304310523-6-25-2019-06-CC-WPOT-BDGUBC-20190625152608

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 304310523
Report Date: 06/25/2019
Date Signed: 06/25/2019 03:26:20 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:	GUERRERO, LIDIA & EDNA		FACILITY NUMBER:	304310523
ADMINISTRATOR:	GUERRERO, LIDIA & EDNA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(949) 598-0924
CITY:	LAKE FOREST	STATE: CA	ZIP CODE:	92630
CAPACITY:	14	CENSUS: 10	DATE:	06/25/2019
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	01:45 PM
MET WITH:	Lidia and Edna Guerreo, Licensees		TIME COMPLETED:	03:45 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 inspection was conducted at the facility by Licensing Program Analyst (LPA) Port. A review of adult records indicates that all facility residents, staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions. There are presently 5 adults and 1 minor child living in the home. During today’s inspection the home and grounds were toured and the licensee was operating within the licensed capacity. There were 3 infants and 7 preschool age children being cared for by licensees Edna Guerrero and Lidia Guerrero. Operating hours are 7:00 AM to 6:00 PM, Monday through Friday. The floor plan was verified. This is a two-story 5 bedroom and 3 bathroom home. Off limits areas are made inaccessible by means of baby gates. The entire upstairs, staircase, garage, kitchen and living room are off limits. The children use the backyard as the outdoor play area, and it is completely fenced. The outdoor play area is free from hazards. There are no bodies of water on the premises. There is a fireplace in the living room screened by a fireplace cover and inaccessible to children in care. Items which could pose a danger to children (detergents, cleaning compounds, and medications) were stored out of the reach of children. The licensee stated 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 fire extinguisher in the home that meet statutory and State Fire Marshall standards. The facility has conducted an emergency drill within the past six months. The licensee stated there are no firearms and/or other dangerous weapons in the home and none were observed during today's visit. LPA verified there is a working telephone service (landline). Page 1 of 3 (Continued on Page 2)

SUPERVISOR'S NAME: Rina Lopez	TELEPHONE: (714) 703-2808
LICENSING EVALUATOR NAME: Wendy Port	TELEPHONE: (714) 703-2815
LICENSING EVALUATOR SIGNATURE:	DATE: 06/25/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/25/2019

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: GUERRERO, LIDIA & EDNA	FACILITY NUMBER: 304310523
	VISIT DATE: 06/25/2019

NARRATIVE

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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 Spanish 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. A hard copy of the Department of Social Services Lead Information Brochure was explained and provided to the licensee.

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
AAP:https://www.healthychildren.org/English/ages-stages/baby/sleep/Pages/A-Parents-Guide-to-Safe-Sleep.aspx
NIH: https://safetosleep.nichd.nih.gov/safesleepbasics/environment/room/text_alternative
Safe to Sleep Campaign: https://safetosleep.nichd.nih.gov/materials

The following violation of the California Code of Regulations, Title 22; Division 12, was observed and cited today: Personnel Requirements 102417(g)(8) (see LIC 809D).

Inspection, report review and exit interview was conducted in Spanish. Notice of Site Visit was posted during the visit. 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 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.

SUPERVISOR'S NAME: Rina Lopez	TELEPHONE: (714) 703-2808
LICENSING EVALUATOR NAME: Wendy Port	TELEPHONE: (714) 703-2815
LICENSING EVALUATOR SIGNATURE:	DATE: 06/25/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/25/2019

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: GUERRERO, LIDIA & EDNA	FACILITY NUMBER: 304310523
	VISIT DATE: 06/25/2019

NARRATIVE

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The licensee understands she must be present in the home and ensure that children that children in care are supervised at all times. The licensee understands children are not to be left in parked vehicles. The licensee understands when temporarily absent from the home, she must arrange for a qualified substitute adult to care for and supervise children in her absence. The substitute adult must have the required criminal record and child abuse index clearance, be associated to the facility, have a valid Pediatric CPR/First Aid, have mandated reporter training, and SB 792 immunization's on file.

The licensee has a current roster of children in care. Children’s records for children present during LPA’s inspection were reviewed for a copy of the emergency information card that contains all the information specified by regulation (LIC 700) and found to be in compliance.

The licensee's has a CPR/First Aid current certification which expires 04/03/2021 however it is not identified as Pediatric and does not have EMSA certification. Proof of immunization against influenza (or written decline) pertussis and measles for licensee and assistant were reviewed and within compliance of SB 792.

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 licensees is exempt from this requirement due to the training not being available in Spanish.

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 .

(Continued on Page 3)

SUPERVISOR'S NAME: Rina Lopez	TELEPHONE: (714) 703-2808
LICENSING EVALUATOR NAME: Wendy Port	TELEPHONE: (714) 703-2815
LICENSING EVALUATOR SIGNATURE:	DATE: 06/25/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/25/2019

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: GUERRERO, LIDIA & EDNA	FACILITY NUMBER: 304310523
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 06/25/2019

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 07/15/2019 Section Cited CCR 102416(c)	1 2 3 4 5 6 7	Personnel Requirements. 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. This requirement was not met as evidenced by:	1 2 3 4 5 6 7	The licensee stated she will contact the first aid/CPR provider to obtain proof of pediatric/EMSA status or complete an EMSA approved pediatric first aid/CPR course. Proof of enrollment or EMSA/Pediatric confirmation will be sent to our office by the due date of 07/15/2019.
	8 9 10 11 12 13 14	Based on record review conducted: The licensee's has a CPR/First Aid current certification which expires 04/03/2021 however it is not identified as Pediatric and does not have EMSA certification. This poses a potential health risk to children in care.	8 9 10 11 12 13 14
	1 2 3 4 5 6 7		1 2 3 4 5 6 7
	1 2 3 4 5 6 7		1 2 3 4 5 6 7

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 Lopez	TELEPHONE: (714) 703-2808
LICENSING EVALUATOR NAME: Wendy Port	TELEPHONE: (714) 703-2815
LICENSING EVALUATOR SIGNATURE:	DATE: 06/25/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/25/2019

LIC809 (FAS) - (06/04)

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