<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376621410
Report Date: 03/16/2023
Date Signed: 03/16/2023 02:54:40 PM


Document Has Been Signed on 03/16/2023 02:54 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, 7575 METROPOLITAN DR., STE 110
SAN DIEGO, CA 92108



FACILITY NAME:PEREZ, ALEJANDRA FAMILY CHILD CAREFACILITY NUMBER:
376621410
ADMINISTRATOR:ALEJANDRA PEREZFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(619) 475-2862
CITY:NATIONAL CITYSTATE: CAZIP CODE:
91950
CAPACITY:14CENSUS: 12DATE:
03/16/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Alejandra PerezTIME COMPLETED:
03:00 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
On 03/16/2023 at 1:00 PM Licensing Program Analyst (LPA), Dana Stevens conducted an unannounced Annual Required Inspection and met with licensee Alejandra Perez.. LPA disclosed the purpose of the inspection and was granted entry into the facility. Licensee's assistant and Licensee's adult daughter were also present and assisting with childcare. 12 daycare children were present at the time of the inspection, ages 4 months, 9 months, 1, 2, 2, 3, 3, 3, 5, 5, 7 and 7 years. Licensee accompanied LPA throughout the inspection of this 4 bedroom, 3 bathroom home. The following areas are used for child care: Daycare room, Living Room, Dining Room, kitchen, one bedroom, and one bathroom. Off-limits areas are 3 bedrooms, 2 bathrooms and garage. These areas are made inaccessible with a door locks. The back yard patio is used for outdoor activities, licensee stated total supervision is provided. There is one crib or play yard for each infant who is unable to climb out of the crib or play yard.  Cribs or play yards are free from all loose articles and objects. The provider physically checks on sleeping infants every 15 minutes.  An Individual Infant Sleeping Plan [LIC 9227 (3/20)] is maintained for each infant up to 12 months of age. The provider places infants up to 12 months of age on their backs for sleeping.

The fire extinguisher, smoke detector, and carbon monoxide detector met requirements.  The licensee has toys, play equipment and materials available. Licensee stated there are no weapons in the home. A review of records on this date indicates that all individuals who require caregiver background checks have received criminal record and child abuse clearances or exemptions. Licensee's First Aid and CPR certifications expire 11/2024.   Licensee's assistant's CPR certification expires 08/2023. Licensee completed Mandated Reporter 05/2021. Licensee's assistant completed Mandated Reporter 08/2021. Facility roster and children and personnel files were reviewed and found complete. 



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.
SUPERVISOR'S NAME: Cynthia GrayTELEPHONE: (619) 767-2258
LICENSING EVALUATOR NAME: Dana StevensTELEPHONE: (619) 767-2238
LICENSING EVALUATOR SIGNATURE:
DATE: 03/16/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/16/2023
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 2


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 7575 METROPOLITAN DR., STE 110
SAN DIEGO, CA 92108
FACILITY NAME: PEREZ, ALEJANDRA FAMILY CHILD CARE
FACILITY NUMBER: 376621410
VISIT DATE: 03/16/2023
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. 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 was reminded that all adults 18 and over living or working in the home, including employees and volunteers, 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 up to $500.00 maximum per day/per person will be assessed if this regulation is violated.

To improve the quality and value of the new inspection process, a survey will 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 tools, please send them by email 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.

No deficiencies cited.

Exit interview conducted and copy of report and appeal rights were provided to the licensee and their signature on this form acknowledges receipt of these rights.

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

SUPERVISOR'S NAME: Cynthia GrayTELEPHONE: (619) 767-2258
LICENSING EVALUATOR NAME: Dana StevensTELEPHONE: (619) 767-2238
LICENSING EVALUATOR SIGNATURE:

DATE: 03/16/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/16/2023
LIC809 (FAS) - (06/04)
Page: 2 of 2