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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 364818878
Report Date: 11/07/2019
Date Signed: 11/14/2019 03:28:16 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1605 EAST PALMDALE BLV, STE A
PALMDALE, CA 93550
FACILITY NAME:REYES FAMILY CHILD CAREFACILITY NUMBER:
364818878
ADMINISTRATOR:REYES, BERENICEFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(760) 961-9368
CITY:APPLE VALLEYSTATE: CAZIP CODE:
92307
CAPACITY:14CENSUS: 10DATE:
11/07/2019
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
10:45 AM
MET WITH:Berenice ReyesTIME COMPLETED:
12:23 PM
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Licensing Program Analyst (LPA) Steven Montoya met with licensee Berenice Reyes for the purpose of conducting a large Family Child Care Home (FCCH) Random Annual Inspection. Licensee provides care for a Large Family Child Care Home for the capacity of 14 children. Currently residing in the home, are licensee, spouse and 3 youth children with all Criminal Record Clearances (DOJ/FBI and Child Abuse Index). LPA toured home to ensure it meets FCCH requirements. Licensee is requesting the days and hours of operation will be:
Monday through Sunday 4:00 AM - 11 30 PM.
INDOOR:
The home is set up as follows: This is a 1 story home with 3 bedrooms and 3 bathrooms. Per Licensee the following areas of the home with be utilized for the Family Child Care: Living Room, dining room, 1 bathroom and Backyard. The off-limits of the home is 3 bedrooms, 2 bathroom. There is a fireplace located in the living room which is made inaccessible to children with a metal cage barrier. The home has central heating and air conditioning. In the kitchen, all sharp utensils, poisons are made inaccessible to children with child safety latches on sink cabinet and drawers. LPA toured the bathroom and inspected sink/toilet are in operable condition. All clean supplies, poison and medications are made inaccessible to children with child safety latches on sink cabinet and drawers. All unused electrical outlets are plugged and made inaccessible to children. the equipment and toys are observed to be safe. Per licensee meals and snack will be provided for children.
SUPERVISOR'S NAME: Claretta YatesTELEPHONE: (661) 789-6944
LICENSING EVALUATOR NAME: Steven MontoyaTELEPHONE: (661) 789-8932
LICENSING EVALUATOR SIGNATURE:

DATE: 11/07/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/07/2019
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, 1605 EAST PALMDALE BLV, STE A
PALMDALE, CA 93550
FACILITY NAME: REYES FAMILY CHILD CARE
FACILITY NUMBER: 364818878
VISIT DATE: 11/07/2019
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Per licensee, the children will nap on cots in living room. There is a fully charged fire extinguisher (2A10BC); and fully stocked first aid kit with manual. Licensee states there are firearms in the home or on the premises that are locked away in the safe. and smoke detectors and carbon monoxide detector were tested

Outside:
The backyard play area is clean and free from all trash and debris or dangerous conditions. Backyard is fenced. There is no swimming pool on the premises.

Documentation:
Licensee has current CPR, First Aid Training with the expiration dates of 08-09-2020 and Prevented Health and Safety Training. All adults in the home have a fingerprint clearance and TB exam. Licensee does not have proof of being immunized against influenza, pertussis and measles. Licensee does not have proof of Mandated Reporting Training and was provided information on needed certificates. Per licensee transportation will be provided. Licensee has valid California Driver License with expiration date 11-18-2021, valid vehicle register with expiration date 03-31-2020 and valid vehicle insurance with expiration date 06-21-2020.

The following was discussed with the licensee:
Mandatory Forms for the children’s files and provider’s files, Requirements for fire drills, earthquake drills and documentation for both. Role and responsibilities of being a mandated reporter.
SUPERVISOR'S NAME: Claretta YatesTELEPHONE: (661) 789-6944
LICENSING EVALUATOR NAME: Steven MontoyaTELEPHONE: (661) 789-8932
LICENSING EVALUATOR SIGNATURE:

DATE: 11/07/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/07/2019
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, 1605 EAST PALMDALE BLV, STE A
PALMDALE, CA 93550
FACILITY NAME: REYES FAMILY CHILD CARE
FACILITY NUMBER: 364818878
VISIT DATE: 11/07/2019
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Licensee reminded that 100% supervision is required at all times to children in care. Licensee was advised how to access forms and Regulations for Family Child Care online at www.ccld.ca.gov. Licensee was made aware that it is he/she responsibility to know the regulations as well as anyone who assists in providing care. Licensing must have the facility’s phone number at all times; if the phone number is changed, licensing must be notified

Regulation prohibits the smoking of tobacco in a private residence that is licensed as a FCCH and in those areas of the home where children are present (24/7 ban). State law prohibits baby walkers, bouncy seats, exersaucers and any other items that fall into that category.
·On January 1, 2018 or before March 30, 2018, a person who, is a licensed child care provider, administrator, or employee of a licensed child day care facility shall complete the on-line mandated reporter training and shall complete renewal mandated reporter training every two years. @www.mandatereporterca.com

**Senate Bill AB 633 - Child Care Facilities: Parent Notification Requirements
Summary: This bill amends Health and Safety Code (HSC) sections 1596.859, 1596.8595, 1596.8895, and 1597.05 to improve the transparency of licensing records and to ensure that parents/guardians using a licensed child care facility are aware of situations that present the greatest danger to children.

Each report (documenting a Type A citation) shall remain posted for 30 days along with the Notice of Site Visit (printed out during this inspection). Family child care homes shall post during hours of operation. Failure to meet the posting requirements shall result in an immediate $100.00 civil penalty In addition; all parents of currently enrolled children and any newly enrolled child for the following 12 months shall receive a copy of report and sign the LIC 9224 acknowledging receipt. Civil Penalty assessments will be assessed if all above requirements are not adhered to.
SUPERVISOR'S NAME: Claretta YatesTELEPHONE: (661) 789-6944
LICENSING EVALUATOR NAME: Steven MontoyaTELEPHONE: (661) 789-8932
LICENSING EVALUATOR SIGNATURE:

DATE: 11/07/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/07/2019
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, 1605 EAST PALMDALE BLV, STE A
PALMDALE, CA 93550
FACILITY NAME: REYES FAMILY CHILD CARE
FACILITY NUMBER: 364818878
VISIT DATE: 11/07/2019
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Health and Safety Code Section 1597.467(b)(1) provides in part: "A report shall be made to the Department…following the occurrence during the operation of a family day care home of any of the following events:
(A) Death of any child from any cause.
(B) Any injury to any child that requires medical treatment.
(C) Any unusual incident or child absence that threatens the physical or
emotional health or safety of any child."

§1597.622 Employees or volunteers at family day care home; immunization requirements; records; exemptions (1) 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. Each employee and volunteer shall receive an influenza vaccination between August 1 and December 1 of each year.

**Incidental medical Services (IMS) policy was discussed. Applicant will wait until facility opens to determine IMS needs. 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
SUPERVISOR'S NAME: Claretta YatesTELEPHONE: (661) 789-6944
LICENSING EVALUATOR NAME: Steven MontoyaTELEPHONE: (661) 789-8932
LICENSING EVALUATOR SIGNATURE:

DATE: 11/07/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/07/2019
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, 1605 EAST PALMDALE BLV, STE A
PALMDALE, CA 93550
FACILITY NAME: REYES FAMILY CHILD CARE
FACILITY NUMBER: 364818878
VISIT DATE: 11/07/2019
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The following deficiencies are being cited in accordance to Title 22 of the California Code of Regulations and/or Health & Safety codes. Please refer to LIC809D for documentation of deficiencies cited: NONE

Exit interview conducted with Licensee Berenice Reyes. A copy of the Appeal Rights (LIC 9058) were given and explained. Licensee’s signature on this form acknowledges receipt of these rights.

Notice of Site Visit has been posted (LIC 9213). The notice shall be posted for 30 consecutive days. Failure to maintain posting as required will result in a $100.00 civil penalty. Copies of this report must be posted for 30 days in visible location the authorized representatives of children.
SUPERVISOR'S NAME: Claretta YatesTELEPHONE: (661) 789-6944
LICENSING EVALUATOR NAME: Steven MontoyaTELEPHONE: (661) 789-8932
LICENSING EVALUATOR SIGNATURE:

DATE: 11/07/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/07/2019
LIC809 (FAS) - (06/04)
Page: 5 of 5