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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 304310523
Report Date: 04/10/2023
Date Signed: 04/24/2023 10:49:56 AM


Document Has Been Signed on 04/24/2023 10:49 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE CO CHILD CARE, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868



FACILITY NAME:GUERRERO, LIDIA & EDNAFACILITY NUMBER:
304310523
ADMINISTRATOR:GUERRERO, LIDIA & EDNAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
9496831265
CITY:LAKE FORESTSTATE: CAZIP CODE:
92630
CAPACITY:14CENSUS: 3DATE:
04/10/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:20 AM
MET WITH:Lidia & Edna GuerreroTIME COMPLETED:
01:25 PM
NARRATIVE
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An Annual Random inspection was conducted at the facility by Licensing Program Analyst (LPA) Mrs. Bootorabi. Upon arrival, an Entrance Checklist (LIC 126) was provided to the licensee Lidia Guerrero.

Census upon entry:
Infants:1
Children Over Two: 2
Adults Working Directly with Children: 2
Other Adults: 3

Licensee was caring for one infant that is her granddaughter and not part of her ratio upon entry.
Infant was observed to be on a leaning back bouncer upon entry. Licensee had family members visiting that is part of her personnel report. The infant was taken out of the licensee's area of care upon entry.
The licensee was operating within the licensed capacity as specified on the license. The Facility Day care hours are 8 am - 5 pm Monday - Friday.

Posted Requirements were review at 9:40 am. Upon arrival, the LPA verified that the following documents were posted in a prominent, publicly accessible area; License, PUB 394 Notification of Parents’ Rights, and LIC 9148 Earthquake Preparedness. The licensee did not meet the posting requirements upon review and was guided to make corrections upon the visit. The LPA discussed the requirements for posting and asked the licensee if she had any questions. The license had no questions at this time. The licensees was able to meet the requirements during todays inspection.
SUPERVISOR'S NAME: Patricia MaganaTELEPHONE: (714) 703-2821
LICENSING EVALUATOR NAME: Araceli BootorabiTELEPHONE: (714) 703-2800
LICENSING EVALUATOR SIGNATURE:
DATE: 04/10/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/10/2023
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
ORANGE CO CHILD CARE, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME: GUERRERO, LIDIA & EDNA
FACILITY NUMBER: 304310523
VISIT DATE: 04/10/2023
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Facility Tour began at 9:45 am The LPA and Edna G. toured the facility inside and outside. The facility sketch (LIC 999) was verified. Areas stated to be off-limits by the facility sketch were made inaccessible using baby gates in the playroom so children do not have access to the kitchen. There is a fireplace in the living room screened by metal gate and inaccessible to children in care.

Detergents, cleaning compounds, medicines, and other items which could pose a danger if readily available to children were stored inaccessible to children in the playroom, napping room, and backyard


by means of (enter the location and means of absence from children. Licensee stated there are no firearms and/or other dangerous weapons in the facility and none were observed during today's inspections.
The indoor playroom floors, equipment, and furniture were clean and were observed to be in good repair and free of sharp edges.

The outdoor play area has an air condition that is not covered by any means. The licensee was advised that the area must be supervised at all times and it is best practice to cover the AC unit to avoid health and safety risk of children in care.

The children's bathrooms are clean and sanitary. The bathroom is not being used at this time by children in care. The licensee was consulted to maintain the restroom as if it is being used by the children to meet requirements during annual inspections. At this time razors and other items that can pose a risk of health & safety risk to children in care.

Children nap on play yards and bedding is stored individually in each play pen. The facility washes blankets at end of the week. All soiled blankets and clothing are washed immediately stated by the Licensee. The LPA observed a total of 4 play yards in the home. 3 of the 4 play yards contained blankets inside. The licensee was given a consultation about not storing blankets inside or using them with blankets. LPA observed play yards meeting requirements upon nap time preparation.

The outdoor activity space was inspected for compliance. The playground was enclosed by a fence at least four feet in height. The surface of the outdoor activity space was maintained and free of dangerous hazards to children. The baby gate closest to the back door was observed to be off during the inspection and licensee was consulted on the importance of maintaining area of limits to children properly maintained. An

SUPERVISOR'S NAME: Patricia MaganaTELEPHONE: (714) 703-2821
LICENSING EVALUATOR NAME: Araceli BootorabiTELEPHONE: (714) 703-2800
LICENSING EVALUATOR SIGNATURE:

DATE: 04/10/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/10/2023
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
ORANGE CO CHILD CARE, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME: GUERRERO, LIDIA & EDNA
FACILITY NUMBER: 304310523
VISIT DATE: 04/10/2023
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AC unit was observed in the backyard area during today's inspection and licensees were consulted on best practice on observing children in care during outdoor play area. A consultation on best practice was given on supervision, health & Safety of children during outdoor play time.

Identify Location & Functioning: The licensee tested the carbon monoxide and smoke detector during today’s inspection. Both were functioning.

Records Reviewed at 10:35 am The LPA requested to review the LIC 610A Emergency Disaster Plan, Verification of Disaster and Fire Drills, and LIC 9040 Facility Roster. Emergency Disaster Plan was verified during today's inspection. Disaster Plan and Fire Drill log was not verified during today's inspections. The facility roster was verified and met requirements. The licensee did not meet the requirements. The LPA provided consultation to support the licensee to meet the requirements at all times. Compliance was not met.

Personnel Records were reviewed at 10:42 am The LPA requested completed personnel records 2 of 2 licensee's for review during today’s inspection. The following documents were reviewed in the files provided by the licensee; CPR First Aid Certification, Immunization records, TB clearance and LIC 9108, and a Mandated Reporter Training Certificate. The facility was not in compliance due to the following documents not being found in the personnel file: LIC 9108, Mandated Reporter Training,and Proof of Influenza.

The licensee was given a consultation to work toward meeting the requirements and has no further questions at this time.The licensee was able to meet compliance during today’s inspection upon consultation and had no further questions

Mandated Reporter Training consultation was provided at 10:48 am: Health and Safety Code (HSC) section 1596.8662 requires all licensed child care providers, administrators and employees of licensed child care facilities, and applicants for family child care home licenses to complete child abuse mandated reporter training and to renew the training every two years.

For additional information and resources on Child Abuse Mandated Reporting, please see the CDSS Resources for Providers. For all other questions, please contact your Local Regional Office. https://mandatedreporterca.com/ Licensees did not meet the requirements.

SUPERVISOR'S NAME: Patricia MaganaTELEPHONE: (714) 703-2821
LICENSING EVALUATOR NAME: Araceli BootorabiTELEPHONE: (714) 703-2800
LICENSING EVALUATOR SIGNATURE:

DATE: 04/10/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/10/2023
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
ORANGE CO CHILD CARE, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME: GUERRERO, LIDIA & EDNA
FACILITY NUMBER: 304310523
VISIT DATE: 04/10/2023
NARRATIVE
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Background Checks were verified for each adult in the home at 10:53 am. A review of the Facility Personnel Report Summary on this date indicates all facility residents, staff, or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions. Currently, there are 5 adults including the licensee and 1 minor child living in the facility. The licensee was reminded that any individuals 18 years or older must have a background check clearance. The licensee was also reminded that any children turning 18 years must obtain a background check to maintain compliance.

Children’s Records Reviewed at 11:00 amThe LPA requested completed children’s records of children enrolled. Children's records were reviewed, and there was a separate, complete, and current record for each child. The LPA reviewed files to verify the following documents LIC 282 Affidavit Regarding Liability Insurance, Immunization Records, LIC 700 Identification and Emergency Medical Treatment, and LIC 995A Notification of Parents’ Rights. One file was missing LIC 282 and licensee will be providing document to parent this evening to meet requirements.

Where to get updates was reviewed with licensees at 12:51 PM.CCLD website www.ccld.ca.gov was provided to licensees to access regulations, updates, and licensing forms.

The licensee was informed of the important updates available at www.ccld.ca.gov and may request to be added to an email list to receive Community Care Licensing Important Notifications from the above website and selecting Receive Important Updates: https://www.cdss.ca.gov/inforesources/community-care-licensing/policy/provider-information-notices/child-care Other useful resources include https://ccld.childcarevideos.org/family-child-care-providers/

The licensee(s) understands they must be present in the facility and must ensure children in care are always supervised. Children are not to be left alone in parked vehicles. When the licensee is temporarily absent from the facility, arrangements must be made for a qualified substitute adult to care for and supervise children while absent. The substitute adult must have the required criminal record, child abuse index clearances, immunizations, Pediatric CPR/First Aid, and mandated reporter training.

SUPERVISOR'S NAME: Patricia MaganaTELEPHONE: (714) 703-2821
LICENSING EVALUATOR NAME: Araceli BootorabiTELEPHONE: (714) 703-2800
LICENSING EVALUATOR SIGNATURE:

DATE: 04/10/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/10/2023
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
ORANGE CO CHILD CARE, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME: GUERRERO, LIDIA & EDNA
FACILITY NUMBER: 304310523
VISIT DATE: 04/10/2023
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During today’s inspection, the licensee and LPA discussed the following at 12:04 pm. The LPA reviewed a safe sleep log with licensee and regulations.

- Stay up to date with LIC 9227 and discuss with parents any new changes


- Ensure 15 min checks are conducted & logged (The initial of the person checking should be included)
- 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.
- Always place infants on their backs to sleep
- Use only a tight-fitting sheet on the crib or play yard mattress
- Do not hang any items from the crib or above the crib
- Keep all items, including blankets, out of the crib or play yard
- Pacifiers may be used if they do not have items attached to them
- Infants should not be swaddled or have any items covering them while sleeping
- The temperature of the room should be comfortable enough for an adult to wear a t-shirt and not be too hot or too cold.

The licensee understands they must be present in the facility and must ensure children in care are always supervised. Children are not to be left alone in parked vehicles. When the licensee is temporarily absent from the facility, arrangements must be made for a qualified substitute adult to care for and supervise children while absent. The substitute adult must have the required criminal record, child abuse index clearances, immunization's, Pediatric CPR/First Aid, and mandated reporter training.


The facility was not in compliance and violations of the California Code of Regulations, Title 22, Division 12 were observed, discussed, and cited at the time of the visit. The following violations of the California Code of Regulations, Title 22; Division 12, were observed and cited today: CCR102417(g)(9)(A) & HSC 1596.8662(b)(1)
SUPERVISOR'S NAME: Patricia MaganaTELEPHONE: (714) 703-2821
LICENSING EVALUATOR NAME: Araceli BootorabiTELEPHONE: (714) 703-2800
LICENSING EVALUATOR SIGNATURE:

DATE: 04/10/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/10/2023
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 04/24/2023 10:49 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE CO CHILD CARE, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868


FACILITY NAME: GUERRERO, LIDIA & EDNA
FACILITY NUMBER: 304310523

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/10/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102417(g)(9)(A)
Operation of A Family Child Care Home
(g) The home shall be free from defects or conditions which might endanger a child. Safety precautions shall include but not limited to: (9) Each family child care home shall have a written disaster plan of action prepared on a form approved by the Department. All children, age and ability permitting, and the provider, the assistant provider, and other members of the household, shall be instructed in their duties under the disaster plan. As their age and ability permit, newly enrolled children shall be informed promptly of their duties as required in the plan. (A) Each family child care home shall conduct fire drills and disaster drills at least once every six months.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, interview and record review, the licensee did not comply with the section cited above by means of not having logs of completed drills which posesa potential health and safety risk to persons in care.
POC Due Date: 04/14/2023
Plan of Correction
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The licensee will complete a drill by due date and submut drill log to LPA via email.
Type B
Section Cited
HSC
1596.8662(b)(1)
Administration of Child Day Care Licensing
(1) On or before March 30, 2018, a person who, on January 1, 2018, is a licensed child day care provider, administrator, or employee of a licensed child day care facility shall complete the mandated reporter training provided pursuant to paragraphs (2) and (3) of subdivision (a), and shall complete renewal mandated reporter training every two years following the date on which he or she completed the initial mandated reporter training.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, interview, record review, the licensee did not comply with the section cited above by means of not having mandated reporter certificartes completed or for review which poses a potential health,and safety risk to persons in care.
POC Due Date: 04/28/2023
Plan of Correction
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Licensee's will complete training and submit certificated via email to the LPA.
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: Patricia MaganaTELEPHONE: (714) 703-2821
LICENSING EVALUATOR NAME: Araceli BootorabiTELEPHONE: (714) 703-2800
LICENSING EVALUATOR SIGNATURE:
DATE: 04/10/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/10/2023
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
ORANGE CO CHILD CARE, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME: GUERRERO, LIDIA & EDNA
FACILITY NUMBER: 304310523
VISIT DATE: 04/10/2023
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Incidental Medical Services (IMS) policy was discussed and the licensee stated she does not provide IMS currently in her FCCH. 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)

Commonly Asked Questions American Child Care Centers and the ADA, available at: http://www.ada.gov/childqanda.htm

Know the Law About The Americans with Disabilities Act and Individuals with Disabilities Education Act https://rrnetwork.org/assets/general-files/Child-Care-Law-Center-ADA_IDEA_Housing-April-2019.pdf

An exit interview was conducted with licensee(s) at 12:57 pm . Appeal Rights were explained. The Licensee was provided a copy of appeal rights (LIC 9058 01/16) and their signature on this form acknowledges receipt of these rights. All appeals must be in writing and received by the Regional Office within 15 business days. First-level appeals should be sent to the regional manager at the address listed above. The Notice of Site Visit was posted and discussed as required by H&S Code Sec. 1596.817. Notice of Site Visit must be posted for 30 consecutive days. Failure to post will result in civil penalties of $100.00. The Notice of Site Visit must be posted on or adjacent to the door.



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/inspection-process


End of Report
SUPERVISOR'S NAME: Patricia MaganaTELEPHONE: (714) 703-2821
LICENSING EVALUATOR NAME: Araceli BootorabiTELEPHONE: (714) 703-2800
LICENSING EVALUATOR SIGNATURE:

DATE: 04/10/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/10/2023
LIC809 (FAS) - (06/04)
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