children. LPA observed them to be kept in the off-limit pantry. LPA observed a

SUPERVISOR'S NAME: Karen Chambers	TELEPHONE: (323) 981-3350
LICENSING EVALUATOR NAME: Elka Chavez	TELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:	DATE: 09/28/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/28/2021

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 3

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: PACHECO FAMILY CHILD CARE	FACILITY NUMBER: 198400182
	VISIT DATE: 09/28/2021

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
26
27
28
29
30
31
32

child safety door knob making the area inaccessible to children in care. The licensee states that there are no poisons in the home and understands that storage areas for poisons must be locked with a key or combination lock. The restroom that children use was observed to be safe and sanitary.

The valve on the required 3A40BC fire extinguisher indicates fully charged and was purchased on 07/01/21, as indicated on the purchase receipt. Smoke and carbon monoxide detectors were tested and are operable.

Licensee states that she is not currently caring for infants and there are no infants enrolled. Licensee states that if an infant is enrolled, the infant will sleep in the living room where they are constantly supervised. Appropriate sleeping arrangements and cots were observed. LPA did not observe cribs as there are no infants enrolled. Licensee advised cribs or play yards cannot hinder the entrance or exit from the sleeping space, mattresses shall be firm and covered with a fitted sheet that overlaps the underside, so it cannot be dislodged. Cribs and play yards must be free of loose articles and objects. No objects can be hung above or attached to the side of the crib. LPA advised the Licensee that infants cannot be swaddled, 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.

Currently, children are using the front yard (fenced) for outdoor play time. The outdoor play area was observed to be fenced. LPA observed that the outdoor yard has toys and other materials for children to play with. LPA did not observe any objects that can pose a danger to children on the outdoor yard. The licensee states that supervision is always provided.

The licensee and other personnel have completed training on preventive health practices including Pediatric First Aid and CPR. The licensee's Pediatric First Aid and CPR expires on 02/2022. There are first aid supplies available. LPA observed them in the den. The licensee has proof of immunization against influenza, pertussis, and measles. LPA observed that the Licensee has current Mandated Reporter AB 1207 Compliant Child Care Training Certificate on file.

There are 2 dogs on the premises. LPA did not observe any pools, spas, hot tubs, fish ponds, or similar bodies of water during the inspection. Emergency Disaster Plan, Parent’s Rights Poster and the Facility

SUPERVISOR'S NAME: Karen Chambers	TELEPHONE: (323) 981-3350
LICENSING EVALUATOR NAME: Elka Chavez	TELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:	DATE: 09/28/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/28/2021

LIC809 (FAS) - (06/04)

Page: 2 of 3

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: PACHECO FAMILY CHILD CARE	FACILITY NUMBER: 198400182
	VISIT DATE: 09/28/2021

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
26
27
28
29
30
31
32

License were observed to be posted. LPA did not observe the following items during the inspection: Infant Walkers, Johnny Jumpers, Saucer Chairs, Trampolines and/or any other item that fall into these categories are not permitted in a family child care facility. Smoking is prohibited in a licensed Family Child Care Home. Per Licensee, no one smokes in the home.

Licensee was reminded that all adults 18 and over living or working in the home, including employees and volunteers, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a licensed Family Child Care Home. A civil penalty of $100.00 minimum/day up to $500.00 maximum per day/per person will be assessed if this regulation is violated.

LPA discussed the safe sleep regulations with licensee and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPA also informed licensee of the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at https://www.cpsc.gov/ and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment.

To improve the quality and value of the new inspection process, a survey will be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or tools, please send them by email to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/process.

Based on the LPA’s observations and records review, the Licensee is in compliance with California Title 22 Regulations. After further review by the department, Licensee will be notified if/when large license is granted. Once licensed, the Licensee is required to adhere to the terms and limitation as stated on the license.

A notice of site visit was given and must remain posted for 30 days.

Exit interview conducted and report was reviewed with the licensee, Maricela Pacheco.

SUPERVISOR'S NAME: Karen Chambers	TELEPHONE: (323) 981-3350
LICENSING EVALUATOR NAME: Elka Chavez	TELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:	DATE: 09/28/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/28/2021

LIC809 (FAS) - (06/04)

Page: 3 of 3