304205636-5-29-2019-06-CC-LBAS-BCMRMJ-20190529130848

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 304205636
Report Date: 05/29/2019
Date Signed: 05/29/2019 01:08:58 PM

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:	LUNA, ROSA		FACILITY NUMBER:	304205636
ADMINISTRATOR:	LUNA, ROSA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(714) 638-9802
CITY:	GARDEN GROVE	STATE: CA	ZIP CODE:	92843
CAPACITY:	14	CENSUS: 6	DATE:	05/29/2019
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	11:00 AM
MET WITH:	Licensee Rosa Luna		TIME COMPLETED:	01:30 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	An unannounced inspection was conducted at the facility by Licensing Program Analyst (LPA) Barajas. LPA met with licensee Rosa Luna and toured the entire facility. LPA observed 4 preschool age children in day care, 2 infants, with 1 assistant Lilia Miranda. The facility was within licensed capacity and the required ratio. Licensee stated there are presently 5 adults living in the home, and no minor children. Day care operating hours are 6:00a.m. to 5:00p.m., Monday through Friday. A review of staff records on this date indicates that all facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions. During today’s inspection each child was observed to have safe, healthful, and comfortable accommodations, furnishings, and equipment. The floor plan was verified. Off limits areas are made inaccessible by means of baby gates, door latches. The children use the backyard as the outdoor play area, and it is completely fenced. The outdoor play area is free from hazards. There is no fireplace. There is a heater that is screened and inaccessible to children in care in living room. Items which could pose a danger to children (detergents, cleaning compounds, and medications) were stored out of the reach of children in garage. Poisonous items are not stored on site, and none were observed during today's inspection. The home provides safe toys, equipment, and materials. There is a working carbon monoxide detector, smoke detector, and 2 fire extinguisher (2A10BC) in the home that meet statutory and State Fire Marshall standards. The licensee has a current roster of children in care. The facility has conducted an emergency drill within the past six months, last one dated 03/17/19. The licensee stated there are no firearms or other dangerous weapons in the home and bodies of water were not observed during today's visit. The LPA advised the licensee to contact licensing department for any changes to hours and days of planned operation, and for any changes to facility, including on/off limit areas and change in phone number. The licensee has a home phone that is used for child care. The licensee was reminded that if a cell phone is only used, it must remain on the premises always during hours of operation. Page 1 of 3

SUPERVISOR'S NAME: Rina Lopez	TELEPHONE: (714) 703-2808
LICENSING EVALUATOR NAME: Leonor Barajas	TELEPHONE: (714) 703-2825
LICENSING EVALUATOR SIGNATURE:	DATE: 05/29/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/29/2019

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, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868

FACILITY NAME: LUNA, ROSA	FACILITY NUMBER: 304205636
	VISIT DATE: 05/29/2019

NARRATIVE

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There were no Title 22 deficiencies cited during today's inspection.
LPA Barajas requested for LIC 279 and LIC 999 floor plan to be updated and submitted to Licensing Department.

Inspection, report review and exit interview was conducted. Notice of Site Visit was posted during the visit. Rosa Luna 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 licensee was provided a copy of their appeal rights (LIC 9058 01/16) and their signature on this form acknowledges receipt of these rights. First level appeals should be sent to the regional manager to the address listed above. Licensee was informed of how/where to access regulations and forms from CCLD website: www.ccld.ca.gov.

End of Report
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SUPERVISOR'S NAME: Rina Lopez	TELEPHONE: (714) 703-2808
LICENSING EVALUATOR NAME: Leonor Barajas	TELEPHONE: (714) 703-2825
LICENSING EVALUATOR SIGNATURE:	DATE: 05/29/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/29/2019

LIC809 (FAS) - (06/04)

Page: 3 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, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868

FACILITY NAME: LUNA, ROSA	FACILITY NUMBER: 304205636
	VISIT DATE: 05/29/2019

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The licensee stated she is present in the home and ensures that children in care are always supervised. The licensee stated children are not left in parked vehicles. The licensee states when temporarily absent from the home, she arranges for a substitute adult to care for and supervise children in her absence.

The licensee's pediatric CPR/First Aid certification is current and expires 03/16/2021 with EMS Safety. Children's records were reviewed for: licensee’s documentation of children’s immunization's on the California School Immunization Card (CDPH 286) and a signed copy of the Family Child Care Home Notification of Parents’ Rights, and in substantial compliance. Proof of immunization against influenza, pertussis and measles for licensee(s)/assistants/volunteers were reviewed and within compliance of SB 792. Licensee and assistant Lilia Miranda provided a written declination letter against influenza on today’s date.

Beginning March 31, 2018, Health and Safety Code 1596.8662 requires all licensed providers, applicants, directors and employees to complete training as specified on their mandated reporter duties and to renew their training every two years, per A.B. 1207. The licensee does not have proof of compliance as specified in A.B. 1207. Mandated Reporter training and certificate not provided for Licensee as training not provided in native language Spanish. Licensee Assistant Lilia Miranda provided a copy of certificate completed 02/12/18.

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

Facility was advised on how to receive notifications for quarterly updates and provided with Child Care Advocate contact information: childcareadvocatesprogram@dss.ca.gov A hard copy of the Spring 2019 Child Care Quarterly Update was provided to the licensee. A hard copy of the 2016 “A Child Care Providers Guide to Safe Sleep” was provided to the licensee in Spanish. The following electronic links were also provided:
English: https//www.cdph.ca.gov/programs/SIDS/Documents/SIDSchildcaresafesleep.pdf
Spanish: https//www.cdph.ca.gov/programs/SIDS/Documents/ChildCareProvSleepSPAN2011.pdf
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SUPERVISOR'S NAME: Rina Lopez	TELEPHONE: (714) 703-2808
LICENSING EVALUATOR NAME: Leonor Barajas	TELEPHONE: (714) 703-2825
LICENSING EVALUATOR SIGNATURE:	DATE: 05/29/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/29/2019

LIC809 (FAS) - (06/04)

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