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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 304311565
Report Date: 10/25/2019
Date Signed: 10/25/2019 11:18:41 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:HERRERA, ANGELICAFACILITY NUMBER:
304311565
ADMINISTRATOR:HERRERA, ANGELICAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(949) 855-6315
CITY:LAKE FORESTSTATE: CAZIP CODE:
92630
CAPACITY:14CENSUS: 6DATE:
10/25/2019
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
08:55 AM
MET WITH:Angelica Herrera - LicenseeTIME COMPLETED:
11:48 AM
NARRATIVE
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An unannounced inspection was conducted today by Licensing Program Analyst (LPA) Mai. Met with licensee, Angelica Herrera, and 1 assistant; licensee guided LPA on a tour of the facility. Present at the time of the inspection were 6 daycare children, 3 infants and 3 preschoolers. There are presently 6 adults living in the home. A review of adults living or working in the home on this date indicated individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions. Operating hours are 7:30 AM to 5:30 PM, Monday through Friday.

The floor plan was verified; the day care areas are the daycare room (enclosed patio), nap room, day care bathroom and fenced backyard. All bedrooms, living room, kitchen, dining area and garage are off-limits areas. Licensee acknowledges that children are never to enter an off-limit area of the home. Fireplace is barricaded. Cleaning solutions, sharp utensils and sharp knives are all inaccessible. During the inspection of the fenced backyard, LPA observed a bottle of Season Long Weed Control for lawns in a separate and gated section of the yard. Licensee stated poisons/hazardous items are kept on the premises but not under key/combo lock. Licensee was reminded and understands that cleaning solutions/chemicals must be made inaccessible to children at all times and poisonous items must be key/combo locked at all times. LPA also observed an unoccupied baby jumper in the day care room. Licensee immediately removed the Fisher Price Rainforest Jumperoo, took it apart and placed it in original manufacture box.

Fire extinguisher (2A:10BC) observed to be fully charged and meet State Fire Marshall standards. Smoke detectors and carbon monoxide detectors were present and tested during inspection. Licensee has fire and disaster drill on file. The licensee does have a landline and was reminded that if a cell phone is used, it must remain on the premises at all times during hours of operation. Licensee stated that there are no firearms on the premises and none were observed during today's visit. LPA advised anytime when firearms are present, they must be locked and stored separately from the ammunition.
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SUPERVISOR'S NAME: Judy HansonTELEPHONE: (714) 703-2807
LICENSING EVALUATOR NAME: Gigi MaiTELEPHONE: (714) 743-8565
LICENSING EVALUATOR SIGNATURE:

DATE: 10/25/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/25/2019
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 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: HERRERA, ANGELICA
FACILITY NUMBER: 304311565
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/25/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
10/25/2019
Section Cited

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102417(g)(4)(A) Operation of a Family Child Care. Home Storage areas for poisons, firearms and other dangerous weapons shall be locked. This requirement was not met as evidenced by:
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Based on observation, Licensee failed to lock a poisonous item "Season Long Weed Control" located in the backyard in an inaccessible separate gated area. Regulations require poisonous items to be locked. This poses a potential health and safety risk to children in care.
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Type B
10/25/2019
Section Cited

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102417(g)(10) Operation of a Family Child Care Home. A baby walker shall not be allowed on the premises of a family child care home in accordance with Health and Safety Code Section 1596.846(b) and (c). This requirement was not met as evidence by:
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Based on observation there was one unocuppied baby jumper in the daycare room. Baby jumpers are not permitted on the premises of a licensed child care facility. 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: 10/25/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/25/2019
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: HERRERA, ANGELICA
FACILITY NUMBER: 304311565
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/25/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
11/08/2019
Section Cited

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1596.8662(b)(1) On or before March 30, 2018, a person who, on January 1, 2018, is a licensed child care provider, administrator, or employee of a licensed child day care facility shall complete the mandated reporter training…This requirement is not met as evidenced by:
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Based on record review and interview, Proof of completion of required mandated reporter training was not available for review during today's inspection for licensee. This poses a potential health and 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: 10/25/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/25/2019
LIC809 (FAS) - (06/04)
Page: 5 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: HERRERA, ANGELICA
FACILITY NUMBER: 304311565
VISIT DATE: 10/25/2019
NARRATIVE
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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

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 Chaptered Legislation for AB 2084 (Nutritious Beverages) http://ccld.ca.gov/res/pdf/12APX-11.pdf

The following violation of the California Code of Regulations, Title 22; Division 12, 102417(g)(4)(A), 102417(g)(10), and HSC 1596.8662(b)(1) and 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: 10/25/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/25/2019
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: HERRERA, ANGELICA
FACILITY NUMBER: 304311565
VISIT DATE: 10/25/2019
NARRATIVE
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There are age appropriate toys and napping equipment on the premises for the potential ages served. The licensee stated she is present in the home and ensures that the 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. Licensee understands the facility is always to be free from smoking. No infant walkers, Johnny jumpers, exersaucer or any other similar items that fall into that category are allowed in the facility.

Facility met all posting requirement. Children’s roster, children’s immunization and parents’ rights forms was available for review. Immunizations for pertussis, measles, and influenza for were available for review for all staff. The licensee's pediatric CPR/First Aid certification is current (exp. 04/2021) and EMSA approved. The required mandated reporter training certificate was not available for review for all staff; the mandated reporter certificate is not required at this time for some staff due to it not being available in Spanish language.

Incidental Medical Services (IMS) policy was discussed, applicant stated she does not plan to provide it at this time. 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 licensing office within 30 days of providing IMS. The plan should describe the facility’s policies and procedures that ensure the proper safeguards are in place. 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 reviewed Unusual Incident Report form and advised the licensee to contact Licensing Officer of the Day within 24 hours by phone or fax and complete the LIC 624B within seven days. LPA reminded licensee on requirements of disaster drills, posting requirements, children’s records and facility/staff records (LIC 311D).

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

DATE: 10/25/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/25/2019
LIC809 (FAS) - (06/04)
Page: 2 of 5