304313708-12-9-2020-06-CC-KDEI-BW5SN6-20201209130101

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 304313708
Report Date: 12/07/2020
Date Signed: 12/09/2020 01:01:11 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:	CHAVEZ, MARIA		FACILITY NUMBER:	304313708
ADMINISTRATOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY:	8	CENSUS: 2	DATE:	12/07/2020
TYPE OF VISIT:	Case Management - Licensee Initiated	UNANNOUNCED	TIME BEGAN:	08:45 AM
MET WITH:	Licensee Ms. Chavez, Maria		TIME COMPLETED:	10:15 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	Licensing Program Analyst (LPA) Ketki Desai conducted an unannounced Virtual Case Management License initiated inspection for a change in capacity at the existing Family Child Care home. LPA met with Licensee Ms. Chavez Maria, via Face-time and gave a tour of the home. At the time of inspection there were 2 infants in care. A review of the Facility Personnel Report Summary indicates all adults, residing in the home who require caregiver background check clearances are cleared Licensee is requesting a Large family childcare home license. Per Licensee, operation hours will be Monday to Sunday, (23 hours), care and supervision shall be provided to children ages. (Infants to School age) Licensee stated she is not currently registered with any Foster Care agency or holds a foster parent license, she was informed if any changes are to occur, Department shall be notified. All areas identified on the facility sketch were inspected, including but not limited to, off limit areas. The facility is a single story, home with 4 bedrooms, 2 bathrooms, living room, dining room, kitchen, and backyard that is fenced. Areas that will be used by children were inspected for safety, comfort, cleanliness, telephone service (cell phone), ventilation and heating. The home has a central Air and Heating system, there is a fireplace in the living area which was observed to have a safe barrier across it, there is no stairway in the home. Off limits areas are made inaccessible by means of child safety gate, door locks and doorknob cover. Detergents, cleaning compounds, medicines, sharp objects and hazardous items that can pose a danger to children are inaccessible in areas designated for children. Licensee states (that there are no poisons on the premises). Licensee was advised that any poisons must be locked with a key or combination lock. (1)

SUPERVISOR'S NAME: Thuy Ho	TELEPHONE: (714) 287-8515
LICENSING EVALUATOR NAME: Ketki Desai	TELEPHONE: (714) 743-8635
LICENSING EVALUATOR SIGNATURE:	DATE: 12/07/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/07/2020

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: CHAVEZ, MARIA	FACILITY NUMBER: 304313708
	VISIT DATE: 12/07/2020

NARRATIVE

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LPA also observed COVID19, precautions at the home, with required postings, temperature checks upon arrival, social distancing and activities being held in small groups. No outside visitors are allowed in the facility at this time.

Based on the Facility Sketch submitted, areas off limits to children and parents are: Licensee has placed the three bedrooms in the home, the dining area, kitchen, living room and restroom located in the master bedroom. Licensee has placed child proof doorknobs and safety locks to prevent the children from entering the off-limit areas during operation hours. Facility has a fireplace in the living area with a safe barrier and two couches have been placed in front making it inaccessible to children.

Areas Designated for Day care activities: Children shall enter the home through the main wooden door at the entrance of the home, children are received here, parents are not allowed beyond this point. Upon arriving temperatures are checked, hands are sanitized, before they enter the Day care area. Licensee has placed a small table with the required items near the entrance gate.

Licensee has designated family room located past the dining room, the first bedroom to the right when entering the hallway and the restroom located in the hallway as Day care areas and backyard is used for outdoor activities by day care children.

It has age appropriate toys and educational material for children. The designated Day care bathroom was observed to be safe and free of hazardous items. It is located adjoining to the napping room in the hallway. The cabinet under the sink area is locked.

Licensee provides all three meals and snacks to enrolled children.

During napping time, children use the assigned bedroom, twin rolling beds are used, licensee provides all linens and blankets for children. Infants nap in crib, all infant care needs (Diapers/ wipes/ lotion/ Baby food) is provided by the parents, which are stored in individual plastic cubbies in the napping area. There is a changing table also for the infant care

OUTDOOR PLAY AREA: Licensee has assigned the back yard for outdoor activities, it is completely fenced and has artificial grass flooring, several age appropriate toys are placed. There is a shaded area with a canopy providing additional shade where climbing structure is placed. Outdoor area was observed to be fenced from all sides. There is a secured fenced at the end of the play yard making the rest of the area inaccessible to children. (Page-2)

SUPERVISOR'S NAME: Thuy Ho	TELEPHONE: (714) 287-8515
LICENSING EVALUATOR NAME: Ketki Desai	TELEPHONE: (714) 743-8635
LICENSING EVALUATOR SIGNATURE:	DATE: 12/07/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/07/2020

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: CHAVEZ, MARIA	FACILITY NUMBER: 304313708
	VISIT DATE: 12/07/2020

NARRATIVE

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Per licensee, there are no Pets, firearms, weapons or bodies of water on the premises.

The value on the 2A10BC fire extinguisher indicates fully charged, as indicated on service tag observed. Smoke and carbon monoxide detectors were tested and are operable that meet the statutory and State Fire Marshall standards.

EMSA approved (PEDIATRIC) CPR & (PEDIATRIC) First Aid are current for the Licensee and expires on 11/2021. Mandated Reporter Training has also been completed by the Licensee. At the time of Pre-Licensing in December,2019, Licensee was exempt taking the Mandated Reporter training but since the training is available in Spanish, she has completed the requirement and obtained the completion certificate.

Licensee has a cell phone that is used for childcare. Licensee was informed if a cell phone is used for childcare, it must always remain on the premises during hours of operation.

The following was discussed with the applicant:
·Individuals who are 18 years of age or older living in the home must obtain a criminal record clearance. Individuals within one month of their 18th birthday must be fingerprinted immediately.
Civil Penalties will be assessed if not in compliance. ·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 certification and a valid criminal record clearance associated to the facility license.
·Annual fees must be paid promptly and by the due date or a late fee shall be assessed and/or the License may be terminated. The fire extinguisher type 2A-10BC must be serviced annually or as often as necessary. Smoke and carbon monoxide detectors should be checked, and batteries replaced as needed.
Applicant was also made aware of the Child Advocacy program so she could receive the updated Quarterly reports and other information in a timely manner. ChildCareAdvocatesProgram@dss.ca.gov. Reporting Requirements: Changes should be reported to the Department as soon as they occur such as construction, remodeling, telephone number changes and/or if you move from your home. Reporting Requirements: Any unusual incidents or injuries must be reported to the Department within 24 hours via telephone and within seven (7) days in writing. Fire and safety drills must be performed every six months and documented for review by the Department.Children and Staff records must be maintained and updated as needed and must be available for review by the Department. (page -3)

SUPERVISOR'S NAME: Thuy Ho	TELEPHONE: (714) 287-8515
LICENSING EVALUATOR NAME: Ketki Desai	TELEPHONE: (714) 743-8635
LICENSING EVALUATOR SIGNATURE:	DATE: 12/07/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/07/2020

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: CHAVEZ, MARIA	FACILITY NUMBER: 304313708
	VISIT DATE: 12/07/2020

NARRATIVE

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No smoking, No infant walkers, No Johnny jumpers, No saucer chairs, No trampolines and any other item that falls into that category are not permitted in the facility.
All adults living and working in the home shall be made of aware of the Departments right to inspection authority, which includes but not limited to the right to enter the home when children are being cared for, interview children and adults and review documentation.
Licensees shall reveal each facility license number in all advertisements, publications or announcements with the intent to attract clients.

UPDATE: H&S 1597.622: Commencing September 1, 2016, 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.
The licensee has submitted proof of immunization's.

UPDATE: Health and Safety Code 1596.7995: Beginning January 1, 2018, all licensed providers, applicants, directors and employees to complete training as specified on mandated reporter duties. Training is available at: www.mandatedreporterca.com

Incidental Medical Services (IMS): This facility provides Incidental Medical Services – IMS. LPA reviewed storage of medication and equipment/supplies, and reviewed children’s, personnel, and administrative records. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Family Child Care Homes Section 102417. 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

Licensee provides Infant care and following was reviewed and new PIN released in September was shared.

A copy of “A Child Care Providers Guild to Safe Sleep” was provided to Licensee:

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 (Page-4)

SUPERVISOR'S NAME: Thuy Ho	TELEPHONE: (714) 287-8515
LICENSING EVALUATOR NAME: Ketki Desai	TELEPHONE: (714) 743-8635
LICENSING EVALUATOR SIGNATURE:	DATE: 12/07/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/07/2020

LIC809 (FAS) - (06/04)

Page: 4 of 5

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: CHAVEZ, MARIA	FACILITY NUMBER: 304313708
	VISIT DATE: 12/07/2020

NARRATIVE

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LPA reviewed with applicant 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.

OTHER INFORMATION AND FORMS PROVIDED: (Posters were emailed to the Licensee)
 Capacity Handout for a Small Family Child Care Home and Large Family Child Care Home was provided.

Fire inspection services have granted the fire clearance on 12/3/2020

The licensee does have a current roster of children in care.

The facility was in compliance for a (Large Family Child Care Home) with Title 22 Regulations at the time of inspection. A license will be issued after final review, in the event additional requirements are needed, the applicant will be notified.

On today’s inspection each child was observed to have a safe, healthful and comfortable accommodation furnishing and equipment’s.

An exit interview conducted with licensee via Face time. This report and the Appeal Rights were also emailed to the Licensee.

The report was read to the Licensee and the Read Receipt shall serve in lieu of Signature.

Exit interview was conducted with Licensee Chavez, Maria via face time who agrees with the above.

SUPERVISOR'S NAME: Thuy Ho	TELEPHONE: (714) 287-8515
LICENSING EVALUATOR NAME: Ketki Desai	TELEPHONE: (714) 743-8635
LICENSING EVALUATOR SIGNATURE:	DATE: 12/07/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/07/2020

LIC809 (FAS) - (06/04)

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