304313160-5-1-2020-06-CC-CODM-BP7QVH-20200501123022

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 304313160
Report Date: 05/01/2020
Date Signed: 05/01/2020 12:33:33 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:	MONTOYA, BERTHA & MARTINEZ, SERGIO		FACILITY NUMBER:	304313160
ADMINISTRATOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY:	8	CENSUS: 2	DATE:	05/01/2020
TYPE OF VISIT:	Case Management - Licensee Initiated	ANNOUNCED	TIME BEGAN:	09:00 AM
MET WITH:	Licensees - Bertha Montoya & Sergio Martinez		TIME COMPLETED:	12:45 PM

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Tele-Inspection through Facetime devise.

Licensing Program Analyst (LPA) Carmen Odom, conducted a tele-inspection at this facility for capacity change and facility inspection. Licensees currently have a small family childcare and has requested to increase to a large family childcare home up to 14 children. Operating hours are 7:00AM- 6:00 PM Monday through Friday. Currently there are 3 adults and 2 minor residents living in the home. A review of adult records indicates that all adult residents or other individuals who require caregiver background checks have received criminal record and child abuse index clearances. A virtual tour of the home was conducted by tele-inspection with Licensee. LPA observed 1 infant, and 1 school age child being cared for by the Licensees. During today’s inspection the Licensees was operating within the licensed capacity. Licensee stated, Mother was present in facility during today’s inspection in off-limits bedroom. LPA Odom requested to see Mother; she was in her bedroom.

During today’s inspection each child was observed to have safe, healthful, and comfortable accommodations, furnishings, and equipment. The facility floor plan is a 1 story home, 4 bedrooms, and 2 restrooms. Licensee stated all 3 bedrooms, 1 bathroom, Garage, kitchen, and laundry room are off-limits. Off limits areas are made inaccessible by means of baby gates, doorknobs and door locks. The accessible childcare areas are living room, bedroom #3 and bathroom in hallway across from bedroom #3. The children use the back-yard patio area on the right side as the outdoor play area, and it is completely fenced. The outdoor play area is free from hazards. The front yard is off limits. The facility has a fireplace in the living room with a black metal cover with a baby lock. The facility has Body of water it was observed during today's tele-inspection, LPA Odom inspected the pool fencing and door, Licensee measured with measuring tape according to the Bodies of water checklist. Licensee stated, the pool is off limits for the childcare. LPAs observed that the in-ground pool met Bodies of Water Title 22 regulations. (Bodies of water check list was completed and in file.)

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SUPERVISOR'S NAME: Judy Hanson	TELEPHONE: (714) 703-2807
LICENSING EVALUATOR NAME: Carmen Odom	TELEPHONE: (714) 703-2819
LICENSING EVALUATOR SIGNATURE:	DATE: 05/01/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/01/2020

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: MONTOYA, BERTHA & MARTINEZ, SERGIO	FACILITY NUMBER: 304313160
	VISIT DATE: 05/01/2020

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Items which could pose a danger to children (detergents, cleaning compounds, and medications) were stored out of the reach of children in garage and locked. Poisonous items are not stored on site, and none were observed during today's inspection. The facility provides safe toys, equipment, and materials. There is a working carbon monoxide detector and smoke detector, and fire extinguisher (2A10BC) in the home that meet statutory and State Fire Marshall standards. The facility conducted an emergency drill within the past six months, last one dated on 02/04/20. The licensee stated there are no firearms or other dangerous weapons in the home. The licensee has a cell phone that is used for childcare. The licensee was reminded that if a cell phone is used as the primary childcare phone, it must remain on the premises always during hours of operation.

The Licensees Pediatric CPR/First Aid certification expires on 01/11/22. Beginning September 1, 2016, Health and Safety (H&S) 1597.622 states, a person shall not be employed or volunteer at a family day care home if he or she has not been immunized against influenza, pertussis, and measles. Proof of immunization against pertussis, measles for Licensees were reviewed and within compliance. Licensees provided a written declination letter for influenza shot.

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, Bertha Montoya has Mandated Reporter training completed on 05/29/19. Licensee, Sergio Martinez does not have Mandated Reporter Training, Licensee is exempt from this requirement due to the training not being available in Spanish.

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

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SUPERVISOR'S NAME: Judy Hanson	TELEPHONE: (714) 703-2807
LICENSING EVALUATOR NAME: Carmen Odom	TELEPHONE: (714) 703-2819
LICENSING EVALUATOR SIGNATURE:	DATE: 05/01/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/01/2020

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: MONTOYA, BERTHA & MARTINEZ, SERGIO	FACILITY NUMBER: 304313160
	VISIT DATE: 05/01/2020

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The Licensees understands they must be present in the facility and must ensure children in care are always supervised and children are not to be left in parked vehicles. When the licensee is temporarily absent from the facility, arrangements must be made for a qualified substitute adult to care and supervise children while absent. The substitute adult must have the required criminal record, child abuse index clearances, immunizations, Pediatric CPR/First Aid, and mandated reporter training.

CCLD website www.ccld.ca.gov was provided to licensee to access regulations, updates, and licensing forms. Licensee was advised to register through childcareadvocatesprogram@dss.ca.gov in order to receive quarterly updates. Licensee was advised of their responsibility to review the Provider Information Notices (PIN) found on the CCLD website.

LPA reviewed the California Department of Social Services Lead Information Brochure was explained and provided to the licensee. A copy of the Provider Information Notice (PIN) 20-02-CCP provides information and guidance from the California Department of Public Health (CDPH), for all childcare facility licensees and providers regarding the Coronavirus. A copy of the 2016 “A Child Care Providers Guide to Safe Sleep” was provided to the licensee. The following electronic links were also provided:
English: https//www.cdph.ca.gov/programs/SIDS/Documents/SIDSchildcaresafesleep.pdf
A copy of the Provider Information Notice (PIN) 20-06-CCP Social and Physical Distancing Guidance and Healthy practices for childcare facilities in response to the global coronavirus (COVID-19) pandemic written in collaboration with the CA Department of Education. A copy of COVID-19 posters and Essential workers list.

The following were discussed: Individuals who are 18 years of age or older living in the home must be fingerprint cleared prior to presence in the facility. Individuals within one month of their 18th birthday must be fingerprinted immediately. No smoking, no infant walkers, baby bouncers, Johnny Jumpers, exersaucer or any other similar items that fall into that category are allowed in the facility. Disaster drills, posting requirements, children record, mandated child abuse and injury/ death reporting, and criminal records clearances/exemption transfer requests, SIDS and Never Shake a Baby. LPA reviewed how to report an unusual incident LIC624.

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SUPERVISOR'S NAME: Judy Hanson	TELEPHONE: (714) 703-2807
LICENSING EVALUATOR NAME: Carmen Odom	TELEPHONE: (714) 703-2819
LICENSING EVALUATOR SIGNATURE:	DATE: 05/01/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/01/2020

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: MONTOYA, BERTHA & MARTINEZ, SERGIO	FACILITY NUMBER: 304313160
	VISIT DATE: 05/01/2020

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LPA Odom reviewed with Licensee, Bertha Montoya, the Facility Pre-Licensing Self-Certification Checklist and Bodies of Water Checklist and met all the requirements. Licensee completed the checklist, signed, dated and e-mailed to LPA.

In the areas that were evaluated, no deficiencies were observed under the California Code of Regulations, Title 22, Division 12 at the time of the visit.

Fire clearance from the Anaheim Fire Prevention, has been received and approved for requested capacity. During today's tele-inspection this facility meets the requirements for licensure of a large family childcare home. This application will be subject to a final in office review. Inspection, report review and exit interview was conducted with Licensee Bertha Montoya in English. 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: Judy Hanson	TELEPHONE: (714) 703-2807
LICENSING EVALUATOR NAME: Carmen Odom	TELEPHONE: (714) 703-2819
LICENSING EVALUATOR SIGNATURE:	DATE: 05/01/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/01/2020

LIC809 (FAS) - (06/04)

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