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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376626543
Report Date: 07/19/2019
Date Signed: 07/19/2019 12:37:13 PM

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:PORTUGAL, MARIVEL & PARRA, OCTAVIO FCCHFACILITY NUMBER:
376626543
ADMINISTRATOR:M. PORTUGAL & O. PARRAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(619) 642-4743
CITY:SPRING VALLEYSTATE: CAZIP CODE:
91977
CAPACITY:14CENSUS: 4DATE:
07/19/2019
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
11:21 AM
MET WITH:Octavio ParraTIME COMPLETED:
01:00 PM
NARRATIVE
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Licensing Program Analysts (LPA), Samantha Salunga and Michelle Palacio made an unannounced Annual Random inspection and met with Licensee, Octavio Parra. There were 4 children in care, who is an infant. Facility was observed operating within ratio and capacity. LPA conducted a tour of the home inside and outside per facility sketch. Licensee is using the following areas for day care: kitchen/dining room, living room, family room, Room #2 and Restroom #2. Off limit areas include: Room #1, Room #3, Room #4, Room #1 bathroom, and storage/laundry room. Business Hours: Monday thru Friday, 6:30am-10:00pm.

Licensee has provided adequate space for the children to eat, sleep and play within the home. Home is clean, orderly and has adequate ventilation. Children’s toys and play equipment are available and observed free of hazards. Stairs are barricaded. There is a working telephone/email address. Fireplace is screened. Fire extinguisher and smoke detector are operational. Licensee states there are no firearms or other weapons in the home. Outdoor play area is fenced. LPA's observed Listerine, Lysol, air spray and dish soap under the child care bathroom sink. Cabinet did not have a latch to make it inaccessible. Three of the children that were present during time of inspection are mobile. There are no existing telephone/email address. Fireplace is screened. Fire extinguisher and smoke detector are operational. Licensee states there are no bodies of water present. Children records were reviewed for Emergency Information. Child #1 does not have enrollment papers. There are no new adults living or working in the home over the age of 18 years. Licensee's are exempt from Mandated Reporter AB1207 training certification due to them having limited English proficiency. Licensee's primary language is Spanish.

LPA reviewed the following with Licensee: Safe Sleep Regulation Concept Handout, Car Seat Law, reporting requirements, regulation highlights, community resources, capacity limitations, supervision, clearances, emergency drills, mandated reporting, SIDS, and Shaken Baby Syndrome. Licensee is reminded that corporal punishment, smoking, walkers, exersaucers, jumpers and bouncy seats shall never be permitted during day care operation. Licensee is aware that interference with a child’s daily functions, physical and mental abuse is not allowed. Licensee is reminded to make anything that reads, "Keep Out of Reach of Children" inaccessible to children.
SUPERVISOR'S NAME: Monica CuddyTELEPHONE: (619) 767-2249
LICENSING EVALUATOR NAME: Samantha SalungaTELEPHONE: (619) 767-2209
LICENSING EVALUATOR SIGNATURE:

DATE: 07/19/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/19/2019
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 4
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: PORTUGAL, MARIVEL & PARRA, OCTAVIO FCCH
FACILITY NUMBER: 376626543
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/19/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
08/01/2019
Section Cited
CCR
102416(c)
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Personnel Requirements. The Licensee and other personnel as specified shall complete training on preventive health practices including pediatric cardiopulmonary resuscitation and pediatric first aid, pursuant to Health and Safety Code Section 1596.866.
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Licensee states he and his wife will enroll in a Pediatric CPR/First Aid class and will provide proof of enrollment to LPA Salunga by POC due date.
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This was not met as evidenced by; Licensee does not have a current CPR/First Aid certification, expiration date, 12/2018. This poses a Potential Health and Safety risk to the clients in care.
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Type B
07/26/2019
Section Cited
CCR
102417(g)(9)(A)
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Each family child care home shall conduct fire drills and disaster drills at least once every six months. This was not met as evidenced by; last fire drill that was conducted and documented was dated 05/07/2018. This poses a Potential Health and Safety risk to the clients in care.
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Licensee states he will conduct a fire drill and document it on his fire drill log and provide proof to LPA via email by POC due date.
Type B
07/19/2019
Section Cited
CCR
102417(g)(4)
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Poisons, detergents, cleaning compounds, medicines, firearms and other items which could pose a danger if readily available to children shall be stored where they are inaccessible to children. This was not met as evidenced by; LPA's observed Listerine, Lysol, air spray and dish soap under the child care bathroom sink. Cabinet did not have a latch to make it inaccessible. This poses a Potential Health and Safety risk to the clients in care.
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LPA's observed a latch in the cabinet, however was not placed on the handles to make the cabinet inaccessible. Licensee immediately placed the latch on the sink cabinet to make it inaccessible. Deficiency is cleared during time of inspection.
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: Monica CuddyTELEPHONE: (619) 767-2249
LICENSING EVALUATOR NAME: Samantha SalungaTELEPHONE: (619) 767-2209
LICENSING EVALUATOR SIGNATURE:

DATE: 07/19/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/19/2019
LIC809 (FAS) - (06/04)
Page: 3 of 4
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: PORTUGAL, MARIVEL & PARRA, OCTAVIO FCCH
FACILITY NUMBER: 376626543
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/19/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
07/26/2019
Section Cited
CCR
102421(b)
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The licensee shall maintain, in each child's record, a copy of the emergency information card required in Section 102417(g)(7). This was not met as evidenced by; Child #1 did not have LIC700 or LIC627.
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Licensee states that he will obtain all required documents for Child #1 and provide proof via text message to LPA Salunga by POC due date.
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This poses a Potential Health and Safety risk to the clients in care.
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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: Monica CuddyTELEPHONE: (619) 767-2249
LICENSING EVALUATOR NAME: Samantha SalungaTELEPHONE: (619) 767-2209
LICENSING EVALUATOR SIGNATURE:

DATE: 07/19/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/19/2019
LIC809 (FAS) - (06/04)
Page: 4 of 4
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: PORTUGAL, MARIVEL & PARRA, OCTAVIO FCCH
FACILITY NUMBER: 376626543
VISIT DATE: 07/19/2019
NARRATIVE
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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

Facility representatives were advised to regularly visit the Community Care Licensing WEB SITE: http://www.ccld.ca.gov/ for quarterly updates and updated regulation information.


Duty Line was provided: (619) 767-2248. LPA also discussed California Megan's Law and LPA provided Director with the following website: www.meganslaw.ca.gov

See LIC809D for cited deficiencies. The LPA reviewed and provided a copy of the Licensee appeal rights (LIC 9058 01/16) and his signature on this form acknowledges receipt of these rights. LIC 9213 NOTICE OF SITE VISIT FORM IS REQUIRED TO BE POSTED FOR 30 DAYS. LPA's observed Licensee post notice of site visit.

*LPA's discussed and informed Licensee that he has an outstanding fee of $176 and provided him with the facility pin number.
SUPERVISOR'S NAME: Monica CuddyTELEPHONE: (619) 767-2249
LICENSING EVALUATOR NAME: Samantha SalungaTELEPHONE: (619) 767-2209
LICENSING EVALUATOR SIGNATURE:

DATE: 07/19/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/19/2019
LIC809 (FAS) - (06/04)
Page: 2 of 4