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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 304313648
Report Date: 09/11/2019
Date Signed: 09/11/2019 10:05:11 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:MELO, RICARDO & UPEGUI, ASTRIDFACILITY NUMBER:
304313648
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY:8CENSUS: 0DATE:
09/11/2019
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
08:27 AM
MET WITH:Ricardo Melo & Astrid UpeguiTIME COMPLETED:
10:15 AM
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Licensing Program Analysts (LPAs), Torrence and Corral conducted an announced Pre-Licensing inspection of the home on today's date. The LPAs Torrence and Corral toured the Early Childhood Setting indoors and outdoors with applicants, Ricardo Melo and Astrid Upegui. The applicants have requested a license for a small family child care home with operating hours of Monday through Friday 5:00 AM to 6:00 PM. A review of adults' records on today's date indicates that all adults live in the home or individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions.

The facility is a two-story home which consist of three bedrooms, three bathrooms, living room, family room, dining room, kitchen, attached garage, front yard (not fenced), and backyard (fenced). The home was clean, orderly, and was at a comfortable temperature. There is a fireplace in the home; which was gated. Off limits areas: entire upstairs; which consist of three bedrooms and two bathrooms, living room, dining room, kitchen, and attached garage. Applicants have placed a children safety gate at the bottom of the stairs, kitchen (safety latches on drawers and safety gate leading to daycare room), dining room (children safety gate leading to the daycare room) and attached garage(locked). The applicants acknowledged the children may never enter the off-limit areas. Per applicants, daycare rooms are the following: family room, one bathroom (located in the hallway), and backyard (fenced).

Cleaning solutions/chemicals, utensils, and sharp knives are all inaccessible. Applicants stated there are no poisons/hazardous items located in the home.



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SUPERVISOR'S NAME: Rina LopezTELEPHONE: (714) 703-2808
LICENSING EVALUATOR NAME: Stacy TorrenceTELEPHONE: (714) 300-3599
LICENSING EVALUATOR SIGNATURE:

DATE: 09/11/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/11/2019
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 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: MELO, RICARDO & UPEGUI, ASTRID
FACILITY NUMBER: 304313648
VISIT DATE: 09/11/2019
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There are age appropriate toys, learning material, and napping equipment on the premises for the potential ages served. There are no bodies of water on the premises. However, there is a stream more than 100 feet from the gated backyard. The applicants stated that there are no firearms on the premises. LPAs advised anytime when firearms are present, they must be locked and stored separately from the ammunition. Fire extinguisher (2A:10-BC) observed to be fully charged, a smoke detector and carbon monoxide detector were present and were functioning during today's inspection.

LPA reviewed the 16 hours Preventative Health, Pediatric CPR/First Aid certification (exp. 07/2021 and 06/2020), and they are EMSA approved and current for the applicants. Current immunization information for pertussis, measles, influenza, and mandated reporter training were verified by LPAs. The LPAs advised the applicants to contact licensing for any changes of off limit areas, operation hours or change in phone number. The applicants have cell phones that are used for child care. The applicants were reminded that if a cell phone is used, it must remain on the premises at all times during hours of operation. Applicants also have a land line available on the premises. In the absence of the licensee a qualified adult must be present supervising the children; a qualified adult is an individual who has a valid and current Pediatric First Aid and CPR training, Immunizations as required by SB 792 (pertussis, measles, and influenza), mandated reporter training and a valid criminal record clearance associated to the facility license.

The following were discussed: Individuals who are 18 years of age or older living or working in the home must be fingerprinted cleared prior to being present in the facility. Individuals within one month of their 18th birthday must be fingerprinted immediately. If adult is fingerprinted cleared and associated to another facility, licensee must complete a Criminal Record Clearances or Exemption Transfer Request form (LIC 9182 or LIC 9188) with copy of ID and Criminal Record Statement (LIC 508) and fax to (714)703-2831 prior to hiring adult. Civil Penalties will be assessed if not in compliance.

LPAs reviewed Unusual Incident Report form and advised the applicants to contact Licensing Officer of the Day within 24 hours by phone or fax and complete the Unusual Incident Report (LIC 624B) within seven days. LPAs reviewed with the applicants of Title 22 regulations, requirements of disaster drills (documented every 6 months), LIC 311D posting requirements, children’s records, facility/staff records, mandated child abuse and injury/death reporting.

SUPERVISOR'S NAME: Rina LopezTELEPHONE: (714) 703-2808
LICENSING EVALUATOR NAME: Stacy TorrenceTELEPHONE: (714) 300-3599
LICENSING EVALUATOR SIGNATURE:

DATE: 09/11/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/11/2019
LIC809 (FAS) - (06/04)
Page: 2 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: MELO, RICARDO & UPEGUI, ASTRID
FACILITY NUMBER: 304313648
VISIT DATE: 09/11/2019
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LPAs explained to the applicants of children's rights, including no intimidation, humiliation, and no corporal punishment. The facility license number must be on all advertisements, publications or announcements with the intent to attract clients.

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

A Child Care Provider’s Guide to Safe Sleep packet, Safety Seat, Never Ever Shake a Baby information, Safe Sleep Regulation, and Effects of Lead Exposure were discussed and provided to the applicants. The Chaptered Legislation for AB 2084 (Nutritious Beverages) is available to view on the website at: http://ccld.ca.gov/res/pdf/12APX-11.pdf.

The applicants were also informed to visit the http://ccld.ca.gov website for Quarterly Updates. The applicants were advised on how to receive notifications for quarterly updates and provided with Child Care Advocate contact information: childcareadvocatesprogram@dss.ca.gov

The applicants were provided a copy of their appeal rights (LIC9058 12/15) and their signature on this form acknowledges receipt of these rights. First level appeal is to Regional manager, address is above on the report. The applicants were informed of how/where to access regulations and forms from CCLD website: www.ccld.ca.gov.

This facility meets licensing requirements on this date and a license for a small family child care home will be issued pending a final review. An exit interview conducted where the report was discussed and provided to the applicants.



End of Report
SUPERVISOR'S NAME: Rina LopezTELEPHONE: (714) 703-2808
LICENSING EVALUATOR NAME: Stacy TorrenceTELEPHONE: (714) 300-3599
LICENSING EVALUATOR SIGNATURE:

DATE: 09/11/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/11/2019
LIC809 (FAS) - (06/04)
Page: 3 of 3