198012547-6-9-2022-33-CC-BBEL-CF93J6-20220609181700

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 198012547
Report Date: 06/09/2022
Date Signed: 06/09/2022 06:17:13 PM

Document Has Been Signed on 06/09/2022 06:17 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, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME:	QUEZADA FAMILY CHILD CARE		FACILITY NUMBER:	198012547
ADMINISTRATOR:	QUEZADA, JACQUELINE		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(909) 472-8036
CITY:	POMONA	STATE: CA	ZIP CODE:	91768
CAPACITY: 14	TOTAL ENROLLED CHILDREN: 16	CENSUS: 8	DATE:	06/09/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	01:35 PM
MET WITH:	Licensee Jackie Quezada		TIME COMPLETED:	06:15 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	An unannounced, in-person Required-5 year inspection was conducted on this date by Licensing Program Analyst (LPA) Emiko Bell. At 01:35 pm, LPA was greeted by licensee on the porch, to whom the reason for the inspection was announced. As a precautionary measure against COVID, the COVID screening questions were posed to licensee and LPA wore a face covering the duration of the inspection. At 02:15 pm, licensee began guiding LPA on a tour of the residence. The tour was completed at 02:40 pm. Census: There were two staff and eight children present. Staff-child ratio was met. Licensee's days and hours of operations are: Mon.-Fri. 06:00 am-10:00 pm; Sat. and Sun. 06:00 am-04:30 pm. This is a single-story, single family residence with four bedrooms and three bathrooms. All areas identified on the facility sketches were inspected in the following order: (indoors): the living room, the kitchen, and the bathroom and then (outdoors): the front yard. The following areas have been designated as off-limit and were not inspected by LPA today: the laundry room, the basement, all four bedrooms, bathrooms #2 & #3 and the garage

SUPERVISORS NAME: Claudia Guangorena
LICENSING EVALUATOR NAME: Betty Bell
LICENSING EVALUATOR SIGNATURE:	DATE: 06/09/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/09/2022

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 CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME: QUEZADA FAMILY CHILD CARE	FACILITY NUMBER: 198012547
	VISIT DATE: 06/09/2022

NARRATIVE

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Physical Plant: The residence was inspected for safety, comfort, cleanliness, telephone service (each licensee has a cell phone); heating and ventilation (there is central heating
and air-conditioning); inaccessibility to poisons, detergents, cleaning compounds (kept in the laundry room; medicine (kept in the laundry room), and other hazardous items that can pose a danger to children.

Toys and napping equipment: There are age-appropriate toys and napping equipment on the premises. There is one play yard, a loveseat, a sofa and mats on which the children nap.

Parent Board: Licensee's Parent Board is located on the patio wall to the left of the entryway. All required postings were observed.

Pets: Licensee does not have any pets.

Fire safety: Licensee has a fire extinguisher, size 3-A:40-B:C, which is kept on a kitchen counter it was last serviced 02/03/22. Licensee keeps an emergency drill log; the last fire drill was run 65/08/22 at 12:00. There are eight smoke detectors: one in each bedroom one in the hallway, one in the kitchen, one in the living room, and one in the back room called the office; only the one in the kitchen, the living room and the hallway were tested today and all are operable. (The smoke detector in the kitchen is a combination smoke/carbon monoxide detector.)

Transportation: Though licensee transports the daycare children, their vehicle was not inspected during today's visit.

SUPERVISORS NAME: Claudia Guangorena
LICENSING EVALUATOR NAME: Betty Bell
LICENSING EVALUATOR SIGNATURE:	DATE: 06/09/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/09/2022

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, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME: QUEZADA FAMILY CHILD CARE	FACILITY NUMBER: 198012547
	VISIT DATE: 06/09/2022

NARRATIVE

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Firearms: Per licensee, there are currently no firearms or weapons on the premises.

Incidental Medical Services: 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

From 04:55-06:00 pm, LPA Bell began reviewing the licensee's and children's files.

Paperwork: Licensee has a Child Care Facility Roster; it is current and complete. Licensee Jaqueline's Pediatric First Aid/CPR expires 01/24 and licensee Andres's First aid/CPR expires 02/24. Neither co-licensee has completed Mandated Reporter Training. Licensee has verification of MMR and TDAP immunizations and TB clearance.

Children’s records were reviewed for: LIC 282- Affidavit Regarding Liability Insurance, LIC 700- Identification and Emergency Information, LIC 627- Consent for Medical Treatment, LIC 995A Notification of Parents’ Rights, and immunizations.

Staff records were reviewed for approved Pediatric First Aid and CPR certification, LIC-501: Personnel Record, LIC 508- Criminal Record Statement, LIC 9052- Employee Rights, Proof of immunization's against measles, pertussis and influenza or influenza declination, TB clearance or risk assessment, LIC 9108- Statement Acknowledging Requirement to Report Child Abuse and current Mandated Reporter Training Certificate.

SUPERVISORS NAME: Claudia Guangorena
LICENSING EVALUATOR NAME: Betty Bell
LICENSING EVALUATOR SIGNATURE:	DATE: 06/09/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/09/2022

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, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME: QUEZADA FAMILY CHILD CARE	FACILITY NUMBER: 198012547
	VISIT DATE: 06/09/2022

NARRATIVE

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Based on the LPA's observations and records review, citations are being issued on today's date, 06/09/22.

To improve the quality and value of the new inspection process, a survey will be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or tools, please send them by email to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/inspection-process.

License was reminded that all adults 18 and over living or working in the home, including employees and volunteers, 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 up to $500.00 maximum per day/per person will be assessed if this regulation is violated.

LPA discussed the safe sleep regulations with licensee 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 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.

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

Exit interview conducted and report was reviewed with Licensee Jacqueline Quezada.

SUPERVISORS NAME: Claudia Guangorena
LICENSING EVALUATOR NAME: Betty Bell
LICENSING EVALUATOR SIGNATURE:	DATE: 06/09/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/09/2022

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 06/09/2022 06:17 PM - It Cannot Be Edited

Created By: Betty Bell On 06/09/2022 at 05:57 PM

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 CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME: QUEZADA FAMILY CHILD CARE	FACILITY NUMBER: 198012547
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 06/09/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

102425(j)(1)

Infant Safe Sleep

The provider shall supervise infants while they are sleeping and adhere to the following requirements: The provider shall physically check on the infant every 15 minutes. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on record review) the licensee did not comply with the section cited above in 1 out of 1 records which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 06/20/2022
	Plan of Correction
1 2 3 4	Licensee stated that she will document the 15 minute check beginning 06/10/22.

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
1 2 3 4	Based on record review, the licensee did not comply with the section cited above in 2 out of 2 records which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 06/20/2022
	Plan of Correction
1 2 3 4	Licensee stated that she and co-licensee will complete the Mandated Reporter Training and provide verification to the Department by the COB on the POC due date of 06/20/22.

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:

Claudia Guangorena

LICENSING EVALUATOR NAME:

Betty Bell

LICENSING EVALUATOR SIGNATURE:

DATE: 06/09/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/09/2022

LIC809 (FAS) - (06/04)

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