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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198003334
Report Date: 07/22/2022
Date Signed: 07/22/2022 10:32:29 AM


Document Has Been Signed on 07/22/2022 10:32 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, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754



FACILITY NAME:CACERES FAMILY CHILD CAREFACILITY NUMBER:
198003334
ADMINISTRATOR:CACERES, ESTHERFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(562) 413-8658
CITY:DOWNEYSTATE: CAZIP CODE:
90240
CAPACITY:14CENSUS: 7DATE:
07/22/2022
TYPE OF VISIT:POCANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Licensee, Esther CaceresTIME COMPLETED:
10:40 AM
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On July 22, 2022 at 9:00 am, Licensing Program Analyst (LPA) Monique Ayala conducted an announced inspection at the facility noted above and met with Licensee, Esther Caceres. The purpose of the inspection was to follow-up on the Plan of Corrections (POCs) that were issued on July 6, 2022. At the time of the inspection, the Licensee and 7 children were present.

During today's inspection, LPA observed the following POCs:
  1. The facility now has two carbon monoxide detectors that were tested and are operable.
  2. Licensee removed the trampoline from the backyard.
  3. The facility now has posted The Emergency Disaster Plan (LIC 610A).
  4. Licensee completed the required Mandated Reporter Training on July 21, 2022.
  5. Licensee now has proof of immunization against pertussis. Licensee has on record documentation of declination for influenza. Licensee has an appointment scheduled for a TB clearance and pertussis. Licensee will submit documentation for TB clearance and pertussis to LPA via e-mail by Friday, July 29th.
  6. Licensee completed the required Pediatric First Aid/CPR on February 20, 2022. Licensee did not obtain a certificate for the Preventative Health and Safety training from American Red Cross. Licensee will submit proof of completion for the Preventative Health and Safety Training to LPA via e-mail by Friday, July 29th.
  7. Licensee now has the required immunization records for all children enrolled in care that are placed in the children's files.
  8. Licensee now has the Consent for Emergency Medical Treatment (LIC 627) for all children enrolled in care that is placed in the children's files.
  9. Licensee now has the Notification of Parents' Rights (LIC 995A) for all children enrolled in care that is placed in the children's files.
SUPERVISOR'S NAME: Valarie CookTELEPHONE: (323) 513-3858
LICENSING EVALUATOR NAME: Monique AyalaTELEPHONE: (323) 246-2016
LICENSING EVALUATOR SIGNATURE:
DATE: 07/22/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/22/2022
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: CACERES FAMILY CHILD CARE
FACILITY NUMBER: 198003334
VISIT DATE: 07/22/2022
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10. Licensee now has the Affidavit Regarding Liability Insurance (LIC 282) for all children enrolled in care
that is placed in the children's files.
11. Licensee installed child safety gates making all off-limit areas inaccessible to children in care.

During the inspection, LPA also observed the following:
  1. A current Fire Drill and Disaster Drill log, recording the latest drill was conducted on July 20,2022.
  2. Licensee now has the Criminal Record Statement (LIC 508), Employee Rights (LIC 9052), and Statement Acknowledging Requirement to Report Child Abuse (LIC 9108) on record.
  3. The required fire extinguisher (2A-10BC) that is fully charged and was last serviced on July 12, 2022.
  4. Licensee now has an updated Facility Sketch (LIC 999A) indicating the "off-limit" areas to children in care. Licensee will submit the LIC 999A to LPA via e-mail by Friday, July 29th.

LPA requested that the following documents be submitted to the Monterey Park Child Care Regional Office located at 1000 Corporate Center Dr., Suite 200B, Monterey Park, CA 91754 by Friday, July 29th: an updated Application for a Family Child Care Home License (LIC 279), updated Current Children in Your Home (LIC 279B), and Proof of Control of Property (mortgage bill, tax bill, deed).

During today's inspection, LPA issued Cleared POC Letters to Licensee for deficiencies that were cited on July 6, 2022. No deficiencies were cited during today's inspection.

A notice of site visit was given and must remain posted for 30 days.

Exit interview conducted and report was reviewed with Licensee, Esther Caceres.
SUPERVISOR'S NAME: Valarie CookTELEPHONE: (323) 513-3858
LICENSING EVALUATOR NAME: Monique AyalaTELEPHONE: (323) 246-2016
LICENSING EVALUATOR SIGNATURE:

DATE: 07/22/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/22/2022
LIC809 (FAS) - (06/04)
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