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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197700426
Report Date: 09/30/2022
Date Signed: 09/30/2022 11:08:14 AM

Document Has Been Signed on 09/30/2022 11:08 AM - 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 CAREFACILITY NUMBER:
197700426
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 1DATE:
09/30/2022
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
09:45 AM
MET WITH:Diana PerezTIME COMPLETED:
11:22 AM
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On 09/30/2022, Licensing Program Analyst (LPA) Justin Dorsey conducted an Capacity Increase Pre-Licensing inspection with Licensee, Diana Perez to ensure the facility meets basic licensing requirements set forth by Title 22, Health and Safety requirements. The Licensee is requesting to provide care for a Large family childcare home for the capacity of 14 children. Currently, there are 2 adults (including Licensee) and 5 family members in the home. LPA toured the home indoor and out to ensure it meets FCCH requirements. The Licensee is requesting the days and hours of operation will be Monday through Friday 7:30am - 5:30pm.

The home is described as follows:

This is a two story home with 3 bedrooms, 3 bathrooms, kitchen, dining area, living room, den, upstairs loft laundry room and garage. The home has central heating and air conditioning.



Indoor:
Main area: Main care is provided in the living room and den. Children use the bathroom in the hallway between the living and den. Children have access to the backyard.
Bathroom #1: Children will use the bathroom #1 in between the living room and den. The bathroom #1 was toured, and inspected, toilets are in operable condition. Toilet and faucets are clean, safe, and operable; bathtub and shower area free of hazard. There are no medications storage in the medicine cabinet.
Kitchen: The kitchen is made inaccessible to children by a gate. Sharp utensils, cleaning supplies, medicines; drawers and cabinets with plastic bags, and sharp things or small things children can swallow; are inaccessible to children. The refrigerator dishwasher, stove, microwave, etc., are clean. The kitchen was clean, orderly, and free of hazardous items. Medications are stored in locked in high backpack in living room and top kitchen cabinet kitchen cabinet.
SUPERVISORS NAME: Claretta Yates
LICENSING EVALUATOR NAME: Justin Dorsey
LICENSING EVALUATOR SIGNATURE: DATE: 09/30/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/30/2022
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, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: PEREZ FAMILY CHILD CARE
FACILITY NUMBER: 197700426
VISIT DATE: 09/30/2022
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Outside: The backyard was inspected. The backyard is completely fenced children will play outside in the backyard. There is turf, dirt, wood chips and concrete for children to play. LPA observed toys and play equipment in good condition. LPA Dorsey observed the left and right side of the backyard to made off-limits by gates.

Off-limit area:
Upstairs area: LPA observed a gate to keep children from accessing the stairs.
Kitchen: LPA Dorsey observed a gate to keep children from accessing this area.
Laundry room: There is safety latch which makes this area inaccessible to children.
Garage: Made inaccessible by locked door.
· Other:
Napping: Per licensee children nap in the living room and den (infants), LPA reminded licensee that children must be supervised when sleeping. LPA Dorsey gave a copy to and went over PIN 20-24-CCP with the licensee.
Electrical outlets: All unused electrical outlets are made inaccessible to children.
There is a First Aid kit located in the daycares living room.
Weapons or Firearms: Per The Licensee, there are no weapons or firearms. LPA did not observe any weapons or firearms.
Cleaning compounds are stored under the sink, kitchen is made inaccessible gate.
Smoke detector and a carbon monoxide detector tested operable.
Fire extinguisher (2A10BC) There is a fully charged fire extinguisher (2A10BC); which meets fire marshal standards. Last purchased 09/12/22.

Documentation:


The Licensee has current CPR, First Aid Training with the expiration dates of 06/2023, and Prevented Health and Safety Training completed: 01/09/2019. The Licensee has her fingerprint clearance and TB exam. The Licensee has proof of being immunized against pertussis, and measles. The Licensee has proof of Mandated Reporting Training dated 07/13/2021. Per licensee, she will provide transportation. Per Licensee breakfast, AM snack, Lunch, PM snack and Dinner are provided for children.
SUPERVISORS NAME: Claretta Yates
LICENSING EVALUATOR NAME: Justin Dorsey
LICENSING EVALUATOR SIGNATURE:

DATE: 09/30/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/30/2022
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, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: PEREZ FAMILY CHILD CARE
FACILITY NUMBER: 197700426
VISIT DATE: 09/30/2022
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The following was discussed with The Licensee:
Large FCC Ratios, Title 22 Personnel Records 102416.1, IMS FCCH Reference Guide, Safe Sleep PIN 20-24-CCP, LIC 9227, Infant Safe Sleep Log.

The Licensee reminded that 100% supervision is required at all times to children in care. The Licensee was advised how to access forms and Regulations for Family Child Care online at www.ccld.ca.gov. The Licensee was made aware that it is her responsibility to know the regulations as well as anyone who assists in providing care. Licensing must have the facility’s phone number at all times; if the phone number is changed, licensing must be notified



The regulation prohibits the smoking of tobacco in a private residence that is licensed as a family childcare home and in those areas of the family day care home where children are present (24/7 ban). State law prohibits baby walkers, bouncy seats, exersaucers, and any other items that fall into that category.
On January 1, 2018, or before March 30, 2018, a person who is a licensed childcare provider, administrator, or employee of a licensed child day care facility shall complete the online mandated reporter training and shall complete renewal mandated reporter training every two years. @www.mandatereporterca.com

Each report (documenting a Type A citation) shall remain posted for 30 days along with the Notice of Site Visit (printed out during this inspection). Family childcare homes shall post during hours of operation. Failure to meet the posting requirements shall result in an immediate $100.00 civil penalty In addition; all parents of currently enrolled children and any newly enrolled child for the following 12 months shall receive a copy of report and sign the LIC 9224 acknowledging receipt. Civil Penalty assessments will be assessed if all above requirements are not adhered to.

§1597.622 Employees or volunteers at family day care home; immunization requirements; records; exemptions (1) Commencing September 1, 2016, a person shall not be employed or volunteer at a family day care home if he or she has not been immunized against influenza, pertussis, and measles. Each employee and volunteer shall receive an influenza vaccination between August 1 and December 1 of each year


SUPERVISORS NAME: Claretta Yates
LICENSING EVALUATOR NAME: Justin Dorsey
LICENSING EVALUATOR SIGNATURE:

DATE: 09/30/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/30/2022
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, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: PEREZ FAMILY CHILD CARE
FACILITY NUMBER: 197700426
VISIT DATE: 09/30/2022
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Incidental medical Services (IMS) policy was discussed. The Licensee will wait until facility opens to determine IMS needs. 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

Safe Sleep in Child Care: Resources can be found on our website at http://www.cdss.ca.gov/inforesources/Child-Care-Licensing/Public-Information-and-Resources/Safe-Sleep. During the visit LPA Dorsey gave a copy to and went over PIN 20-24-CCP with licensee.

As a result of this inspection, the home does meet Title 22 Regulations. The applicant is ready for licensure pending the manager's approval.


An exit interview was conducted, Appeal Rights and Notice of Site Visit were given and the report was reviewed with Licensee Diana Perez.
SUPERVISORS NAME: Claretta Yates
LICENSING EVALUATOR NAME: Justin Dorsey
LICENSING EVALUATOR SIGNATURE:

DATE: 09/30/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/30/2022
LIC809 (FAS) - (06/04)
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