197700426-7-23-2021-12-CC-JDOY-C57U65-20210723151745

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 197700426
Report Date: 07/23/2021
Date Signed: 07/23/2021 03:18:00 PM

Document Has Been Signed on 07/23/2021 03:18 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, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551

FACILITY NAME:	PEREZ FAMILY CHILD CARE		FACILITY NUMBER:	197700426
ADMINISTRATOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY: 8	TOTAL ENROLLED CHILDREN: 0	CENSUS: 0	DATE:	07/23/2021
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	01:57 PM
MET WITH:	Diana Perez		TIME COMPLETED:	03:33 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	Licensing Program Analyst (LPA) Justin Dorsey conducted an unannounced annual random inspection. The LPA met with licensee Diana Perez who guided the LPA on a tour of the facility. Upon entry to the facility the LPA observed 0 child in care. This is a two story family home. There is a living room, den room, kitchen, dining room, 3 bedrooms and 3 restrooms. Main care is provided in the den room, living room and dining room. The homes entire first floor has been converted into a daycare. The children use the bathroom located downstairs. LPA Dorsey observed a gate between the living room and den which acts as a barrier to separate the infants from the rest of the children. LPA Dorsey also observed a child safety gate near the homes stair case to prevent children from accessing the upstairs area. The off-limits areas include the homes entire upstairs ( 3 bedrooms, 3 restrooms, and loft) laundry area, kitchen and garage. LPA Dorsey observed the homes backyard. The toys and the equipment are in good repair, LPA Dorsey did not observe any hazardous items in the backyard. The day care home provides breakfast, morning snack, lunch, afternoon snack and dinner. According to the licensee she has not transported children since opening the day-care. LPA advised licensee that if she begins transporting children that her auto insurance and drivers license must be current. The home is operating the child care Monday thru Friday: 6:00a.m. to 6:30p.m. The home was inspected inside and out for safety, comfort, cleanliness, telephone service, heating and ventilation, inaccessibility to poisons, detergents, cleaning compounds, medicines, and hazardous items that can pose a danger to children. The knives are kept in the kitchen in a drawer and all cleaning chemicals are stored underneath the sink in the kitchen. LPA Dorsey observed a gate which restricts children's access to the kitchen. Medications are stored on the top kitchen cabinet inaccessible to children.

SUPERVISORS NAME: Claretta Yates
LICENSING EVALUATOR NAME: Justin Dorsey
LICENSING EVALUATOR SIGNATURE:	DATE: 07/23/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/23/2021

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, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551

FACILITY NAME: PEREZ FAMILY CHILD CARE	FACILITY NUMBER: 197700426
	VISIT DATE: 07/23/2021

NARRATIVE

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There are age appropriate toys and equipment on the premises. Per the licensee there are no weapons or firearms of any kind in the facility. The LPA did not observe any weapons.

The homes first aid kit was observed. The required fire extinguisher (2A10BC) did not have a service tag. Per licensee she bought the fire extinguisher about 2 years ago. LPA Dorsey observed the fire extinguisher was still charged. LPA Dorsey advised the licensee to service the current extinguisher or but a new one and file the receipt for future reference. smoke and carbon monoxide detector are in operable condition. Fire and disaster drills are conducted every six-month, last emergency drill was conducted 05/10/2021. Licensee's Pediatric CPR and First Aid certificate expires on 06/2023.

The facility annual fees are current. Licensee had all the required posted documents: Facility License (LIC 203, Notice of Parent's Rights Poster (PUB 394), Emergency Disaster Plan (LIC 610A), and Earthquake Preparedness Checklist (LIC 9148)

Licensee also provided Mandated Reporter certification of completion dated 3/26/2021.
The LPA observed a current child roster. Child files were found to be complete.

The following were discussed: No smoking, infant walkers, Johnny jumpers, exersaucers and any other item that falls into that category are permitted in the facility. The LPA also discussed earthquake safety and necessity of drills, required forms for children’s files, facility files and posting requirements and penalty.

The licensee was informed that all adults living in or having access to the home are required to have fingerprint clearances with Department of Justice, FBI and Child Abuse Index prior to having contact with children. If the aforementioned is not adhered to, a Civil Penalty of up to $500, per non-cleared adult will be assessed immediately. Please advise your analysis of any person who will be visiting regularly or for longer than #1 week.

The applicant was advised of the requirement to report Unusual Incidents. A report shall be made to the department by telephone or fax during the department's normal business hours before the close of the next working day following the occurrence during the operation of family day care home. In addition, a written report shall be submitted to the department within seven days following the occurrence of any events specified above. The applicant was informed to utilize the Unusual Incident Report/Injury Report form LIC624B when submitting the report to the department.

SUPERVISORS NAME: Claretta Yates
LICENSING EVALUATOR NAME: Justin Dorsey
LICENSING EVALUATOR SIGNATURE:	DATE: 07/23/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/23/2021

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, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551

FACILITY NAME: PEREZ FAMILY CHILD CARE	FACILITY NUMBER: 197700426
	VISIT DATE: 07/23/2021

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Safe Sleep new upcoming regulations were discussed with Licensee and referred to the CCL web site for additional information and PINS.

Beginning on January 1, 2018, Assembly Bill 1207 (2015) requires all licensed providers, applicants, directors and employees to complete training as specified on their mandated reporter duties and to renew their training every two years. Applicants must meet requirements as a precondition to licensure. New employees shall have 90 days from date of employment to complete training as required. The training may be conducted at the following website www.mandatedreporterca.com.

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

Child Care Advocates:

To sign up for our Quarterly Updates please email the Child Care Advocates at
chilcareadvocatesprogram@dss.ca.gov & (916) 654-1541

The licensee was informed of the responsibility to report suspected Child Abuse by calling the Child Abuse Hot-line at 1-800-540-4000.

The facility was in compliance per Title 22 regulations, no deficiencies will be cited today. An exit interview was conducted, a copy of this Report and a Notice of Site visit was provided to licensee Diana Perez. Appeal rights were provided and discussed with licensee Perez.

SUPERVISORS NAME: Claretta Yates
LICENSING EVALUATOR NAME: Justin Dorsey
LICENSING EVALUATOR SIGNATURE:	DATE: 07/23/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/23/2021

LIC809 (FAS) - (06/04)

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