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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197413650
Report Date: 08/18/2022
Date Signed: 08/18/2022 03:28:22 PM

Document Has Been Signed on 08/18/2022 03:28 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:PEREZ FAMILY CHILD CAREFACILITY NUMBER:
197413650
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 3DATE:
08/18/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
02:00 PM
MET WITH:Ana Perez, LicenseeTIME COMPLETED:
03:45 PM
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Licensing Program Analyst (LPA) Denise Gibbs conducted an unannounced case management inspection to the above facility on 8/18/22 at 2:00PM. LPA met with Ana Perez, Licensee, who guided analyst on a tour of the facility. The purpose of this inspection is due to licensee’s request for a capacity increase.

Current facility capacity is eight children, licensee wishes to increase to a capacity of 14. Hours of operation hours will remain the same, Mon-Fri 6:00 AM -96:00PM. There were three children and one other adult present when LPA arrived. Adults in the home has been discussed and noted. A current children’s roster was available for review.

This is a Two-story home which consists of four bedrooms, two bathrooms, kitchen/eating area, two living rooms, a foyer, front yard and backyard (fenced). Main care is provided in the two living rooms at the front of the house, separated by a walkway. Per Licensee, areas off limits to children and parents include: two bedrooms and bathroom upstairs and two bedrooms downstairs (locked). Stairs that lead to the second floor are accessed from the side of the home behind a locked door. Stairs can also be accessed from inside the home through a locked door in the kitchen.

Areas that will be used by children were inspected for safety, comfort, cleanliness. All areas for children have age appropriate toys and materials available for children. LPA did not observe and hazards in the main care areas. Smoke and carbon monoxide detectors located in the living room were tested and are operable. Fire extinguisher indicated fully charged and was serviced within the year, 2/2022. The home maintains telephone service via landline and cell phone. LPA observed a wall heater down the hallway next to an off limits room. Per Licensee, the heater is inoperable. Facility has ceiling fans for ventilation. Isolation area for sick children waiting to be picked up is in the foyer or one of the living rooms, away from the other children. LPA observed that detergents and cleaning compounds are stored in the kitchen with a child lock. Licensee states that there
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SUPERVISORS NAME: Trevino Cochran
LICENSING EVALUATOR NAME: Denise Gibbs
LICENSING EVALUATOR SIGNATURE: DATE: 08/18/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/18/2022
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, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME: PEREZ FAMILY CHILD CARE
FACILITY NUMBER: 197413650
VISIT DATE: 08/18/2022
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are no infants currently in care. Licensee is aware of infant safe sleep regulations which were discussed in detail during annual inspection on 6/17/22.

Bathroom for children's use is located down the hallway to the right of the home. Bathroom was observed to be sanitary and free of hazards.

The children will still use the back yard for outdoor play, which was observed to be fenced. LPA did not observe hazards in the outdoor space. Out door space does have multiple storage areas that are made inaccessible to children via gates. Facility has two small dogs. One dog remains in the home during daycare hours and the other is in an off limits area in the backyard. There are no fire arms, weapons or bodies of water at the facility.

All required postings were observed. Last disaster drill was conducted 8/2022. Children’s and staff records are complete. Licensee does have a qualified assistant for the increased capacity. LPA provided and discussed capacity for a large family child care home with licensee and provided capacity worksheets for both small and large child care homes.

Licensee is seeking to provide care for 14 children 1-12 years old. A fire clearance has been granted as of 5/22/22. Based on today’s observation a capacity increase will be granted upon Licensing Program Manager (LPM) approval.

At this time, the facility is in compliance with California Title 22 Regulations. Therefore, there are no deficiencies being issued today 8/18/22.

The Notice of Site Visit (LIC 9213) – must remain posted for 30 days.

Exit interview was conducted with Ana Perez, Licensee.

SUPERVISORS NAME: Trevino Cochran
LICENSING EVALUATOR NAME: Denise Gibbs
LICENSING EVALUATOR SIGNATURE:

DATE: 08/18/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/18/2022
LIC809 (FAS) - (06/04)
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