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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 136610383
Report Date: 02/09/2023
Date Signed: 02/09/2023 02:41:45 PM

Document Has Been Signed on 02/09/2023 02:41 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:MONTELONGO, ANA & GREGORIO FAMILY CHILD CAREFACILITY NUMBER:
136610383
ADMINISTRATOR:ANA & GREGORIO M.FACILITY TYPE:
810
ADDRESS:TELEPHONE:
(760) 768-6413
CITY:CALEXICOSTATE: CAZIP CODE:
92231
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 6DATE:
02/09/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:00 PM
MET WITH:Ana & Gregorio MontelongoTIME COMPLETED:
02:50 PM
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On February 9, 2023, at 12:00 p.m., Licensing Program Analyst (LPA), Gloria Gonzalez conducted an unannounced Annual Required Inspection and met with the Licensee, Ana & Gregorio Montelongo.  LPA disclosed the purpose of the inspection and was granted entry into the facility by the Licensee.  Six (6) daycare children and one (1) staff member was in the facility during this inspection. This facility is a one story, 4 bedroom, 3 bathroom house. Licensee accompanied LPA inside and out of the facility during this inspection. The following areas used for child care are: living room, dining room, kitchen, TV room (playroom), and part of the backyard. Licensee submitted a written statement requesting to add room #1 (nap room) for daycare use. LPA inspected the room and is ready for use as of this date. Off limits areas are bedrooms #2, #3, #4, bathrooms #2-#3, garage, and part of the backyard and are inaccessible through use of door knob covers and door locks. Hours of operation are: Monday-Friday from 6:00 am-6:00 pm.

The fire extinguisher, smoke detector, and carbon monoxide detector met requirements.  Hazardous items were made inaccessible to children during the inspection. The licensee has toys, play equipment and materials available.  The home has a fenced backyard available for outdoor activities at time of inspection. No bodies of water observed on the premises 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.  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.

Licensee’s First Aid and CPR certification expires on 3/2023.  Licensee has required immunizations.  Licensee, Ana completed Mandated Reporter Training on 7/22/21 and Gregorio did not have the Mandated Reporter Training Certificate. Facility roster is maintained and was reviewed.  The last fire and disaster drills were conducted and documented on 1/3/23. 
SUPERVISORS NAME: Tulam Vu
LICENSING EVALUATOR NAME: Gloria Gonzalez
LICENSING EVALUATOR SIGNATURE: DATE: 02/09/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/09/2023
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: MONTELONGO, ANA & GREGORIO FAMILY CHILD CARE
FACILITY NUMBER: 136610383
VISIT DATE: 02/09/2023
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Licensee was advised if there is to be an infant in care, there must be 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. Licensee physically checks on sleeping infants up to 24 months of age every 15 minutes.  An Individual Infant Sleeping Plan [LIC 9227 (3/20)] is maintained for each infant up to 12 months of age.  Licensee places infants up to 12 months of age on their backs for sleeping. 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.

LPA provided and discussed the following:  Report suspected child abuse and neglect, maintain children’s records according to regulation, post all required forms.  Licensee was reminded that corporal punishment, smoking, exersaucers, bouncy seats, walkers, and jumpers and/or similar equipment are not allowed in daycare.  Licensee was also provided information regarding SIDS, Lead exposure and Shaken Baby Syndrome.  LPA and Licensee discussed California Megan's Law and LPA provided:www.meganslaw.ca.gov. 
LPA advised if there is an unusual incident to report to call Licensing within 24 hours and to follow up with an LIC624B within 7 days. In addition, for general questions, questions regarding licensing requirements call Child Care Licensing.

Duty Line at (619) 767-2248. Access our updated Regulation & Forms by using our WEBSITE: http://ccld.ca.gov.

LPA discussed and provided Licensee with the following: child care advocates email address: childcareadvocatesprogram@dss.ca.gov.
SUPERVISORS NAME: Tulam Vu
LICENSING EVALUATOR NAME: Gloria Gonzalez
LICENSING EVALUATOR SIGNATURE:

DATE: 02/09/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/09/2023
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: MONTELONGO, ANA & GREGORIO FAMILY CHILD CARE
FACILITY NUMBER: 136610383
VISIT DATE: 02/09/2023
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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.

Type B deficiency is being cited: (see the LIC809-D page).

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.

A copy of the report and appeal rights (LIC 9058) and notice of site visit (LIC9213) was provided to Licensee and must remain posted for 30 days.

LPA interpreted and explained the inspection report to licensee in Spanish, licensee stated she understood.

An exit interview was conducted and report was reviewed with the licensee's Ana & Gregorio Montelongo.
SUPERVISORS NAME: Tulam Vu
LICENSING EVALUATOR NAME: Gloria Gonzalez
LICENSING EVALUATOR SIGNATURE:

DATE: 02/09/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/09/2023
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 02/09/2023 02:41 PM - It Cannot Be Edited


Created By: Gloria Gonzalez On 02/09/2023 at 02:31 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 7575 METROPOLITAN DR., STE 110
SAN DIEGO, CA 92108

FACILITY NAME: MONTELONGO, ANA & GREGORIO FAMILY CHILD CARE
FACILITY NUMBER: 136610383

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/09/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
HSC
1596.8662(b)(1)
Administration of Child Day Care Licensing
(1) On or before March 30, 2018, a person who, on January 1, 2018, is a licensed child day care provider, administrator, or employee of a licensed child day care facility shall complete the mandated reporter training provided pursuant to paragraphs (2) and (3) of subdivision (a), and shall complete renewal mandated reporter training every two years following the date on which he or she completed the initial mandated reporter training.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on interview and record review, the licensee did not comply with the section cited above in not having the Mandated Reporter Certificate for Co Licensee, G. Montelongo which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 02/28/2023
Plan of Correction
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Licensee states she will submit proof of Mandated Reporter Training for Co Licensee by 2/28/23 to the department by email.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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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:Tulam Vu
LICENSING EVALUATOR NAME:Gloria Gonzalez
LICENSING EVALUATOR SIGNATURE:
DATE: 02/09/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/09/2023


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