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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 304313920
Report Date: 09/03/2021
Date Signed: 09/03/2021 12:08:13 PM

Document Has Been Signed on 09/03/2021 12:08 PM - It Cannot Be Edited

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:MADRID, SHERIFACILITY NUMBER:
304313920
ADMINISTRATOR:MADRID, SHERIFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(714) 624-6221
CITY:BUENA PARKSTATE: CAZIP CODE:
90621
CAPACITY: 14TOTAL ENROLLED CHILDREN: 0CENSUS: 0DATE:
09/03/2021
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
10:20 AM
MET WITH:Licensee Ms. Madrid, Sheri TIME COMPLETED:
12:30 PM
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Licensing Program Analyst (LPA) Ketki Desai conducted an announced in-person Pre-Licensing inspection (Relocation) for a new Large Family Child Care home. LPA met with Licensee Ms. Madrid,Sheri who guided analyst on a tour of the new single family home.

Licensee is requesting a Large family childcare home license. Operation hours will be Monday to Friday, 7.00 AM to 6.00 PM, care and supervision shall be provided to children ( 6 weeks to 12 years old) Infants to School age

At the time of inspection today, there were no enrolled children present. LPA observed. License wearing face mask, and following CDC and Dept of Public Health Guidelines. Upon entrance, Licensee shall check the temperatures, complete the COVID questions, offer face mask to children, removes outdoors shoes, offers non skid socks, along with use of Hand sanitizers and hand washing protocols.

All areas identified on the facility sketch were inspected, including but not limited to, off limit areas. This is a single story home, that consists of 3 bedrooms, 2 full restrooms, living room, kitchen, play room with open back yard, side yard, Front yard and a detached garage.

A review of the Facility Personnel Report Summary indicates adults residing in the home are cleared, and associated to the new facility and have completed the caregiver background check clearances exemptions.
Licensee stated is not registered with any Foster Care agency or holds a foster parent license. Licensee was reminded if changes to notify the licensing office.
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, unit is placed in the area inaccessible to children. (Side yard) . There is no Fireplace or stair way in the designated childcare area.
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SUPERVISORS NAME: Thuy Ho
LICENSING EVALUATOR NAME: Ketki Desai
LICENSING EVALUATOR SIGNATURE: DATE: 09/03/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/03/2021
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: MADRID, SHERI
FACILITY NUMBER: 304313920
VISIT DATE: 09/03/2021
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Detergents, cleaning compounds, medicines, sharp objects and hazardous items that can pose a danger to children are inaccessible in areas designated for children. The 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.

Based on the Facility Sketch submitted, areas off limits to children and parents are: All the three bedrooms with one full bathroom , detached garage. Licensee has installed child safety locks on kitchen cabinets (one under the sink and one cabinet next to the dishwasher) Detached garage has a self locking door which falls in the side yard. All the three bedroom doors were observed to be locked with a child safety lock installed on it. Master bathroom also has a child safety lock installed on it . Making the rooms and bathroom inaccessible to children. Licensee understands that licensing staff may have access to off-limit areas during inspection visit if necessary.

Areas Designated for Day care activities: Children shall enter the home through the front yard into main door of the home, leading into the living area of the home, designated for nap time, children shall walk through the open kitchen area into the play room, which has all the educational activities including indoor toys. This room has a glass sliding room which leads into the open back yard. Licensee has set up this room with age appropriate activities for children and safe toys for infants.

Bathroom designated for children is in the hallway next to the bedroom, there is cabinet under the sink which has additional paper products only. Step stool is stored here . Bathroom was clean and appropriate for child use.

Living area is open and spacious, children shall use mats during napping time, all linens and blankets are provided by the Licensee. Infants needs shall be provided by the parents.

OUTDOOR PLAY AREA: Licensee has a huge open yard, where all outdoor play items are set up under the shaded area. The outdoor back yard is completely fenced with grass flooring. There are age appropriate climbing structures. There is locked storage shed in the corner and is inaccessible to children.



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. There is also a new alarm system set up and approved by the Fire Safety officer.
Side yard has a door which is the designated Emergency Exit door as per the Fire Safety Officer. (2)
SUPERVISORS NAME: Thuy Ho
LICENSING EVALUATOR NAME: Ketki Desai
LICENSING EVALUATOR SIGNATURE:

DATE: 09/03/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/03/2021
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: MADRID, SHERI
FACILITY NUMBER: 304313920
VISIT DATE: 09/03/2021
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Licensee will provide Breakfast/ Lunch / AM & PM snacks to the enrolled children. She is in process of enrolling in the food program. If food is brought from home, it shall be labelled and stored accordingly.

Licensee has meet all the posting requirements in the home.

Licensee have completed the required Health and Safety with Nutrition and Lead Poisoning component Training and Pediatric First Aid and CPR is valid through 2/2023. There are first aid supplies available.

There are no weapons or Bodies of water in the home. The home was clean, orderly, and at a comfortable temperature.
Licensee has several pets (one dog/3 cats and 2 birds) Birds are in a cage in the backyard.

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.
Licensee 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. (page-3)
SUPERVISORS NAME: Thuy Ho
LICENSING EVALUATOR NAME: Ketki Desai
LICENSING EVALUATOR SIGNATURE:

DATE: 09/03/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/03/2021
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: MADRID, SHERI
FACILITY NUMBER: 304313920
VISIT DATE: 09/03/2021
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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.

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

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

LPA provided Guardian Information and website info:

https://www.cdss.ca.gov/inforesources/cdss-programs/community-care-licensing/caregiver-background-check/guardian (Page-4)
SUPERVISORS NAME: Thuy Ho
LICENSING EVALUATOR NAME: Ketki Desai
LICENSING EVALUATOR SIGNATURE:

DATE: 09/03/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/03/2021
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: MADRID, SHERI
FACILITY NUMBER: 304313920
VISIT DATE: 09/03/2021
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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


Fire inspection from Orange County Fire Authority have granted the fire clearance for a Large Family Child Care home with specific instruction where the garage is not permitted for Day care.

COVID 19 Self Assessment guide was reviewed and received from the applicant.

On today’s inspection the new relocation site was observed to have a safe, healthful and comfortable accommodation furnishing and equipment’s for the new enrollees.

The facility was complying 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 Licensee will be notified.

An exit interview conducted with licensee Ms.Madrid, Sheri Appeal Rights were explained.


SUPERVISORS NAME: Thuy Ho
LICENSING EVALUATOR NAME: Ketki Desai
LICENSING EVALUATOR SIGNATURE:

DATE: 09/03/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/03/2021
LIC809 (FAS) - (06/04)
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