376627405-4-14-2022-20-CC-MHEZ-CDGUBJ-20220414152626

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 376627405
Report Date: 04/14/2022
Date Signed: 04/14/2022 03:26:42 PM

Document Has Been Signed on 04/14/2022 03:26 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:	JIMENEZ, MARIA FAMILY CHILD CARE		FACILITY NUMBER:	376627405
ADMINISTRATOR:	MARIA JIMENEZ		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(914) 294-7349
CITY:	LA MESA	STATE: CA	ZIP CODE:	91942
CAPACITY:	14	CENSUS: 10	DATE:	04/14/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	01:30 PM
MET WITH:	Maria Jimenez, Licensee		TIME COMPLETED:	03:30 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 April 14, 2022 at 1:30 PM, Licensing Program Analyst (LPA), Marie Hernandez conducted an unannounced annual inspection and met with the Licensee Maria Jimenez. LPA disclosed the purpose of the inspection and was granted entry into the facility by the Licensee. There were ten children present with the Licensee and the adult helper, Magalie Garcia during the inspection today. The facility is a two story home. The following areas are used for child care: The living room, day care room, hallway bathroom and the backyard. The off limit areas are the kitchen, downstairs bedroom #1, side yard and the entire upstairs.. The operation hours are Monday through Friday from 7:00 AM to 5:00 PM. The fire extinguisher, smoke detector, and carbon monoxide detector met requirements, per LPA observation. The hazardous items were inaccessible to children in care. LPA informed licensee that poisons shall be placed in a storage area and locked at all times. LPA observed toys, play equipment and materials available for the children’s use. The home has a fenced backyard available for outdoor activities of children. The licensee was informed that children shall be supervised during outdoor activities. Licensee stated there are no bodies of water on the premises and LPA did not observe any bodies of water during the inspection. Licensee stated there are no weapons in the home. A review of staff records on this date indicates that all facility staff or other individuals who require caregiver background checks have received criminal record and child abuse clearances or exemptions. Licensee’s First Aid and CPR certification expires on 01/17/2023. The Licensee and the adult helper have the required immunization records. The Licensee’s Mandated Reporter Training (AB1207) expired on 01/16/2024. LPA reminded the Licensee that the Mandated Reporter training shall be renewed every two years. LPA reviewed the children's records. The fire/disaster drills have been maintained. The last fire/disaster drill was conducted on 01/03/2022. The child roster was reviewed and in compliance. See LIC 809-C continuation...

SUPERVISOR'S NAME: Cynthia Gray	TELEPHONE: (619) 767-2258
LICENSING EVALUATOR NAME: Marie Hernandez	TELEPHONE: (619) 767-2224
LICENSING EVALUATOR SIGNATURE:	DATE: 04/14/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/14/2022

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, 7575 METROPOLITAN DR., STE 110
SAN DIEGO, CA 92108

FACILITY NAME: JIMENEZ, MARIA FAMILY CHILD CARE	FACILITY NUMBER: 376627405
	VISIT DATE: 04/14/2022

NARRATIVE

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The Licensee currently does not plan on providing IMS to clients. 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 the publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: http://www.ada.gov/childqanda.htm.

The Licensee was reminded that all adults 18 and over living in the home, persons who provide care and supervision to children, and staff who have contact with children, 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.

LPA discussed the safe sleep regulations with Licensee and discussed the Child Care Licensing Safe Sleep web page 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.

LPA reviewed with Licensee the LIC 311D, Forms/Records To Keep In Your Family Child Care Homes, children’s forms/records, facility forms/records, and information to be posted.

Community Care Licensing Division (CCLD) regularly sends information to licensed facilities, providers, and stakeholders by way of Provider Information Notices (PIN), Program Quarterly Update Newsletters and other important information communication platform.

To receive important licensed related information to licensed facilities, visit the CCLD Important Information website at https://www.cdss.ca.gov/inforesources/community-care-licensing/subscribe and select the Child Care option to receive email communication.

No deficiency cited today. An exit interview was conducted and the report was reviewed with the Licensee, Maria Jimenez.

SUPERVISOR'S NAME: Cynthia Gray	TELEPHONE: (619) 767-2258
LICENSING EVALUATOR NAME: Marie Hernandez	TELEPHONE: (619) 767-2224
LICENSING EVALUATOR SIGNATURE:	DATE: 04/14/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/14/2022

LIC809 (FAS) - (06/04)

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