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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 334845812
Report Date: 10/31/2023
Date Signed: 10/31/2023 10:50:39 AM

Document Has Been Signed on 10/31/2023 10:50 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVERSIDE CC RO, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501
FACILITY NAME:GUO FAMILY CHILD CAREFACILITY NUMBER:
334845812
ADMINISTRATOR:GUO, YANXIAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(714) 352-9020
CITY:EASTVALESTATE: CAZIP CODE:
92880
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 9DATE:
10/31/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
08:42 AM
MET WITH:Licensee GUO, YANXIATIME COMPLETED:
11:00 AM
NARRATIVE
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On 10-31-2023 and time listed above, Licensing Program Analyst (LPA) Steven Montoya arrived at the facility to conduct an annual inspection. LPA was granted entry by Licensee, Yanxia Guo. LPA toured the facility, inside and out, reviewed records, and observed and/or discussed the following: Days and hours of operation are Monday- Friday, 8 am 6 pm OFF-LIMIT AREAS INCLUDE: Upstairs bedroom 4, 2 bathrooms, garage.

The inspection consisted of reviews of the CARE tool domains. The inspection found the facility to be in compliance except as noted on the LIC809D. Deficiencies were cited this visit.

The facility is operating within the licensed capacity and appropriate ratios. Licensee is present in the home and appropriate supervision is provided: A working telephone is present. Appropriate fire extinguisher: smoke and carbon monoxide detectors are present and were tested by the Licensee during this inspection. All hazardous items are inaccessible which could pose a danger to children. Storage of poisons/toxins are locked. Fireplace is properly covered. Stairs are properly barricaded Facility is clean, orderly and has adequate heating and ventilation- Yes. Facility has safe and age-appropriate toys for both indoor and outdoor activities Yes. Outdoor play area is fenced. Verification of control of property on file.

Gilbert SenaTELEPHONE:
Steven MontoyaTELEPHONE:
DATE: 10/31/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/31/2023
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
RIVERSIDE CC RO, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501
FACILITY NAME: GUO FAMILY CHILD CARE
FACILITY NUMBER: 334845812
VISIT DATE: 10/31/2023
NARRATIVE
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Property owner/landlord notification and consent on file Pediatric CPR and First Aid Card expires on 2-19-2024 Health & Safety Certificate - completed on 3-15-2020 Mandated reporter: Child Care Expires:2-21-2020 809D

Fire clearance in file. Documentation of fire & earthquake completed. Last drill on 12-01-2021 809D Children’s records are complete: 4 See LIC857 Employee records are complete: 2 See LIC 859

No guns or weapons present as stated by the Licensee. Licensee understands all guns, weapons and ammunition must be key locked separately and made inaccessible per Title 22 regulations.

There are no bodies of water during this visit Licensee understands all bodies of water 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.



Additionally, the following was reviewed with Licensee.
- AB 1207 – Mandated Child Abuse Reporting: Child Day Care Personnel Training, beginning January 1, 2018 – 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.

- Effective January 1, 2017 – Children under 2 years of age shall ride in a rear-facing car seat unless the child weighs 40 or more pounds OR is 40 or more inches tall. For additional information regarding car seat laws see www.chp.ca.gov

Licensee provided the Unusual Incident Reporting email: UnusualIncidentReportsDO09@dss.ca.gov
The Duty Officer is available to answer questions Mon. – Fri. at 1-844-LET-US-NO (1-844-538-8766)
SUPERVISOR'S NAME: Gilbert SenaTELEPHONE:
LICENSING EVALUATOR NAME: Steven MontoyaTELEPHONE:
LICENSING EVALUATOR SIGNATURE:

DATE: 10/31/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/31/2023
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
RIVERSIDE CC RO, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501
FACILITY NAME: GUO FAMILY CHILD CARE
FACILITY NUMBER: 334845812
VISIT DATE: 10/31/2023
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MyChildCarePlan.org – Centers and Family Child Care Homes Licensee was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain childcare by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.

Licensee does not provided IMS services Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02- CCP. 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: https://www.ada.gov/resources/child-care-centers/.



Licensee was reminded that all adults 18 and over living or working in the home, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a licensed Family Child Care Home A civil penalty of $100.00 minimum/day for a maximum of 5 days or, if the penalty is for a repeat violation, for a maximum of 30 days per person will be assessed if this regulation is violated.

LPA discussed the safe sleep regulations with licensee and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-andresources/safe sleep as an additional resource. LPA also informed licensee of the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at https://www.cpsc.gov/ and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment.

SUPERVISOR'S NAME: Gilbert SenaTELEPHONE:
LICENSING EVALUATOR NAME: Steven MontoyaTELEPHONE:
LICENSING EVALUATOR SIGNATURE:

DATE: 10/31/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/31/2023
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
RIVERSIDE CC RO, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501
FACILITY NAME: GUO FAMILY CHILD CARE
FACILITY NUMBER: 334845812
VISIT DATE: 10/31/2023
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To improve the quality and value of the new inspection process, a survey may be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or CARE tools, please send email inquiries to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/inspection-process.

During the exit interview, the LICENSEE Yanxia Guo confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS.

Exit interview conducted and report was reviewed with the licensee Yanxia Guo.

A notice of site visit was given and must remain posted for 30 days.

SUPERVISOR'S NAME: Gilbert SenaTELEPHONE:
LICENSING EVALUATOR NAME: Steven MontoyaTELEPHONE:
LICENSING EVALUATOR SIGNATURE:

DATE: 10/31/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/31/2023
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 10/31/2023 10:50 AM - It Cannot Be Edited


Created By: Steven Montoya On 10/31/2023 at 10:23 AM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501

FACILITY NAME: GUO FAMILY CHILD CARE
FACILITY NUMBER: 334845812

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/31/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102417(g)(9)(A)
Operation of A Family Child Care Home
(g) The home shall be free from defects or conditions which might endanger a child. Safety precautions shall include but not limited to: (9) Each family child care home shall have a written disaster plan of action prepared on a form approved by the Department. All children, age and ability permitting, and the provider, the assistant provider, and other members of the household, shall be instructed in their duties under the disaster plan. As their age and ability permit, newly enrolled children shall be informed promptly of their duties as required in the plan. (A) Each family child care home shall conduct fire drills and disaster drills at least once every six months.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review the licensee did not comply with the section cited above in [count] out of [1] of records review. which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 11/07/2023
Plan of Correction
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Licensee will completed Earthquake/Fire drill and record completion by the above date. Licensee will send report to LPA Montoya via email: Steven.Montoya@dss.ca.gov.
Type B
Section Cited
HSC
1596.8662(b)(1)
Administration of Child Day Care Licensing
(1) On or before March 30, 2018, a person who, on January 1, 2018, is a licensed child day care provider, administrator, or employee of a licensed child day care facility shall complete the mandated reporter training provided pursuant to paragraphs (2) and (3) of subdivision (a), and shall complete renewal mandated reporter training every two years following the date on which he or she completed the initial mandated reporter training.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, the licensee did not comply with the section cited above in [count] out of 1 of records review. Licensee (L1) which poses as a potential health, safety or personal rights risk to persons in care.
POC Due Date: 11/07/2023
Plan of Correction
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Licensee will completed Mandated reporting Certificate and send results to LPA Montoya via Email: Steven.Montoya@dss.ca.gov.
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Gilbert Sena
TELEPHONE:
LICENSING EVALUATOR NAME:Steven Montoya
TELEPHONE:
LICENSING EVALUATOR SIGNATURE:
DATE: 10/31/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/31/2023


LIC809 (FAS) - (06/04)
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Document Has Been Signed on 10/31/2023 10:50 AM - It Cannot Be Edited


Created By: Steven Montoya On 10/31/2023 at 10:23 AM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501

FACILITY NAME: GUO FAMILY CHILD CARE
FACILITY NUMBER: 334845812

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/31/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102418(g)
Immunizations
(g) The licensee shall document each child's immunizations as required by the California Code of Regulations, Title 17, Section 6070, and shall maintain such documentation for as long as the child is enrolled.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, the licensee did not comply with the section cited above in [count] out of [2 out of 4)[children records (LIC 857) (C1 and C2) which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 11/07/2023
Plan of Correction
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Licensee will review files, request records from parents and submit result to LPA Montoya via email. Steven.Montoya@dss.ca.gov.
Type B
Section Cited
CCR
102425(c)
Infant Safe Sleep
An Individual Infant Sleeping Plan [LIC 9227 (3/20)] shall be completed for each infant up to 12 months of age the provider has in care and included in the infant's file at the facility.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, the licensee did not comply with the section cited above in [2] out of [4] records review Childrens records (C1 and C2 which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 11/07/2023
Plan of Correction
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Licensee will complete Infant Safe Sleep plan with parents and submit to LPA Montoya via email. Steven.Montoya@dss.ca.gov.
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Gilbert Sena
TELEPHONE:
LICENSING EVALUATOR NAME:Steven Montoya
TELEPHONE:
LICENSING EVALUATOR SIGNATURE:
DATE: 10/31/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/31/2023


LIC809 (FAS) - (06/04)
Page: 6 of 7
Document Has Been Signed on 10/31/2023 10:50 AM - It Cannot Be Edited


Created By: Steven Montoya On 10/31/2023 at 10:23 AM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501

FACILITY NAME: GUO FAMILY CHILD CARE
FACILITY NUMBER: 334845812

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/31/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102425(c)(1)
Infant Safe Sleep
An Individual Infant Sleeping Plan [LIC 9227 (3/20)] shall be completed for each infant up to 12 months of age the provider has in care and included in the infant's file at the facility. This plan shall be signed and dated by the infant’s authorized representative.

This requirement is not met as evidenced by:
Deficient Practice Statement
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4
Based on record review, the licensee did not comply with the section cited above in [2] out of [4] [children records) (Child 1 and 2 LIC 857 which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 11/07/2023
Plan of Correction
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Licensee will completed LIC9227 and submit to LPA Montoya via email: Steven.Montoya@dss.ca.gov.
Type B
Section Cited
CCR
102425(c)(2)
Infant Safe Sleep
An Individual Infant Sleeping Plan [LIC 9227 (3/20)] shall be completed for each infant up to 12 months of age the provider has in care and included in the infant's file at the facility. The Individual Infant Sleeping Plan [LIC 9227 (3/20)] shall be maintained in the infant’s file and shall be available to the Department for review.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review the licensee did not comply with the section cited above in [2] out of [4] records review. Child 1and2 which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 11/07/2023
Plan of Correction
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Licensee will completed record review and submit Infant safe sleep plan to LPA Montoya via email. Steven.Montoya@dss.ca.gov.
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Gilbert Sena
TELEPHONE:
LICENSING EVALUATOR NAME:Steven Montoya
TELEPHONE:
LICENSING EVALUATOR SIGNATURE:
DATE: 10/31/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/31/2023


LIC809 (FAS) - (06/04)
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