197700696-4-28-2023-12-CC-JDOY-CRBVCZ-20230428161959

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 197700696
Report Date: 04/28/2023
Date Signed: 04/28/2023 04:21:08 PM

Document Has Been Signed on 04/28/2023 04:21 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:	BONIFACIO & OROS FAMILY CHILD CARE		FACILITY NUMBER:	197700696
ADMINISTRATOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY: 8	TOTAL ENROLLED CHILDREN: 8	CENSUS: 0	DATE:	04/28/2023
TYPE OF VISIT:	Prelicensing	UNANNOUNCED	TIME BEGAN:	02:52 PM
MET WITH:	Alma Bonifacio & Edgardo Oros		TIME COMPLETED:	04:34 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 announced visit with Applicants Alma Bonifacio and Edgardo Oros who guided analyst on a tour of the facility for a Pre licensing Inspection. This is a one-story home with 3 bedrooms, 2 bathrooms with kitchen, living room, family room, and attached garage. There is no pool/or body of water on the premises. Family members residing in the home include the applicants and three family members. Days/hours of operation will be Monday through Friday from 06:00 AM to 06:00 PM and Saturday 06:00 AM to 03:00 PM

Physical Plant: Home is clean and orderly, the homes fireplace is screened, LPA observed age-appropriate toys and play equipment, working smoke detector and carbon monoxide detector, and 2A10BC Fire Extinguisher. Per licensee no one smokes in the home. There is a designated area for ill child(ren) as necessary, no weapon/firearms, facility sketch complete and current. Children will have access to the living room, family room, and one bathroom. Off limit areas include all 3 of the home’s bedrooms, kitchen and garage. There is a working telephone (cell), poisons and cleaning items inaccessible (locked under sink) to children.

Kitchen/bathroom: The following are inaccessible: Sharp items, mouthwash, shampoo, razor, nail polish. Sharp items, medications and chemicals are inaccessible. Children have access to the bathroom in the home’s hallway near the home’s bedrooms. Toilets and faucets are clean and operable.

Outdoor: LPA Dorsey observed the homes backyard. The backyard includes a concrete, grass and padded area which children can play. LPA observed the home to have a swing (for ages 9-48 months) and a play structures (for ages 2-5 years old), LPA reminded applicants to follow the age requirements for children's play equipment. LPA observed the backyard toys and equipment to be in good condition. LPA did not observe any items that could be hazardous to children in care. According to the applicants children will not be permitted to play on the right or left side of the home, at the moment there is no gates restricting children from these areas. LPA did not observe any hazardous in these areas of the backyard.

SUPERVISORS NAME: Claretta Yates
LICENSING EVALUATOR NAME: Justin Dorsey
LICENSING EVALUATOR SIGNATURE:	DATE: 04/28/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/28/2023

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)

Page: 1 of 3

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: BONIFACIO & OROS FAMILY CHILD CARE	FACILITY NUMBER: 197700696
	VISIT DATE: 04/28/2023

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
26
27
28
29
30
31
32

Advisory/Other: First Aid kit readily available. CPR/First Aid expire on 02/2025 for both applicants. The electrical outlets are covered. LPA Dorsey observed mats and a crib for children/infants to nap. Per licensee the children will nap in the living room. Applicant reminded to always supervise children.

Pets: There are 2 huskies at the home.

LPA Dorsey advised Applicants All adults living/residing in the home are fingerprint cleared and associated.

Documents Provided and Discussed: Safe Sleep PIN 20-24-CCP, LIC 9227, Infant Safe Sleep Log, Small FCCH Capacity Worksheet, and Title 22 102416.1 Personnel Records

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

The following was discussed with the Applicants:

Mandatory licensing forms for the children’s files, facility forms/records, and information to be posted in the family child care home; Requirements to conduct fire and disaster drills once every six months and record it; Role and responsibilities of being a mandated reporter were reviewed; Licensee/Applicant reminded that 100% supervision is required at all times to children in care; Licensee/Applicant made aware that it is her/their 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; Regulation prohibits the smoking of any kind during the operation of the day care.

Applicants 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 LIC624B when submitting the report to the department.

SUPERVISORS NAME: Claretta Yates
LICENSING EVALUATOR NAME: Justin Dorsey
LICENSING EVALUATOR SIGNATURE:	DATE: 04/28/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/28/2023

LIC809 (FAS) - (06/04)

Page: 2 of 3

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: BONIFACIO & OROS FAMILY CHILD CARE	FACILITY NUMBER: 197700696
	VISIT DATE: 04/28/2023

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
26
27
28
29
30
31
32

Applicants advised that the Notice of Site Visit must be posted at the entrance of the facility for a period of 30 days whenever a licensing inspection is conducted. If a Type A deficiency is cited, a copy of the licensing report must also be posted for 30 days. The same report must be provided to parents/guardians of children newly enrolled at the facility during the next 12 months & licensee must obtain a signed Acknowledgement of Licensing Reports (LIC 9224) from parent/guardian & place it in each child's file. Copies of the reports must be provided to each parent when a Type A violation is cited along with Acknowledgment of Receipt of Licensing Reports LIC 9224. If these requirements are not met civil penalties per violation will be assessed.

Prior to making alterations or additions to a family childcare home or grounds, the licensee shall notify the Department of the proposed changed, including, but not limited to, the following: Conversion of a garage (either attached or detached) into a "childcare" room; Room additions to the family child care home. Any change from an area of the family childcare home previously identified as "off limits" to an area where care and supervision will be provided to children in care. The licensee shall provide the Department with a copy of an inspection report when an inspection is required by the local building inspector as a result of the alteration, addition or construction.

Corrections needed:

1.) A cover will be placed on the homes air conditioning unit. Per applicants a picture will be sent to LPA Dorsey once the AC unit is covered.

Exit interview conducted and a copy of this report was given to Applicants Alma Bonifacio and Edgardo Oros.

SUPERVISORS NAME: Claretta Yates
LICENSING EVALUATOR NAME: Justin Dorsey
LICENSING EVALUATOR SIGNATURE:	DATE: 04/28/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/28/2023

LIC809 (FAS) - (06/04)

Page: 3 of 3