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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 304311418
Report Date: 10/08/2019
Date Signed: 10/08/2019 03:34:51 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:LEMUS, GLORIAFACILITY NUMBER:
304311418
ADMINISTRATOR:LEMUS, GLORIAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(714) 835-3802
CITY:SANTA ANASTATE: CAZIP CODE:
92701
CAPACITY:14CENSUS: 12DATE:
10/08/2019
TYPE OF VISIT:Case Management - Legal/Non-complianceUNANNOUNCEDTIME BEGAN:
01:10 PM
MET WITH:Gloria Lemus - LicenseeTIME COMPLETED:
03:55 PM
NARRATIVE
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An unannounced inspection was conducted at the facility by Licensing Program Analyst (LPA) Mai for the purpose of monitoring compliance plan on file. Met with licensee, Gloria Lemus, and her assistant. 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 (including licensee) and 4 minor children living in the home. The facility and grounds were toured and the licensee was operating within the licensed capacity. There were 2 infants, 6 preschoolers, 4 school-age children in care. Operating hours are 6:00 AM to 6:30 PM, Monday through Friday.

The floor plan was verified. Facility is a two-story home with detached garage. The main day care area is the living room, dining area, family room and front daycare room as the napping room. The entire upstairs is off-limit. During today’s inspection, the stairs was not barricaded, a baby gate was next to the stairs and not securely installed.

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 family room screened by a fire place 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.

Fire extinguisher (3A40BC) observed to be fully charged and meet State Fire Marshall standards. Smoke detectors and carbon monoxide detectors were present and tested during inspection. The facility has conducted an emergency drill within the past six months (last drill on 09/09/19). The licensee stated there are no firearms and/or other dangerous weapons in the home and none were observed during today's visit.
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SUPERVISOR'S NAME: Judy HansonTELEPHONE: (714) 703-2807
LICENSING EVALUATOR NAME: Gigi MaiTELEPHONE: (714) 743-8565
LICENSING EVALUATOR SIGNATURE:

DATE: 10/08/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/08/2019
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 5
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: LEMUS, GLORIA
FACILITY NUMBER: 304311418
VISIT DATE: 10/08/2019
NARRATIVE
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The licensee stated she is present in the home and ensures that children that children in care are supervised at all times. 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 facility has an updated children’s roster. Children’s records were reviewed and found to be in substantial compliance. There is a small Shih Tzu dog present at the facility in a gated area near the kitchen.

The licensee's pediatric CPR/First Aid certification is not current and expired on 09/23/2019. Proof of immunization against influenza (or written decline) pertussis and measles for licensee and assistant present today were reviewed and within compliance of SB 792. Licensee has completed the Mandated Reporter Training on 07/27/19. The licensee’s assistant is exempt from this requirement due to English not being his Primary language.

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 .

A Child Care Provider’s Guide to Safe Sleep packet, Safety Seat, Never Ever Shake a Baby information, California Child Passenger Safety Law were discussed and recommended to be posted. Safe Sleep Regulation and Effects of Lead Exposure were discussed and provided to the licensee. The licensee was advised on how to receive notifications for quarterly updates and provided with Child Care Advocate contact information: childcareadvocatesprogram@dss.ca.gov

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SUPERVISOR'S NAME: Judy HansonTELEPHONE: (714) 703-2807
LICENSING EVALUATOR NAME: Gigi MaiTELEPHONE: (714) 743-8565
LICENSING EVALUATOR SIGNATURE:

DATE: 10/08/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/08/2019
LIC809 (FAS) - (06/04)
Page: 2 of 5
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: LEMUS, GLORIA
FACILITY NUMBER: 304311418
VISIT DATE: 10/08/2019
NARRATIVE
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The following electronic links were also provided:
SIDS: https//www.cdph.ca.gov/programs/SIDS/Documents/SIDSchildcaresafesleep.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, 102416(c), 102417(g)(3) and HSC 597.622 were observed and cited today.

The Notice of Site Visit was posted. 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. Exit interview was conducted. 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. All appeals must be in writing and received by the Licensing office within 15 business days. Licensee was informed of how/where to access regulations and forms from CCLD website: www.ccld.ca.gov.

Page 3 of 3 [End of Report]
SUPERVISOR'S NAME: Judy HansonTELEPHONE: (714) 703-2807
LICENSING EVALUATOR NAME: Gigi MaiTELEPHONE: (714) 743-8565
LICENSING EVALUATOR SIGNATURE:

DATE: 10/08/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/08/2019
LIC809 (FAS) - (06/04)
Page: 3 of 5
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: LEMUS, GLORIA
FACILITY NUMBER: 304311418
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/08/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
11/04/2019
Section Cited

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1597.622 Effective September 1, 2016, a person may not be employed or volunteer at a child care center or a family child care home unless he or she has been immunized against influenza, pertussis, and measles or qualifies for an exemption...This requirement was not met as evidenced by:
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Based on record review and interview, Licensee failed to obtain proof of immunizations/immunity against measles and pertussis for her assistant. This poses a potential health risk to children in care.
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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: Judy HansonTELEPHONE: (714) 703-2807
LICENSING EVALUATOR NAME: Gigi MaiTELEPHONE: (714) 743-8565
LICENSING EVALUATOR SIGNATURE:
DATE: 10/08/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/08/2019
LIC809 (FAS) - (06/04)
Page: 4 of 5
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: LEMUS, GLORIA
FACILITY NUMBER: 304311418
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/08/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
11/04/2019
Section Cited

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102416(c) Personnel Requirements.
The Licensee and other personnel shall complete training on...pediatric cardiopulmonary resuscitation and pediatric first aid, pursuant to Health and Safety Code...This requirement is not meet as evidenced by:
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Based on record review, the licensee failed to ensure current pediatric CPR and 1st aid training cards. This poses a potential Health and Safety risk to the children in care.
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Type B
10/08/2019
Section Cited

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102417(g)(3) Operation of a Family Child Care Home. Where children are less than five years old are in care, stairs shall be fenced or barricaded. This requirement is not met as evidenced by:
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Based on observation, Licensee failed to barricaded or install a baby gate on the stairs. This poses a potential safety risk to children in care.
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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: Judy HansonTELEPHONE: (714) 703-2807
LICENSING EVALUATOR NAME: Gigi MaiTELEPHONE: (714) 743-8565
LICENSING EVALUATOR SIGNATURE:
DATE: 10/08/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/08/2019
LIC809 (FAS) - (06/04)
Page: 5 of 5