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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 136610587
Report Date: 06/23/2022
Date Signed: 06/30/2022 12:23:49 PM

Document Has Been Signed on 06/30/2022 12:23 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:GUEVARA, JOHANA FAMILY CHILD CAREFACILITY NUMBER:
136610587
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 0DATE:
06/23/2022
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
01:45 PM
MET WITH:JOHANA GUEVARATIME COMPLETED:
04:05 PM
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Licensing Program Analyst (LPA) Claudia Amador conducted an announced pre-licensing inspection with the applicant, Johana Guevara. The purpose of the inspection is to ensure that the home complies with standards established in CCR, Title 22, Division 12, Chapter 3, for Family Child Care Homes. This two-story, three-bedroom, three-bath home was toured and inspected.

The applicant will use the following areas for childcare: living room #1, living room #2, bathroom #1, and back yard. The off-limits areas include the garage, kitchen, dining room, and all bedrooms and bathrooms on the second floor. They are made inaccessible to daycare children through doorknob covers. Three safety gates will be placed. One safety gate will be placed at the kitchen entrance from living room #2, the other will be placed blocking the stairway to the 2nd floor and the last one blocking the entrance to the dining room/ kitchen area.

The applicant will utilize the patio for outdoor activities; it is not properly fenced. The applicant will fix the fence and remove the deteriorated fence panels. There is no fireplace on the premises. There are no bodies of water observed during the time of visit. The fire extinguisher is rated 3A 40B: C and is located in the hallway going to the garage. Smoke and carbon monoxide detectors meet requirements and are operational. All poisons, detergents, cleaning compounds, and medicines are inaccessible. They are located in off-limit areas with cupboard latches and door locks and secured out of reach of children. Children’s toys and play equipment are available. The applicant has a working telephone/cell phone. The applicant indicated there are no firearms or other weapons in the home.
SUPERVISORS NAME: Jason Garay
LICENSING EVALUATOR NAME: Claudia Amador
LICENSING EVALUATOR SIGNATURE: DATE: 06/23/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/23/2022
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: GUEVARA, JOHANA FAMILY CHILD CARE
FACILITY NUMBER: 136610587
VISIT DATE: 06/23/2022
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Applicant maintains documentation of proof of property control for review by the Department. The applicant completed Mandated Reporter AB1207 training certification on 06/2022. The applicant has completed the 8 hours of preventative health, on 12/2021. Pediatric CPR and First Aid certifications expire on 04/2023. Required documents are posted.

LPA advised that before making alterations or additions to the home or grounds, the applicant shall notify the Department of the proposed change. Applicant states they are financially secure to operate a family childcare home for children and will comply with all regulations and laws governing family childcare homes. The hours of operation are Monday through Sunday, 12:00 a.m. – 11:59 p.m.
Applicant and adult residents in the home have criminal record clearances or/and exemptions on file.

The applicant 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 before the 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 the applicant and discussed the Child Care Licensing Safe Sleep webpage https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPA also informed the applicant 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.

The Incidental Medical Services (IMS) policy was discussed. For IMS information, see PIN 22-02-CCP. When any IMS is provided, an updated Plan of Operation that includes 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.
SUPERVISORS NAME: Jason Garay
LICENSING EVALUATOR NAME: Claudia Amador
LICENSING EVALUATOR SIGNATURE:

DATE: 06/23/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/23/2022
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: GUEVARA, JOHANA FAMILY CHILD CARE
FACILITY NUMBER: 136610587
VISIT DATE: 06/23/2022
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The New Provider Resource Packet was reviewed with the applicant, including information on the following: Safe Sleep, Lead Exposure, SIDS, shaken baby, child abuse reporting, community resources, children’s records, facility records, required postings, immunizations, unusual incident report, facility roster, car seat law, visual for ratio/capacity, fire/disaster drill log. The applicant was also informed the following items are prohibited during daycare operating hours (walkers, exersaucers, jumpers, and bouncy seats). Corporal punishment and smoking are not allowed in the daycare.

LPA reviewed with the applicant 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 through Provider Information Notices (PIN), Program Quarterly Update Newsletters, and other important information communication platforms.

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

Southern California Child Care Advocate information was provided. The applicant was encouraged to subscribe through the CCLD website to be placed on an email list for updated regulation information. Advocate information was provided: (714) 703-2800 or childcareadvocatesprogram@dss.ca.gov. Duty Line phone number was also provided: (619) 767-2248.

The exit interview was conducted, and the applicant, Johana Guevara reviewed the report.

A Regular Small Family Child Care Home license may be issued upon final file review and after proof of making the left side patio inaccessible, securing and repairing the backyard fence, and placing the safety gates in their respective areas.
SUPERVISORS NAME: Jason Garay
LICENSING EVALUATOR NAME: Claudia Amador
LICENSING EVALUATOR SIGNATURE:

DATE: 06/23/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/23/2022
LIC809 (FAS) - (06/04)
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