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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 367700128
Report Date: 05/04/2020
Date Signed: 05/05/2020 10:23:17 AM

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:RIVAS FAMILY CHILD CAREFACILITY NUMBER:
367700128
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY:8CENSUS: 3DATE:
05/04/2020
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
10:30 AM
MET WITH:Brandie RivasTIME COMPLETED:
11:40 PM
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Licensing Program Analyst (LPA) Neal conducted a televisit with Applicant, Brandie Rivas today for the purpose of a pre-licensing inspection for a small family child care home. Home consists of 4 bedrooms, 2 bathrooms, kitchen, living room, family room, laundry room, garage and backyard. Parents will enter child care room through front door. There is a pool on the premises. Family members residing in the home include 2 adults (applicant and her boyfriend) and 3 children.

Home was inspected inside and outside for safety, comfort, cleanliness, telephone service, heating and ventilation, inaccessibility to poisons, detergents, cleaning compounds, medicines, and hazardous items that are inaccessible to children. Child care is to be provided in the one of the bedrooms and living room. Children will use the bathroom down the hall to the left of the bedrooms. Off limits areas include all other bedrooms (child safety knobs), master bathroom, laundry room and the garage. Garage is accessed through the laundry room and no child care activities are conducted there. Cleaning compounds and detergents are kept in the child locked laundry room. Knives and medications are kept in lock boxes in the laundry room. Parent board was observed in child care play room.
SUPERVISOR'S NAME: Mariela RamonTELEPHONE: (661) 202-3798
LICENSING EVALUATOR NAME: Jazelle NealTELEPHONE: (661) 568-8945
LICENSING EVALUATOR SIGNATURE:

DATE: 05/04/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/04/2020
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: RIVAS FAMILY CHILD CARE
FACILITY NUMBER: 367700128
VISIT DATE: 05/04/2020
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Applicant shall conduct fire/earthquake drills every 6 months and document. A Child Roster form was provided via email. There are mats available for sleeping children. Children will play outside in the backyard. There is a concrete area for active play. The home has an in-ground pool. There is a cover over the top that is bolted into the cement on all sides to secure inaccessibility. LPA observed an individual walk across the center of the pool. The cover withstands the full weight of an adult.
Per Applicant, there are no weapons or firearms of any kind in the facility. The required fire extinguisher, carbon monoxide detector and smoke detector were observed in operable condition. The facility has central AC and heat. Applicant has current Pediatric CPR/First Aid certification, set to expire 8/21/2021. Applicant has a first aid kit. Preventative Health and Safety with child nutrition training was completed on 11/2/2019. Mandated Reporter training for child care was completed. Licensee was reminded that Mandated Reporter training for child care must be completed by licensee and any adults assisting at the child care at the website, www.mandatedreporterca.com, every 2 years.
Applicant is reminded of the following:
Mandatory Forms for the children’s files and provider’s files, requirements for fire drills, earthquake drills and documentation for both. Roles and responsibilities of being a mandated reporter were reviewed. Applicant is reminded that 100% supervision is required at all times to children in care. Applicant was advised how to access forms and Regulations for Family Child Care online at www.ccld.ca.gov. Applicant was made aware that it is her responsibility to know the regulations as well as anyone who assists in providing care. Applicant was advised that inaccessibility of hazards must be constantly reassessed depending on the children in 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 family child care home and in those areas of the family day care 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.
SUPERVISOR'S NAME: Mariela RamonTELEPHONE: (661) 202-3798
LICENSING EVALUATOR NAME: Jazelle NealTELEPHONE: (661) 568-8945
LICENSING EVALUATOR SIGNATURE:

DATE: 05/04/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/04/2020
LIC809 (FAS) - (06/04)
Page: 2 of 3
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: RIVAS FAMILY CHILD CARE
FACILITY NUMBER: 367700128
VISIT DATE: 05/04/2020
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For Child Care Advocates information go to: www.childcareadvocatesprogram@cdss.ca.gov

Applicant was advised to review Quarterly Updates on the department's website.



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

Requirements for fingerprint clearances and associations were discussed and verified with the licensee.
Applicant was advised of the requirement to report unusual incidents and/or injuries to the parent/guardian and Licensing within the time frame specified by the regulation and on the form LIC624B. The "Notification of Parent's Rights" poster must be posted in an area of the home accessible to parents. Handouts for Seat Belt Safety, SIDS, Shaken Baby Syndrome are recommended to be posted as well.

The application for a small Family Child Care Home will be submitted for approval with a maximum capacity of 6 or 8 with parent notification.

Inspection was conducted via Televisit and the report was sent to the applicant via email and confirmed with "Read Receipt".

SUPERVISOR'S NAME: Mariela RamonTELEPHONE: (661) 202-3798
LICENSING EVALUATOR NAME: Jazelle NealTELEPHONE: (661) 568-8945
LICENSING EVALUATOR SIGNATURE:

DATE: 05/04/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/04/2020
LIC809 (FAS) - (06/04)
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