<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 304311318
Report Date: 10/11/2019
Date Signed: 10/11/2019 04:43:56 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:ROBLES, MARIAFACILITY NUMBER:
304311318
ADMINISTRATOR:ROBLES, MARIAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(714) 535-3398
CITY:ANAHEIMSTATE: CAZIP CODE:
92801
CAPACITY:14CENSUS: 6DATE:
10/11/2019
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Maria Robles - LicenseeTIME COMPLETED:
03:20 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
Licensing Program Analysts (LPAs) Villa and Chan conducted an unannounced annual random inspection to ensure the health & safety standards as required by regulations governing family child care homes are met. Upon arrival LPA Villa was greeted by Licensee, Maria Robles. Also present during todays inspection was Hector J. Robles. Per licensee there are four adults residing in the home. All adults present during this inspection have obtained a criminal record clearance prior to working or residing in the home.

Census was obtained during today’s inspection, there were six children present all were napping. One of the six children present was an infant. The facility was observed to be within ratio. Per Licensee she has 15 children enrolled in her day care. An updated children’s roster was available during the inspection. Licensee states her hours of operation are Monday through Friday, 24 hours, and no weekends.

A tour of the home was conducted inside and outdoors. The home is a single-story home with four bedrooms and three bathrooms. The areas designated for the day care are the family room and the back yard that has been fenced and covered with age appropriate toys. Licensee uses the living room as the napping area for the children. The children use the restroom located near the family room. All areas were observed to be clean and free of hazards.



The off-limit areas are the four bedrooms and the two restroom in the home. All bedrooms and the restroom that are off limits are locked to prevent access by the children in care. Licensee was reminded that the children are not to enter the off-limit areas.

The licensee stated there are no firearms on the premises. Disinfectants, cleaning solutions, poisons and other items that are dangerous to children were properly stored and or locked away. The smoke detector, fire extinguisher, and carbon monoxide detector were present and within regulations.
SUPERVISOR'S NAME: Judy HansonTELEPHONE: (714) 703-2807
LICENSING EVALUATOR NAME: Yesenia VillaTELEPHONE: (714) 293-9465
LICENSING EVALUATOR SIGNATURE:

DATE: 10/11/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/11/2019
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: ROBLES, MARIA
FACILITY NUMBER: 304311318
VISIT DATE: 10/11/2019
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
26
27
28
29
30
31
32
The home had safe and comfortable furnishings and equipment for the children. CPR & First Aid are current for licensee (exp. 05/05/20). Some of the children's files were reviewed and had the required parents' rights, emergency contact information, affidavit regarding lability insurance, consent for medical treatment, and immunization information.

Licensee has the Parent’s Rights poster and other appropriate forms posted. Licensee and staff files were reviewed for Immunizations, MMR, TDAP and Influenza. Files were observed to be complete. Licensee is exempt from the mandated reporter training as her primary language is Spanish. Children records were reviewed for LIC700, LIC627 and Blue Immunization cards. Licensee completed last fire and earthquake drill on 07/10/19. Licensee has a working telephone via cell phone and home phone.

The licensee maintains a first aid kit in the home. 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. LPAs reviewed SIDs, safe sleeping practices. 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 in her care. 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. LPA Villa demonstrated how to access quarterly updates with the State cell phone.
SUPERVISOR'S NAME: Judy HansonTELEPHONE: (714) 703-2807
LICENSING EVALUATOR NAME: Yesenia VillaTELEPHONE: (714) 293-9465
LICENSING EVALUATOR SIGNATURE:

DATE: 10/11/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/11/2019
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: ROBLES, MARIA
FACILITY NUMBER: 304311318
VISIT DATE: 10/11/2019
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
26
27
28
29
30
31
32
There were no violations found under Title 22 Regulations, no citations 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 Robles.
SUPERVISOR'S NAME: Judy HansonTELEPHONE: (714) 703-2807
LICENSING EVALUATOR NAME: Yesenia VillaTELEPHONE: (714) 293-9465
LICENSING EVALUATOR SIGNATURE:

DATE: 10/11/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/11/2019
LIC809 (FAS) - (06/04)
Page: 3 of 3