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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 304313055
Report Date: 08/07/2019
Date Signed: 08/07/2019 12:34:00 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:BELTRAN-BLAY, MONA MFACILITY NUMBER:
304313055
ADMINISTRATOR:BELTRAN-BLAY, MONA MFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(714) 891-4513
CITY:GARDEN GROVESTATE: CAZIP CODE:
92845
CAPACITY:14CENSUS: 12DATE:
08/07/2019
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Licensee Mona Beltran-BlayTIME COMPLETED:
01:00 PM
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Licensing Program Analyst (LPA) and licensee toured the Early Childhood Educator Settings inside and outside. LPA observed 3 infants and 9 preschool age children having lunch. Present was licensee and her assistant. The facility was within licensed capacity and the required ratio. A review of staff records on this date indicates that all facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions.
This is a single story home with four bedrooms and 3 baths. LPA observed a gate installed by the hallway and kitchen entry to prevent children from accessing into the off-limit areas. Licensee stated off limit areas include: 3 bedrooms, 2 bathrooms in the hallway, kitchen, and garage. Licensee acknowledged that children may never enter these off-limit areas. Family members residing at facility are 3 adults and no children. The home was inspected for safety, comfort, cleanliness, telephone service, heating and ventilation, inaccessibility to poisons, detergents, cleaning compounds, medicines, and hazardous items that can pose a danger to children.

Per Licensee there are no weapons, firearms in the facility at this time. There was a dog being kept away from children in the dog run. No *swimming pool, spa or other bodies of water observed on the premises. There are age appropriate toys and equipment on the premises. The required fire extinguisher (2A10BC), carbon monoxide, and smoke detectors are in operable condition. The fireplace was screened. Facility roster, staff’s required immunization (MMR, TDAP, FLU) were available for review. Licensee was reminded that no child shall be left alone in a parked vehicle at any time. All day-care activities take place in the living room, the first bedroom by the living room, and the bathroom in the kitchen area. Children are able to have outside play in the enclosed backyard. Licensee and her assistant are current with Pediatric CPR and First Aid and both valid until 7/2020.

Licensee does not provide Incidental Medical Services to the children.

SUPERVISOR'S NAME: Rina LopezTELEPHONE: (714) 703-2808
LICENSING EVALUATOR NAME: Thuy HoTELEPHONE: (714) 296-6577
LICENSING EVALUATOR SIGNATURE:

DATE: 08/07/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/07/2019
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 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: BELTRAN-BLAY, MONA M
FACILITY NUMBER: 304313055
VISIT DATE: 08/07/2019
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The following were discussed: Individuals who are 18 years of age or older living in the home must be finger print cleared prior to presence in the facility. Individuals within one month of their 18th birthday must be fingerprinted immediately. No smoking, no infant walkers, No Johnny jumpers, no exersaucer or any other similar items that fall into that category are allowed in the facility. Disaster drills,

Hard copy and link of Child Care Providers Guide to Safe Sleep provided to licensee on this day: https://www.cdph.ca.gov/programs/SIDS/Documents/SIDSchildcaresafesleep.pdf

After a tour of the home and review children and staff's records, no deficiency was observed.

Exit interview conducted. Notice of Site Visit was posted. Licensee was informed to keep the Notice of Site Visit posted for 30 days during the day care hours or $100 civil penalty will be assessed.

LPA reviewed with licensee the following safe sleep best practices:



· 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.
SUPERVISOR'S NAME: Rina LopezTELEPHONE: (714) 703-2808
LICENSING EVALUATOR NAME: Thuy HoTELEPHONE: (714) 296-6577
LICENSING EVALUATOR SIGNATURE:

DATE: 08/07/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/07/2019
LIC809 (FAS) - (06/04)
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