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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 300610065
Report Date: 05/13/2019
Date Signed: 05/13/2019 11:57:10 AM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME:NIETO, DIANAFACILITY NUMBER:
300610065
ADMINISTRATOR:NIETO, DIANAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(949) 770-1033
CITY:MISSION VIEJOSTATE: CAZIP CODE:
92691
CAPACITY:12CENSUS: 4DATE:
05/13/2019
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
10:20 AM
MET WITH:LicenseeTIME COMPLETED:
12:30 PM
NARRATIVE
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An inspection was conducted at the facility by Licensing Program Analyst (LPA) Mahnaz (Nancy) Malek and LPA Mila Quinto. A review of staff records indicates that all facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions.

There are presently one other adult living in the home. During today’s inspection the home and grounds were toured and the licensee was operating within the licensed capacity. Present during today's inspection was the licensee, Diana Nieto and assistant, Norberta Torres. Licensee's spouse, Edward Nieto was upstairs during LPA's inspection. There were a total of 4 children present of whom 2 were under two years old. The floor plan was verified. Off limits areas are made inaccessible by means of door knob covers. The main day care area is one room which the children were present. The other room is used for children to nap. There was a gate installed in front of the stairs. The licensee and the assistant's pediatric CPR/First Aid certification are current but not EMSA approved. Items which could pose a danger to children were not accessible to children. Poisonous items were not observed during today's inspection. There is carbon monoxide detector in the house, The smoke detector was tested. Appropriate fire extinguisher is outdated and expired. The licensee has a current roster of children in care. Emergency Disaster drill log within the past six months was available. The licensee stated there are no firearms and/or other dangerous weapons in the home and none were observed during today's inspection. The backyard is completely fenced. The outdoor play area is free from hazards. There is a dog (Lhasa Apso) and a cat in the house. There is a jacuzzi observed in the back yard today. The four locks were installed on the jacuzzi. A gate was also barricaded the yard from the jacuzzi area. Children's records: parents' rights and California School Immunization Record were reviewed.


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SUPERVISOR'S NAME: Rina LopezTELEPHONE: (714) 703-2808
LICENSING EVALUATOR NAME: Mahnaz MalekTELEPHONE: (714) 703-2810
LICENSING EVALUATOR SIGNATURE:

DATE: 05/13/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/13/2019
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 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, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME: NIETO, DIANA
FACILITY NUMBER: 300610065
VISIT DATE: 05/13/2019
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 .

There is proof of immunization against pertussis and measles and Flu for the licensee and the assistant in the house. Facility was advised on how to receive notifications for quarterly updates and provided with Child Care Advocate contact information: childcareadvocatesprogram@dss.ca.gov

A copy of child care provider's guide to safe sleep pamphlet and a copy of Never Ever Shake a Baby pamphlet with the website www.dontshake.org were given to the facility representative on the last inspection.
An updated pamphlet regarding safe sleep regulations in childcare and a pamphlet for lead poisoning facts were given to the director today.


Report reviewed and discussed with the licensee. Notice of Site Visit was posted. Facility representative was informed that the notice of site visit must be posted for 30 consecutive days. Failure to post will result in civil penalties of $100. Appeal rights provided and explained. The director/licensee was provided a copy of their appeal rights (LIC 9058 01/16) and their signature on this form acknowledges receipt of these rights. Licensee was informed of how/where to access regulations and forms from CCLD website: www.ccld.ca.gov.

On today's inspection, the following violations of the California Code of Regulations, Title 22; Division 12 were observed. Please see attached LIC 809D.

Exit interview was conducted.
SUPERVISOR'S NAME: Rina LopezTELEPHONE: (714) 703-2808
LICENSING EVALUATOR NAME: Mahnaz MalekTELEPHONE: (714) 703-2810
LICENSING EVALUATOR SIGNATURE:

DATE: 05/13/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/13/2019
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, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868

FACILITY NAME: NIETO, DIANA
FACILITY NUMBER: 300610065
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/13/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
06/07/2019
Section Cited
CCR
102416(c)
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The licensee and other personnel as specified shall complete training on preventive health practices, including pediatric cardiopulmonary resuscitation and pediatric first aid, pursuant to Health and Safety Code Section 1596.866. The licensee and assistant's CPR and 1st aid are current but not EMSA approved.
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The licensee and assistant will send a copy of the CPR and 1st aid which meet the licensing regulations by an EMSA approved agency.
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This requirement was not met as evidenced by reviewing the cards. Licensee failed to meet this section of the regulations. This is a potential risk to the health and safety of children in care.
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Type B
05/17/2019
Section Cited
CCR
102417(g)(1)
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The home shall contain a fire extinguisher and smoke detector device which meet standards established by the State Fire Marshal. The fire extinguisher in the house was outdated and expired. The home had 3 other fire extinguisher which were not expired but did not meet the licensing regulations size wise.
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The licensee will send a picture of the right size of fire extinguisher(2-A-10-B:C) to our office by the due date.
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This requirement was not met as evidenced by reviewing the cards. Licensee failed to meet this section of the regulations. This is a potential risk to the health and safety of children in care.
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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: Rina LopezTELEPHONE: (714) 703-2808
LICENSING EVALUATOR NAME: Mahnaz MalekTELEPHONE: (714) 703-2810
LICENSING EVALUATOR SIGNATURE:

DATE: 05/13/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/13/2019
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, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868

FACILITY NAME: NIETO, DIANA
FACILITY NUMBER: 300610065
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/13/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
05/17/2019
Section Cited
CCR
102419(d)
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Licensee provides the child's parent or representative with a copy of the family child care home notification of parent rights. One child did not have this requirement on file. A copy of the parent's right was given to the licensee to give it to the parent.
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A singed copy of the form (LIC 995A) will be sent to our office by the due date.
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This requirement was not met as evidenced by reviewing the files. Licensee failed to meet this section of the regulations. This is a potential risk to the health and safety of children in care.
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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: Rina LopezTELEPHONE: (714) 703-2808
LICENSING EVALUATOR NAME: Mahnaz MalekTELEPHONE: (714) 703-2810
LICENSING EVALUATOR SIGNATURE:

DATE: 05/13/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/13/2019
LIC809 (FAS) - (06/04)
Page: 4 of 4