191607306-2-8-2023-54-CC-MAYA-CNUVAF-20230208151553

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 191607306
Report Date: 02/08/2023
Date Signed: 02/08/2023 03:16:06 PM

Document Has Been Signed on 02/08/2023 03:16 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, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME:	FLORES FAMILY DAY CARE		FACILITY NUMBER:	191607306
ADMINISTRATOR:	FLORES, ELVA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(562) 630-7354
CITY:	LAKEWOOD	STATE: CA	ZIP CODE:	90712
CAPACITY: 14	TOTAL ENROLLED CHILDREN: 3	CENSUS: 2	DATE:	02/08/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	01:15 PM
MET WITH:	Licensee, Elva Flores and Licensee's Husband/Assistant, Jose Flores		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 February 8, 2023 at 1:15 PM, Licensing Program Analyst (LPA) Monique Ayala conducted an unannounced inspection at the facility noted above and met with Licensee, Elva Flores and Licensee's Husband/Assistant, Jose Flores. The purpose of the inspection was to conduct the Required - 1 Year inspection. The operating hours of the facility is Monday through Friday from 7:00 AM to 5:00 PM. Entrance Checklist (LIC 126) was provided to the Licensee upon arrival. Individuals residing in the home were discussed and noted. At the time of the inspection, the Licensee, Licensee's Husband/Assistant, and two (2) children were present. All adults present have obtained a criminal record clearance or exemption. LPA conducted a tour of the inside and outside of the facility accompanied by the Licensee. This facility is a two-story home that consists of four (4) bedrooms, three (3) bathrooms, family room, living room, kitchen, dining room, laundry room, gated outdoor patio (located next to fenced pool), fenced pool area, separate fenced backyard, and garage. Areas that are accessible to children include: one (1) bedroom (located downstairs), 1 bathroom (located downstairs), family room, living room, kitchen, dining room, fenced backyard, and front yard. Per Licensee, the children utilize the fenced backyard, front yard, and the local park for outdoor activity. Licensee was advised that direct visual supervision must be provided at all times while using the front yard and/or park for outdoor activity. Areas off-limits to children include: 3 bedrooms (located upstairs), 2 bathrooms (located upstairs), laundry room, gated outdoor patio (located in the backyard), gated pool area, and garage. LPA observed a child safety gate installed at the bottom of the stairs, making the stairs and upstairs inaccessible. LPA observed the doors to the garage and laundry room closed, making the areas inaccessible. LPA observed the required fencing that meets licensing regulations to prevent access to the pool and jacuzzi in the backyard. Licensee was advised that off-limit areas must be made inaccessible during operating hours or while children in care are present.

SUPERVISORS NAME: Valarie Cook
LICENSING EVALUATOR NAME: Monique Ayala
LICENSING EVALUATOR SIGNATURE:	DATE: 02/08/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/08/2023

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, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME: FLORES FAMILY DAY CARE	FACILITY NUMBER: 191607306
	VISIT DATE: 02/08/2023

NARRATIVE

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The following documents were posted in a prominent, publicly accessible area: Facility License, Notification of Parents' Rights (PUB 394), Earthquake Preparedness (LIC 9148), and Emergency Disaster Plan (LIC 610A). Licensee has a current Facility Roster (LIC 9040) available for review. Licensee also has verification of Disaster and Fire Drills, the last drill was conducted on December 2, 2022.

Areas used by children were inspected for safety, comfort, heating, cleanliness and telephone service. The home does not have any wall heaters. LPA observed a fireplace located in the living room and den that were barricaded. Per Licensee, the fireplaces are not in use. The home is equipped with central air and heating. Detergents, cleaning compounds, and medicines were made inaccessible to children. Per Licensee, there are no poisons kept in the home. Licensee was advised that if any poisons are purchased, it is required to be locked with a key or combination lock.

Per Licensee, the home has 4 cats. LPA observed the cats in the gated outdoor patio. LPA advised the Licensee that best practice is to keep pets isolated from children in care. Per Licensee, there are no firearms and/or weapons on the premises. LPA observed age appropriate toys and napping equipment for children. LPA also observed electrical outlet covers installed in the child care areas. Per Licensee, snacks and meals are provided to the children by the facility. Licensee was reminded that any food that is brought from the child's home shall be labeled with the child’s name and properly stored or refrigerated.

LPA observed the required fire extinguisher (2-A:10-B:C or larger) that is fully charged and was last serviced on April 18, 2022. Licensee was reminded to have the fire extinguisher serviced yearly. Smoke detector and carbon monoxide detector were tested and are operable. First Aid kit and emergency supplies are available and kept in 1 bedroom (child care room) and bathroom.

LPA conducted a record review of 2 children's records and 2 personnel records. Based on the children's record review, 1 child (C1) did not have verification of the 15-minute physical checks while child is napping available for review. Based on the personnel record review, Licensee's Husband/Assistant had all of the required documents per licensing regulations available for review.

SUPERVISORS NAME: Valarie Cook
LICENSING EVALUATOR NAME: Monique Ayala
LICENSING EVALUATOR SIGNATURE:	DATE: 02/08/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/08/2023

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, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME: FLORES FAMILY DAY CARE	FACILITY NUMBER: 191607306
	VISIT DATE: 02/08/2023

NARRATIVE

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Based on Licensee's record review, Licensee has proof of immunization against measles, pertussis, and influenza, and a TB clearance available for review. Licensee and Licensee's Assistant/Husband have a current Pediatric First Aid and CPR certification (expires June 2023). Licensee did not have the Preventative Health and Safety Practices certificate of completion available for review. Licensee and Licensee's Husband/Assistant completed the Mandated Reporter Training (AB 1207) on April 15, 2021. Licensee was advised that the Mandated Reporter training (AB 1207) must be completed every 2 years and is available at www.mandatedreporterca.com.

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.

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 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.

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

SUPERVISORS NAME: Valarie Cook
LICENSING EVALUATOR NAME: Monique Ayala
LICENSING EVALUATOR SIGNATURE:	DATE: 02/08/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/08/2023

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, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME: FLORES FAMILY DAY CARE	FACILITY NUMBER: 191607306
	VISIT DATE: 02/08/2023

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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.

Deficiencies were cited during today's inspection (refer to deficiency page).

A Notice of Site Visit (LIC 9213) was given and must remain posted for 30 days.

Exit interview conducted and report was reviewed with Licensee, Elva Flores and Licensee's Husband/Assistant, Jose Flores.

SUPERVISORS NAME: Valarie Cook
LICENSING EVALUATOR NAME: Monique Ayala
LICENSING EVALUATOR SIGNATURE:	DATE: 02/08/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/08/2023

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 02/08/2023 03:16 PM - It Cannot Be Edited

Created By: Monique Ayala On 02/08/2023 at 02:40 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
, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME: FLORES FAMILY DAY CARE	FACILITY NUMBER: 191607306
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 02/08/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

102416(c)

Personnel Requirements

(c) 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. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on record review, the licensee did not comply with the section cited above as the Licensee did not have proof of completion for the Preventative Health and Safety Practices (EMSA-approved) training available for review which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 03/08/2023
	Plan of Correction
1 2 3 4	Licensee will complete the Preventative Health and Safety Practices (EMSA-approved) training, and submit proof of completion to LPA via e-mail by March 8, 2023.

Type B

Section Cited

CCR

102425(j)(2)(D)

Infant Safe Sleep

Documentation shall be maintained in the infant’s file and be available to the Department for review. Documentation shall include the following: This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on record review, the licensee did not comply with the section cited above as 1 child (C1) did not have verification of the 15-minute physical checks while the child is napping available for review which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 03/08/2023
	Plan of Correction
1 2 3 4	Licensee will conduct 15-minute physical checks while C1 is napping, and submit proof of completion for a duration of at least one week to LPA via e-mail by March 8, 2023.

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:

Valarie Cook

LICENSING EVALUATOR NAME:

Monique Ayala

LICENSING EVALUATOR SIGNATURE:

DATE: 02/08/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/08/2023

LIC809 (FAS) - (06/04)

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