364815781-7-11-2022-12-CC-DMAX-CG8SAQ-20220711134242

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 364815781
Report Date: 07/11/2022
Date Signed: 07/11/2022 01:42:50 PM

Document Has Been Signed on 07/11/2022 01:42 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, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551

FACILITY NAME:	FUENTES FAMILY CHILD CARE		FACILITY NUMBER:	364815781
ADMINISTRATOR:	FUENTES, ROSA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(909) 473-9238
CITY:	SAN BERNARDINO	STATE: CA	ZIP CODE:	92407
CAPACITY:	14	CENSUS: 2	DATE:	07/11/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	10:36 AM
MET WITH:	Rosa Fuentes, Licensee		TIME COMPLETED:	01:45 PM

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Licensing Program Analyst (LPA) Maddox met with Rosa Fuentes, Licensee for the purpose of conducting a Pre-Licensing inspection. This is a single home or apartment with 5 bedroom, 2 bathrooms home with kitchen/dining, living room, formal dining room, and garage. Family members residing in the home include Licensee, husband, son (minor). Days/hours of operation will be Sun thru Sat 4am to evening (1 infant's hours are 5pm to 7 am). Child care areas include the family room; play room (enclosed patio); 2 bathrooms, living room for older children, and the backyard.

Physical Plant: Home is clean and orderly, fireplace is inaccessible, age appropriate toys and play equipment, working smoke detector and carbon monoxide detector, operable Fire Extinguisher (2A10BC), no one smokes in the home. There is a designated area for ill child(ren) as necessary, there are/are no weapon/firearms. Off-limit areas are identified as all bedrooms, and formal dining room. Off limits areas are inaccessible to children. There is a working telephone on the premises, Cleaning compounds inaccessible to children (located in the garage). Medicines are inaccessible to children (located in upper cabinet in the kitchen).

Kitchen: The following are inaccessible - Sharp utensils, lighter and/or matches, open bottles of alcohol are inaccessible.

SUPERVISOR'S NAME: Mariela Ramon	TELEPHONE: (661) 202-3798
LICENSING EVALUATOR NAME: Donna Maddox	TELEPHONE: (661) 568-8971
LICENSING EVALUATOR SIGNATURE:	DATE: 07/11/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/11/2022

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, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551

FACILITY NAME: FUENTES FAMILY CHILD CARE	FACILITY NUMBER: 364815781
	VISIT DATE: 07/11/2022

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Bathroom: Toilets and faucets are clean, safe and operable. Bathtub and shower are free of hazards.

Outdoor: There are 2 large dogs that are kept in the dog run while children are outside. The yard is safe for children (inaccessible – lawn mower, gardening tools, poisonous plants, thorn trees, cactus), LPA observed rubber cushioning. There are no bodies of water on the premises.

Describe what you see in the backyard. There is a covered patio section for children to play. There are 2 separate gated areas that have miscellaneous plants. This play area is clear and clean of debris. There are age appropriate toys on the patio.

Advisory/Other: First Aid kit was observed with supplies readily available. CPR/First Aid expire 7/13/2022. The electrical outlets are covered. Electrical outlet are inaccessible. Windows are free from cracks, bugs and debris. There are (or there are no) hanging window blinds cords accessible to children.

Documents Provided and or Discussed: The following were observed/discussed and or provided: Seat Belt Safety, Safe Sleep poster observed. LPA observed the following forms were posted – Notification of Parents' Rights (PUB394), Roster (LIC9040), License. Emergency and Disaster Information (LIC610, LIC9148), Lead Flyer Requirement, liability insurance (LIC182) must have signed form on file if no liability insurance (observed in children's files).

SUPERVISOR'S NAME: Mariela Ramon	TELEPHONE: (661) 202-3798
LICENSING EVALUATOR NAME: Donna Maddox	TELEPHONE: (661) 568-8971
LICENSING EVALUATOR SIGNATURE:	DATE: 07/11/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/11/2022

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, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551

FACILITY NAME: FUENTES FAMILY CHILD CARE	FACILITY NUMBER: 364815781
	VISIT DATE: 07/11/2022

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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-and-resources/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.

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 - Licensee provides IMS

The following was discussed with the Licensee/Applicant:

Licensee was reminded that 100% supervision is required at all times to children in care; The responsibility to know the regulations as well as anyone who assists in providing care; If the phone number is changed, licensing must be notified; Regulation prohibits the smoking of any kind during the operation of the day care.

SUPERVISOR'S NAME: Mariela Ramon	TELEPHONE: (661) 202-3798
LICENSING EVALUATOR NAME: Donna Maddox	TELEPHONE: (661) 568-8971
LICENSING EVALUATOR SIGNATURE:	DATE: 07/11/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/11/2022

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, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551

FACILITY NAME: FUENTES FAMILY CHILD CARE	FACILITY NUMBER: 364815781
	VISIT DATE: 07/11/2022

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Licensee was advised of the requirement to report Unusual Incidents. A report shall be made to the department by telephone or fax during the department's normal business hours before the close of the next working day following the occurrence during the operation of family day care home. In addition, a written report shall be submitted to the department within seven days following the occurrence of any events specified above. Licensee was informed to utilize the Unusual Incident Report/Injury Report LIC624B when submitting the report to the department.

Licensee advised that the Notice of Site Visit must be posted at the entrance of the facility for a period of 30 days whenever a licensing inspection is conducted. If a Type A deficiency is cited, a copy of the licensing report must also be posted for 30 days. The same report must be provided to parents/guardians of children newly enrolled at the facility during the next 12 months & licensee must obtain a signed Acknowledgement of Licensing Reports (LIC 9224) from parent/guardian & place it in each child's file. Copies of the reports must be provided to each parent when a Type A violation is cited along with Acknowledgment of Receipt of Licensing Reports LIC 9224. If these requirements are not met civil penalties per violation will be assessed.

Prior to making alterations or additions to a family child care home or grounds, the licensee shall notify the Department of the proposed changed. Any change from an area of the family child care home previously identified as "off limits" to an area where care and supervision will be provided to children in care. The licensee shall provide the Department with a copy of an inspection report when an inspection is required by the local building inspector as a result of the alteration, addition or construction.

Exit interview conducted, copy of this report was read and provided to Licensee, Rosa Fuentes on this date.

SUPERVISOR'S NAME: Mariela Ramon	TELEPHONE: (661) 202-3798
LICENSING EVALUATOR NAME: Donna Maddox	TELEPHONE: (661) 568-8971
LICENSING EVALUATOR SIGNATURE:	DATE: 07/11/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/11/2022

LIC809 (FAS) - (06/04)

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