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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 304312394
Report Date: 03/10/2020
Date Signed: 03/10/2020 05:53:51 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:HERNANDEZ-AREVALO ASCENCION E & AREVALO ROBERTOFACILITY NUMBER:
304312394
ADMINISTRATOR:AREVALO ESPERANZAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(714) 415-9125
CITY:ANAHEIMSTATE: CAZIP CODE:
92805
CAPACITY:14CENSUS: DATE:
03/10/2020
TYPE OF VISIT:OfficeANNOUNCEDTIME BEGAN:
03:00 PM
MET WITH:Ascencion Hernandez-Arevalo and Roberto Arevalo TIME COMPLETED:
06:15 PM
NARRATIVE
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An Informal office meeting was conducted today with licensees Ascencion Hernandez-Arevalo and Roberto Arevalo. In attendance were the co licensees as well as the Regional Manager (RM) Bertha Manzanares and Licensing Program Analyst (LPA) Gesine Connolly. The informal office meeting was conducted in Spanish by Regional Manager Bertha Manzanares.

Bertha Manzanares explained the purpose of the Informal office meeting was to review regulations due to multiple complaint allegations regarding personal rights/lack of supervision and inappropriate discipline/interaction with children in care received in the licensing office over a period 2018 -2019.

The RM reviewed that during the period 2018 to 2019 licensees have received four complaints with multiple allegations regarding personal rights/lack of supervision. During this period licensee was cited for failure to report to licensing an injury a child endured while in care: an injury that required the attention of a medical professional. During today's meeting RM Manzanares reviewed reporting requirements. Licensees were reminded observable child negligence is reportable. Licensees said they understood and would comply.

Also addressed today was the participation of the co licensee in the care and supervision of the children. Licensee Ascencion said the participation by co licensee is minimum as care and supervision is assigned to the assistants who are present on a daily basis. Co licensee is responsible for the drop off and pick up of children who attend school.

During today's informal meeting the facility's discipline policy was addressed. The licensees described their discipline policy: child is provided a book to read, the child is read to, staff talk to the child. In regard to criminal record clearances for assistants licensee Ascencion said assistant clearances will be associated to the facility before employment begins. Additionally the co licensee said the Guardian System will be utilized when accessed on line. Continued on page two
SUPERVISOR'S NAME: Rina LopezTELEPHONE: (714) 703-2808
LICENSING EVALUATOR NAME: Gesine ConnollyTELEPHONE: (714) 293-9314
LICENSING EVALUATOR SIGNATURE:

DATE: 03/10/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/10/2020
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 2
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: 03/10/2020
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A Child Care Providers Guild to Safe Sleep” was discussed. The following was reviewed.
· Always place infants on their backs for sleeping
· Use only a tight-fitting sheet on the crib or play yard mattress
· Do not hang any items from the crib or above the crib
· Keep all items, including blankets, out of the crib or play yard
· Pacifiers may be used as long as they do not have items attached to them
· Infants should not be swaddled or have any items covering them while sleeping
· The temperature of the room should be comfortable enough for an adult to wear a t-shirt and not be too hot or too cold

Licensees were provided copies of the following regulations: Personal Rights, Operation of a Family Child Care Home/Supervision, Criminal Record Clearance.

Additionally the following was discussed with the licensees:
1. The licensees were advised that it is their responsibility to know & understand the requirements of Title 22 Regulations.
2. The licensees' facility must be in compliance at all times.
3. The licensees were advised to check the Child Care Licensing web site at www.ccld.ca.gov for quarterly updates, forms and regulations and to check the Spanish web site for care of infants
https//www.cdph.ca.gov/programs/SIDS/Documents/ChildCareProvSleepSPAN2011.pdf.
4. Licensees will be put on required visits for two years.

The RM explained to licensees that if there are additional issues/allegations regarding personal rights/lack of supervision or inappropriate discipline/interaction during future visits a non-compliance meeting may be held and/or to determine if further administrative action would be needed.

Exit interview conducted with licensees. RM explained to licensees that a copy of this office visit report would need to be given to parents of all children in care and the Acknowledgement form would need to be signed and placed in each child's file. A copy of report would need to be provided to all new parents for the next twelve months.
SUPERVISOR'S NAME: Rina LopezTELEPHONE: (714) 703-2808
LICENSING EVALUATOR NAME: Gesine ConnollyTELEPHONE: (714) 293-9314
LICENSING EVALUATOR SIGNATURE:

DATE: 03/10/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/10/2020
LIC809 (FAS) - (06/04)
Page: 2 of 2