334830480-7-12-2021-10-CC-LEDS-C4UU9T-20210712152319

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 334830480
Report Date: 07/12/2021
Date Signed: 07/12/2021 03:23:30 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 3737 MAIN STREET, STE 700
RIVERSIDE, CA 92501

FACILITY NAME:	CERVANTES FAMILY CHILD CARE		FACILITY NUMBER:	334830480
ADMINISTRATOR:	CERVANTES, ERIKA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(951) 488-7121
CITY:	MORENO VALLEY	STATE: CA	ZIP CODE:	92557
CAPACITY:	14	CENSUS: 5	DATE:	07/12/2021
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	02:15 PM
MET WITH:	Erika Cervantes-Licensee		TIME COMPLETED:	03:31 PM

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	(1) On July 12, 2021 at 2:15 PM, Licensing Program Analysts (LPA) La Kesha Edwards arrived at the facility to conduct a Required – 1 year inspection as part of a compliance review and met with Licensee, Erika Cervantes. LPA conducted COVID-19 Screening questions prior to entry. Licensee accompanied LPA inside and out of the facility during the inspection and the following was observed and/or discussed: Normal days and hours of operation are: Monday through Friday, 6:00 AM to 6:00 PM OFF-LIMIT AREAS INCLUDE: Upstairs, family room, living room and garage · The facility is operating within the licensed capacity and appropriate ratios · The Licensee is present in the home and has ensured that children in care are supervised at this time · When temporarily absent from the home, the Licensee shall arrange for a substitute adult to care for and supervise children · A working telephone is present · Appropriate fire extinguisher, smoke detector and carbon monoxide detector is present and were tested by the applicant during this inspection. · All hazardous items are inaccessible, this includes: detergents, cleaning compounds, medications and other items which could pose a danger to children · Storage of poisons is inaccessible to children and locked · There is a properly barricaded fire place

SUPERVISOR'S NAME: Dawn Parker	TELEPHONE: (951) 320-2101
LICENSING EVALUATOR NAME: Lakesha Edwards	TELEPHONE: (951) 970-4412
LICENSING EVALUATOR SIGNATURE:	DATE: 07/12/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/12/2021

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 4

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 3737 MAIN STREET, STE 700
RIVERSIDE, CA 92501

FACILITY NAME: CERVANTES FAMILY CHILD CARE	FACILITY NUMBER: 334830480
	VISIT DATE: 07/12/2021

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
26
27
28
29
30
31
32

· No guns or weapons present as stated by the Licensee. Licensee Erika Cervantes understands
all guns, weapons and ammunition must be key-locked separately and made inaccessible per Title
22 regulations.
· Stairs are barricaded at this time
· Home is clean and orderly, with heating and ventilation for safety and comfort
· Safe and appropriate toys and equipment are present for both indoor and outdoor activities.
· Outdoor play areas are fenced or appropriate supervision is present
· Verification of control of property on file (viewed grant)
· Property owner/landlord notification and consent on file
· Facility Sketch, Emergency Disaster Plan & Notification of Parent’s Rights poster are posted
· Pediatric CPR and First Aid Card expire on 10/23/2021
· Health & Safety Certificate - completed on 12/2007
· There are no bodies of water, at this time. Licensee Erika Cervantes understands all bodies of water including ponds, above ground pools & spas, in-ground pools & spas, and some fountains must be properly covered or fenced per Title 22 regulations. The Department must be notified before and after installation of the above types of bodies of water. In addition, all wading pools or similar product must be emptied immediately after use and stored in an upright position.
· Clean, safe and age appropriate toys
· Documentation of fire drills on file, last drill conducted on 6/28/2021
· Each child’s file contains a copy of the emergency information card with required information
· Criminal record clearances are required prior to all adults living or working in a Family Child Care Home. A civil penalty of $100.00 per day the person has been present, may be assessed. All individuals subject to a criminal record review shall obtain a criminal record clearance or exemption prior to working, residing or volunteering in a licensed home. This was verified on 7/12/2021.
The Licensee can submit transfer forms to associate new individuals or to disassociate someone from your facility at: Associations_Disassociations858@dss.ca.gov
· The Department was granted inspection authority as required by the Health and Safety Code
· The Licensee was informed of their reporting requirements and is provided with the Regional Office’s Unusual Incident Reporting email mailbox: UnusualIncidentReportsDO10@dss.ca.gov

SUPERVISOR'S NAME: Dawn Parker	TELEPHONE: (951) 320-2101
LICENSING EVALUATOR NAME: Lakesha Edwards	TELEPHONE: (951) 970-4412
LICENSING EVALUATOR SIGNATURE:	DATE: 07/12/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/12/2021

LIC809 (FAS) - (06/04)

Page: 2 of 4

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 3737 MAIN STREET, STE 700
RIVERSIDE, CA 92501

FACILITY NAME: CERVANTES FAMILY CHILD CARE	FACILITY NUMBER: 334830480
	VISIT DATE: 07/12/2021

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
26
27
28
29
30
31
32

· Incidental Medical Services (IMS) policy was discussed. Facility is not providing IMS at this time. 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
· For more information on SIDS and Safe Sleep Environments, please visit:
California Department of Public Health – California SIDS Program: http://www.cdph.ca.gov/programs/SIDS/pages/default.aspx
AAP – Safe Sleep Campaign: http://www.healthychildcare.org/sids/html
AAP-Free Training: Reducing the Risk of SIDS in Early Education and Child Care: http://shop.aap.org/Reducing-the-Risk-of-SIDS-in-Early-Education-and-Child-Care
And Caring for our Children, Safe Sleep Practices and SIDS/Suffocation Risk Reduction: http://cfoc/nrckids/org/standardview/spccol/safe_sleep

- Access to forms & Regulations for Family Child Care online at www.ccld.ca.gov
- Responsibility to know the regulations for anyone providing care
- Inaccessibility of hazards must be constantly reassessed depending on the children in care
- Current facility’s phone numbers must be on file at all times.
- Failure to meet the posting requirements shall result in an immediate $100 civil penalty.
- Documentation of fire & earthquake drills are to be conducted every six months
- Responsibilities of being a mandated reporter
- Baby walkers, bouncy seats, exersaucers and other similar items are prohibited
- The licensee is urged to visit the U.S. Consumer Product Safety Commission webpage at www.cpsc.gov to ensure that equipment purchased for the day care has not been recalled.
- Once licensed, the Notice of Site Visit must be posted at the entrance of the facility for a period of 30 days. If a serious violation is cited, a copy of the licensing report (LIC809/LIC9099) must also be posted for 30 days.

SUPERVISOR'S NAME: Dawn Parker	TELEPHONE: (951) 320-2101
LICENSING EVALUATOR NAME: Lakesha Edwards	TELEPHONE: (951) 970-4412
LICENSING EVALUATOR SIGNATURE:	DATE: 07/12/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/12/2021

LIC809 (FAS) - (06/04)

Page: 3 of 4

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 3737 MAIN STREET, STE 700
RIVERSIDE, CA 92501

FACILITY NAME: CERVANTES FAMILY CHILD CARE	FACILITY NUMBER: 334830480
	VISIT DATE: 07/12/2021

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
26
27
28
29
30
31
32

A civil penalty of $100 per violation will be assessed for noncompliance.
- Access to forms & Regulations for Family Child Care Homes online at www.ccld.ca.gov.
- Please email: childcareadvocatesprogram.ca.gov to receive Department updates. They will be sent directly to your e-mail account once you have set up an account. This website can also be accessed through www.ccld.ca.gov
- The Duty Officer is available to answer questions Monday – Friday at 1-844-LET-US-NO (1-844-538-8766).

There are no deficiencies cited during this visit.

During the exit interview, the LICENSEE, Erika Cervantes confirmed that there are no Registered Sex Offenders living in the facility and/or using the facility address for their mailing address.

As a REMINDER: when your child(ren) turn 18 years of age, you MUST SUBMIT an updated LIC279, LIC508 and TB Screen and have your child submit for LIVESCAN background clearance. This also applies to any adult PRIOR to them moving into the home or who currently lives in the home. Also, PRIOR to employment of any adult, you must submit the LIC508, TB screening and obtain a background clearance through LIVESCAN.

A NOTICE OF SITE VISIT WAS ISSUED AND LPA VERIFIED THAT IT WAS POSTED IN A PROMINENT LOCATION AT THE FACILITY BEFORE LEAVING. THE LICENSEE UNDERSTANDS THAT IT MUST REMAIN POSTED FOR THE NEXT 30 DAYS.

A copy of this report was provided to the licensee and must be made available to the public for the next 3 years. Appeal rights discussed and a copy provided to the licensee on this date.

SUPERVISOR'S NAME: Dawn Parker	TELEPHONE: (951) 320-2101
LICENSING EVALUATOR NAME: Lakesha Edwards	TELEPHONE: (951) 970-4412
LICENSING EVALUATOR SIGNATURE:	DATE: 07/12/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/12/2021

LIC809 (FAS) - (06/04)

Page: 4 of 4