304312394-10-1-2019-06-CC-WPOT-BGJNMU-20191001103542

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 304312394
Report Date: 10/01/2019
Date Signed: 10/01/2019 10:35:53 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:	HERNANDEZ-AREVALO ASCENCION E & AREVALO ROBERTO		FACILITY NUMBER:	304312394
ADMINISTRATOR:	AREVALO ESPERANZA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(714) 415-9125
CITY:	ANAHEIM	STATE: CA	ZIP CODE:	92805
CAPACITY:	14	CENSUS: 3	DATE:	10/01/2019
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	09:41 AM
MET WITH:	Ascencion Esperanza Hernandez-Arevalo		TIME COMPLETED:	11:00 AM

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 2 adults (licensee and co-licensee) living in the home. During today’s inspection the home and grounds were toured and the licensee was operating within the licensed capacity. There was 1 infant and 2 preschool age children being care for by the licensee. Also present in an off-limits area was co-licensee, Roberto Arevalo. Current operating hours are 5:00 AM to 10:00 PM, Monday through Sunday. However the licensee stated she is available 24 hours per day, per the needs of parents. The floor plan was verified. Off limits areas are made inaccessible by means of baby gates and door knob covers. This facility has a separate day care entrance located on the right rear side of the home. The front of the home, all of the bedrooms are garage is off limits. The main day care area is the day care room and kitchen area. The children use the front yard 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 Items which could pose a danger to children (detergents, cleaning compounds, and medications) were stored out of the reach of children. Poisonous items are not stored on site, and none were observed during today's inspection. The home provides safe toys, equipment, and materials. During today’s inspection each child was observed to have safe, healthful, and comfortable accommodations, furnishings, and equipment. 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 (cellular) service. Page 1 of 3 (Continued on Page 2)

SUPERVISOR'S NAME: Rina Lopez	TELEPHONE: (714) 703-2808
LICENSING EVALUATOR NAME: Wendy Port	TELEPHONE: (714) 293-9315
LICENSING EVALUATOR SIGNATURE:	DATE: 10/01/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/01/2019

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)

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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: HERNANDEZ-AREVALO ASCENCION E & AREVALO ROBERTO	FACILITY NUMBER: 304312394
	VISIT DATE: 10/01/2019

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 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

There were no Title 22 deficiencies cited during today's inspection.

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) 293-9315
LICENSING EVALUATOR SIGNATURE:	DATE: 10/01/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/01/2019

LIC809 (FAS) - (06/04)

Page: 3 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: HERNANDEZ-AREVALO ASCENCION E & AREVALO ROBERTO	FACILITY NUMBER: 304312394
	VISIT DATE: 10/01/2019

NARRATIVE

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The licensee understands she must be present in the home and must ensure children that children in care are supervised at all times. The licensee stated children are not 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 clearances, SB 792 immunizations, mandated reporter training, and valid pediatric first aid/CPR certifications.

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 full compliance.

The licensee's pediatric CPR/First Aid certification is current, which expires 03/16/2021. Proof of immunization against influenza (or written decline) pertussis and measles for licensees are 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 licensee has proof of compliance as specified in A.B. 1207.

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) 293-9315
LICENSING EVALUATOR SIGNATURE:	DATE: 10/01/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/01/2019

LIC809 (FAS) - (06/04)

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