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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 304310536
Report Date: 07/18/2019
Date Signed: 07/18/2019 10:54:51 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:AMEZQUITA, PABLO & RODRIGUEZ, MARIA GUADALUPEFACILITY NUMBER:
304310536
ADMINISTRATOR:RODRIGUEZ, MARIAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(562) 690-9305
CITY:LAHABRASTATE: CAZIP CODE:
90631
CAPACITY:14CENSUS: 10DATE:
07/18/2019
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Maria Rodriguez, LicenseeTIME COMPLETED:
11:20 AM
NARRATIVE
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Licensing Program Analyst (LPA) Yesenia Villa conducted an unannounced annual random site inspection to ensure the health & safety standards as required by regulations governing family child care homes are met. Upon arrival, LPA was greeted by licensee, also present during todays visit was assistant Maria Rios and Licensees son Kenneth Amezquita. All adults present in the home have obtained a criminal record clearance. Ratio was obtained during todays visit, there were 6 toddlers and 4 infants in care. The facility was observed to be within ratio.

A tour of the home was conducted inside and outdoors. Per Licensee there are 4 adults residing in the home. The home is a three bedroom 2 and ½ bathroom residence. There are two small dogs in the home that remain outdoors per licensee. The dogs breed are: Miniature Schanauzer and a Shih Tzu, licensee had proof of vaccinations for both dogs. Licensee states her hours of operation are 6:30am-4:30pm, Monday thru Friday.

An updated roster was available during the inspection. Per Licensee there are 12 children enrolled in the day care.

The areas designated for the day care are the backroom of the home and restroom located next to the back room. The children use the backyard for outdoor play time, LPA Villa observed the backyard to be fenced with age appropriate toys and no hazards. The off-limit areas are the living room, dinning room, kitchen, bedrooms and restroom located in the hallway. The off-limit areas are secured by a sliding door and a baby gate that prevents access to the home. Page 1-3

SUPERVISOR'S NAME: Judy HansonTELEPHONE: (714) 703-2807
LICENSING EVALUATOR NAME: Yesenia VillaTELEPHONE: (714) 703-2818
LICENSING EVALUATOR SIGNATURE:

DATE: 07/18/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/18/2019
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 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: AMEZQUITA, PABLO & RODRIGUEZ, MARIA GUADALUPE
FACILITY NUMBER: 304310536
VISIT DATE: 07/18/2019
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The Licensee was reminded that full supervision is required at all times to ensure children do not have access to the off-limit areas. There are no bodies of water on the premises. Licensee has the Parent’s Rights poster and other appropriate forms posted on wall in the play room. Pediatric First Aid/CPR certificates are valid thru 12/08/19 for licensee and assistant. Licensees disaster drill log notes last drill was conducted on 06/19/19.

Licensee has a working telephone via cell phone and home phone. The licensee has completed the mandated reporter training 03/10/2018 and was reminded that the training expires every two years..

Detergents and cleaning supplies were inaccessible to the children in care. Fire extinguisher was inspected and met state regulations. There is an operational smoke detector and carbon monoxide in the living room. The licensee maintains a First Aid Kit in the home. There are adequate age appropriate toys, books, and games. There are no firearms present on the premises as stated by licensee. Ten children’s files were reviewed for LIC700 and Blue Immunization card. All files were complete. Licensees and Licensees assistant files were reviewed during todays inspection and were complete.



The following were discussed: Individuals who are 18 years of age or older living in the home must be finger print cleared prior to being in the presence of the children in care. Individuals within one month of their 18th birthday must be fingerprinted immediately. No smoking, No infant walkers, No baby bouncers, No Johnny jumpers, No exersaucers and any other item that falls into that category is to be in the home. LPA discussed disaster drills, posting requirements, children records requirements, mandated child abuse and injury/death reporting.

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SUPERVISOR'S NAME: Judy HansonTELEPHONE: (714) 703-2807
LICENSING EVALUATOR NAME: Yesenia VillaTELEPHONE: (714) 703-2818
LICENSING EVALUATOR SIGNATURE:

DATE: 07/18/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/18/2019
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, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME: AMEZQUITA, PABLO & RODRIGUEZ, MARIA GUADALUPE
FACILITY NUMBER: 304310536
VISIT DATE: 07/18/2019
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LPAs reviewed SIDs, Never Shake A Baby, safe sleeping practices pamphlet. Infants should sleep mouth up, on their backs, free of clutter surrounding their sleeping space. Safe sleep guidelines flyer was provided during today’s visit.

Incidental Medical Services (IMS) policy was discussed. Licensee states there are no children requiring medication. 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

LPA advised the Licensee to access forms and regulations on line at: www.ccld.ca.gov, Licensee was advised where to access the quarterly updates and LPA Villa provided Licensee with the following email childcareadvocatesprogram@dss.ca.gov.

There were no deficiencies cited during todays inspection.

The Notice of Site Visit (LIC 9213) – must remain posted for 30 consecutive days during the hours of operation after each site visit by a licensing representative. Failure to maintain posting as required will result in a civil penalty of $100.00. Exit interview was conducted with Licensee and Appeal rights were provided and explained. Licensee was informed that appeals must be submitted in writing within 15 days of a citation.

An exit interview was completed with licensee Maria Rodriguez Page 3 of 3 end of report.
SUPERVISOR'S NAME: Judy HansonTELEPHONE: (714) 703-2807
LICENSING EVALUATOR NAME: Yesenia VillaTELEPHONE: (714) 703-2818
LICENSING EVALUATOR SIGNATURE:

DATE: 07/18/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/18/2019
LIC809 (FAS) - (06/04)
Page: 3 of 3