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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198009629
Report Date: 03/06/2025
Date Signed: 03/06/2025 02:29:20 PM

Document Has Been Signed on 03/06/2025 02:29 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
MONTEREY PARK SW RO, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME:RIVAS FAMILY CHILD CAREFACILITY NUMBER:
198009629
ADMINISTRATOR/
DIRECTOR:		RIVAS, GUADALUPEFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(562) 215-4709
CITY:HAWAIIAN GARDENSSTATE: CAZIP CODE:
90716
CAPACITY: 14TOTAL ENROLLED CHILDREN: 17CENSUS: 7DATE:
03/06/2025
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:00 AM
MET WITH:Assistant - Giselle RivasTIME VISIT/
INSPECTION COMPLETED:
03:00 PM
NARRATIVE
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Licensing Program Analyst (LPA) R. Derraco conducted an unannounced annual inspection to the above facility on 03/06/25. LPA arrived at the facility at 9:30 and met with Assistant S1, who guided analyst on a tour of the facility. Also present during this inspection were S2, S3, and S4. Per assistant, there are 17 children that are currently enrolled. There were 7 children present upon arrival, 2 of which are infants.

Individuals who reside in the home have been noted and discussed. LPA advised assistant S1 that S2 and S3 are not on the association list and that a citation under Health and Safety Code section 1596.871(c)(1)(A) will be issued.

This is a two-story home which consists of 5 bedrooms, 4 bathrooms, kitchen/dining room, living room, garage, front yard and backyard (fenced). The off limit areas include all 5 bedrooms, 3 bathrooms, garage, and backyard.

The main care are is located in living room. LPA observed age appropriate toys, childrens reading material, wooden storage locker, dramatic play sets, child sized table and chairs, 2 pack n' play playpens, and 3 wooden highchair feeding tables. The play pens were obseved to have blankets and toys inside while an infant was using it. LPA advised S1 that a citation under California Code of Regulation (CCR) section 102425(b) will be issued. A fireplace was observed to have a cover and a lock. An unsecured wooden board measuring 1 foot 3 and 1/2 inches high was observed at the entrance of the stairs. LPA advised S1 that a citation under CCR section 102417(g)(3) will be issued. A tension gate was observed at the entrance of the kitchen and the main care area. LPA did not observe any sharp or pointy objects to be accessible to children in care. The dining room was observed with a dining table and chairs, 3 additional pack n play play pens and a wooden infant changing station. The bathroom designated for children in care was observed to have an operable sink, faucet and toilet. The outdoor play area is located in the front yard and was observed with (page 1 of 4)
SUPERVISORS NAME: Denise Gibbs
LICENSING EVALUATOR NAME: Randy Derraco
LICENSING EVALUATOR SIGNATURE: DATE: 03/06/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/06/2025
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 10
Document Has Been Signed on 03/06/2025 02:29 PM - It Cannot Be Edited


Created By: Randy Derraco On 03/06/2025 at 11:51 AM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME: RIVAS FAMILY CHILD CARE
FACILITY NUMBER: 198009629

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/06/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
HSC
1596.871(c)(1)(A)
Administration of Child Day Care Licensing
Subsequent to initial licensure, a person specified in subdivision (b) who is not exempt from fingerprinting shall obtain either a criminal record clearance or an exemption from disqualification, pursuant to subdivision(f) of this section or Section 1522.7, from the State Department of Social Services prior to employment, residence, or initial presence in the facility.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, interview and record review, the licensee did not associate indivuduals that are caring for children, to the facility, which poses an immediate Health, safety and/or personal rights risk to persons in care.
POC Due Date: 03/07/2025
Plan of Correction
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POC Visit
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Denise Gibbs
LICENSING EVALUATOR NAME:Randy Derraco
LICENSING EVALUATOR SIGNATURE:
DATE: 03/06/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/06/2025


LIC809 (FAS) - (06/04)
Page: 2 of 10
Document Has Been Signed on 03/06/2025 02:29 PM - It Cannot Be Edited


Created By: Randy Derraco On 03/06/2025 at 11:51 AM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME: RIVAS FAMILY CHILD CARE
FACILITY NUMBER: 198009629

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/06/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102417(a)
Operation of A Family Child Care Home
(a) The licensee shall be present in the home and shall ensure that children in care are supervised at all times. When circumstances require the licensee to be temporarily absent from the home, the licensee shall arrange for a substitute adult to care for and supervise the children during his/her absence. Temporary absences shall not exceed 20 percent of the hours that the facility is providing care per day.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, interview and record review, the licensee exceeded 20 percent of the hours that thefacility is providing care per day by being temporarily absent, which poses a potential Health, safety and/or personal rights risk to persons in care.
POC Due Date: 03/17/2025
Plan of Correction
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POC visit
Type B
Section Cited
HSC
1596.8662(b)(1)
Administration of Child Day Care Licensing
(1) On or before March 30, 2018, a person who, on January 1, 2018, is a licensed child day care provider, administrator, or employee of a licensed child day care facility shall complete the mandated reporter training provided pursuant to paragraphs (2) and (3) of subdivision (a), and shall complete renewal mandated reporter training every two years following the date on which he or she completed the initial mandated reporter training.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, interview and record review, the staff members did not complete renewal of mandated reporter training eery two years. which poses a potential Health, safety and/or personal rights risk to persons in care.
POC Due Date: 03/17/2025
Plan of Correction
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POC Visit
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Denise Gibbs
LICENSING EVALUATOR NAME:Randy Derraco
LICENSING EVALUATOR SIGNATURE:
DATE: 03/06/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/06/2025


LIC809 (FAS) - (06/04)
Page: 4 of 10
Document Has Been Signed on 03/06/2025 02:29 PM - It Cannot Be Edited


Created By: Randy Derraco On 03/06/2025 at 11:51 AM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME: RIVAS FAMILY CHILD CARE
FACILITY NUMBER: 198009629

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/06/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
HSC
1596.8662(c)
Administration of Child Day Care Licensing
(c) Current proof of completion for each licensed child day care provider or applicant for that license, administrator, and employee of a licensed child day care facility shall be submitted to the department upon inspection of the child day care or upon request by the department.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, interview and record review, the licensee did not provide proof of completion which poses a potential Health, safety and/or personal rights risk to persons in care.
POC Due Date: 03/17/2025
Plan of Correction
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POC Visit
Type B
Section Cited
HSC
1597.622(c)
Administration of Child Day Care Licensing
(c) The family day care home shall maintain documentation of the required immunizations or exemptions from immunization, as set forth in this section, in the person's personnel record that is maintained by the family day care home.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, interview and record review, the licensee did not maintain immunzation records for staff members which poses a potential Health, safety and/or personal rights risk to persons in care.
POC Due Date: 03/17/2025
Plan of Correction
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POC visit
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Denise Gibbs
LICENSING EVALUATOR NAME:Randy Derraco
LICENSING EVALUATOR SIGNATURE:
DATE: 03/06/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/06/2025


LIC809 (FAS) - (06/04)
Page: 5 of 10
Document Has Been Signed on 03/06/2025 02:29 PM - It Cannot Be Edited


Created By: Randy Derraco On 03/06/2025 at 11:51 AM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME: RIVAS FAMILY CHILD CARE
FACILITY NUMBER: 198009629

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/06/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102416(c)
Personnel Requirements
(c) The licensee and other personnel as specified shall complete training on preventive health practices, including pediatric cardiopulmonary resuscitation and pediatric first aid, pursuant to Health and Safety Code Section 1596.866.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, interview and record review, the S1 and S3 did not complete Pediatric first aide and CPR training which poses a potential Health, safety and/or personal rights risk to persons in care.
POC Due Date: 03/17/2025
Plan of Correction
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POC Visit
Type B
Section Cited
CCR
102416.1(a)
Personnel Records
(a) Personnel records shall be maintained on each employee and shall contain the following information:

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, interview and record review, the licensee did not maintain on personnel records on each employee which poses and potential Health, safety and/or personal rights risk to persons in care.
POC Due Date: 03/17/2025
Plan of Correction
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POC Visit
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Denise Gibbs
LICENSING EVALUATOR NAME:Randy Derraco
LICENSING EVALUATOR SIGNATURE:
DATE: 03/06/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/06/2025


LIC809 (FAS) - (06/04)
Page: 6 of 10
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MONTEREY PARK SW RO, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME: RIVAS FAMILY CHILD CARE
FACILITY NUMBER: 198009629
VISIT DATE: 03/06/2025
NARRATIVE
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perimeter fencing, outdoor play equipment and a children's climbing structure. LPA observed S1 preparing and providing food for children in care. LPA advised S1 that children who bring food from home must have containers individually labeled and properly stored or refrigerated. LPA did not observe the following items during the inspection: Infant Walkers, Johnny Jumpers, Saucer Chairs. Emergency Disaster Plan, Parent’s Rights Poster and the Facility License were observed to be posted in the main care area.

All areas identified on the facility sketch that are accessible for children to use were inspected for safety,
comfort, and cleanliness. There is telephone service via a landline. Per S1, the home is equipped with central heating and air conditioning. S1 understands that storage areas for poisons must be locked, not just made inaccessible. The valve on the required 3A 40BC fire extinguisher indicates fully charged and was purchased in 09/2024, as indicated on receipt. Smoke and carbon monoxide detectors were tested and are operable. No bodies of water were observed in the back yard play area. LPA observed 2 pet dogs in the off limits backyard and in the off limits bedroom. S1 states that there are no firearms stored in the home. Smoking is prohibited in a licensed Family Child Care Home. Per S1, no one smokes in the home.

S1 and S3 have not completed training on preventive health practices including Pediatric First Aid and CPR. LPA advised licensee that a citation under CCR section 102416(c) will be issued. S1, S2 and S3 do not have proof of the Mandated Reporter AB 1207 compliant Child Care Training Certificate on file. LPA advised S1 that a citation under HSC section 1596.8662(b)(1) will be issued. File review was not observed to have proper mandated immunization records. LPA advised S1 that a citation under HSC section 1597.622(c) will be issued. LPA observed that S2 does not have a personnel record kept on file. LPA advised that a citation under CCR section 102416.1(a) will be issued. Children’s records were reviewed, including emergency information and were observed to be complete. A current children’s roster was available for review. During the inspection, S1 states that licensee is not home and will not return under 03/10/25. LPA advised S1 that a citation under CCR section 102417(a) will be issued.

S1 was reminded that all adults 18 and over living or working in the home, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a licensed Family Child Care Home. A civil penalty of $100.00 minimum/day for a maximum of 5 days or, if the penalty is for a repeat violation, for a maximum of 30 days per person will be assessed if this regulation is violated.
(page 2 of 4)
SUPERVISORS NAME: Denise Gibbs
LICENSING EVALUATOR NAME: Randy Derraco
LICENSING EVALUATOR SIGNATURE:

DATE: 03/06/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/06/2025
LIC809 (FAS) - (06/04)
Page: 8 of 10
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MONTEREY PARK SW RO, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME: RIVAS FAMILY CHILD CARE
FACILITY NUMBER: 198009629
VISIT DATE: 03/06/2025
NARRATIVE
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LPA discussed the safe sleep regulations with S1 and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPA also informed licensee S1 of the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at https://www.cpsc.gov/ and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment.

Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02-CCP. 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: https://www.ada.gov/resources/child-care-centers/.

S1 was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain child care by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.

During the exit interview, the S1 confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS.

LPA advised the S1 to access forms, regulations and quarterly updates online at: www.cdss.ca.gov.

The following deficiencies listed on the attached LIC 809 (deficiency page) are being cited in accordance with California Code of Regulations Title 22. Deficiencies that are being cited need to be cleared to protect the children’s health & safety.

LPA R. Derraco informed S1 that this report dated 03/06/25 document(s) one Type A citation(s) which shall be posted for 30 consecutive days as there is/are immediate risk(s) to the health, safety, or personal rights of children in care.
(page 3 of 4)
SUPERVISORS NAME: Denise Gibbs
LICENSING EVALUATOR NAME: Randy Derraco
LICENSING EVALUATOR SIGNATURE:

DATE: 03/06/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/06/2025
LIC809 (FAS) - (06/04)
Page: 9 of 10
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MONTEREY PARK SW RO, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME: RIVAS FAMILY CHILD CARE
FACILITY NUMBER: 198009629
VISIT DATE: 03/06/2025
NARRATIVE
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Also, LPA R. Derraco informed the S1 to provide a copy of this licensing report dated 03/06/25 that documents any Type A citation(s) to parents/guardians of all children currently enrolled by the next business day or the next day the children are in care, and to any newly enrolled parents/guardians for 12 months from the date of this report. A signed Acknowledgement of Receipt of Licensing Report (LIC 9224), or other written statement, must be placed in the child's file for verification.

Notice of site visit was given and must posted for the next 30 days.

Exit interview conducted and report was reviewed with assistant, S1.

(page 4 of 4)
SUPERVISORS NAME: Denise Gibbs
LICENSING EVALUATOR NAME: Randy Derraco
LICENSING EVALUATOR SIGNATURE:

DATE: 03/06/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/06/2025
LIC809 (FAS) - (06/04)
Page: 10 of 10