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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198016966
Report Date: 05/10/2023
Date Signed: 05/10/2023 10:14:05 PM

Document Has Been Signed on 05/10/2023 10:14 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 CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME:RODRIGUEZ FAMILY CHILD CAREFACILITY NUMBER:
198016966
ADMINISTRATOR:RODRIGUEZ, GABRIELAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(562) 508-9266
CITY:LONG BEACHSTATE: CAZIP CODE:
90806
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 0DATE:
05/10/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Gabriela Rodriguez, LicenseeTIME COMPLETED:
12:30 PM
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Licensing Program Analyst (LPA) Dayna Chambers conducted an unannounced annual inspection to the above facility on May 10, 2023. LPA arrived at the facility at 9:30AM and met with Gabriela Rodriguez, Licensee who guided analyst on a tour of the facility. Per Licensee, operation hours are 5:00am to 12:00am Monday through Friday and closed Saturday and Sunday. There are 7 children that are currently enrolled. A current children’s roster was available for review. There were no children present upon arrival.
This is a two-story single family home which consists of upstairs and downstairs. First Floor has 1 bedroom and restroom, dining room/kitchen and Livingroom. The Second floor has 3 bedrooms, 2 bathrooms, and a laundry room. In the back of home in the backyard, there is an additional building that is used for the children’s activity room and a bathroom. The children use a restroom on the first floor and in the outside activity room.
LPA observed that there is a fireplace in the first floor Livingroom and it is screened. Per Licensee, areas off limits to children and parents include: upstairs and on first floor, the bedroom and bathroom. The stairs were observed to be gated for children under the age of 5. The licensee provides food for children in care.
Individuals who reside in the home were noted and discussed. Per Licensee, they currently have one assistant. All adults present in the home have obtained a criminal record clearance or exemption prior to working, residing, or volunteering in the licensed childcare home. Licensee states that there are no firearms stored in the home. There is one puppy on the premises. 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 cellphone and the cellphone stays at the facility during operation hours. There is ventilation and heating central heat and air in the home. Safe toys play equipment and materials were observed. Detergents, cleaning compounds, medications, and other items which could pose a danger to children were observed to be inaccessible to children. The licensee states that there are no poisons in the home and understands that storage areas for poisons must be locked with a key or combination lock. The restroom that children use was observed to be safe and sanitary. The valve on the required 3A 10BC fire extinguisher indicates fully charged and was serviced on 01/11/2023, as indicated on service tag. Dual Smoke and carbon monoxide detector was tested and operable.
SUPERVISORS NAME: Valarie Cook
LICENSING EVALUATOR NAME: Dayna Chambers
LICENSING EVALUATOR SIGNATURE: DATE: 05/10/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/10/2023
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: RODRIGUEZ FAMILY CHILD CARE
FACILITY NUMBER: 198016966
VISIT DATE: 05/10/2023
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Licensee states that she is not currently caring for infants. Licensee states that if an infant is enrolled, the infant will sleep in the living room where they would be constantly supervised. LPA advised the Licensee that infants shall be placed on their backs for sleeping and shall be supervised. Infants shall be checked on every 15 minutes and the time of each 15-minute check shall be documented with child’s name and date. The LIC 9227 Individual Infant Sleeping Plan shall be completed for each infant up to 12 months of age. A copy of the LIC 9227 was provided to Licensee. a copy of the Provider Information Notice (PIN) 20-24 CCP: Recently Approved Safe Sleep Regulations in Effect, LPA provided Infant Safe Sleep FAQs, and example sleep chart, Title 22 regulations for Infant Safe Sleep, Operation of a FCCH, and Immunizations resources. Currently, children are using the back yard for outdoor play time. The outdoor play area was observed to be fenced. LPA observed that the outdoor yard has toys and other materials for children to play with. LPA did/did not observe any objects that can pose a danger to children on the outdoor yard. The licensee and other personnel have completed training on preventive health practices including Pediatric First Aid and CPR. The licensee's Pediatric First Aid and CPR expires on 08/16/2024. There are first aid supplies available. LPA advised that if a child shows signs of illness he/she/they shall be separated from other children. Children’s records were reviewed, including emergency information, and were observed to be complete. LPA observed that the Licensee and assistant do have proof of the Mandated Reporter AB 1207 compliant Child Care Training Certificate on file. LPA issued a Confidential Names List (LIC 811) to the licensee which documents staff and children’s files reviewed during this inspection. All homes shall conduct fire and disaster drills at least once every six months, and document the date and time of each drill. Last drill documented was conducted on 01/12/23 and 01/17/23. LPA did not observe any pools, spas, hot tubs, fish ponds, or similar bodies of water during the inspection. Emergency Disaster Plan, Parent’s Rights Poster and the Facility License were observed to be posted. LPA did not observe the following items during the inspection: Infant Walkers, Johnny Jumpers, Saucer Chairs, Trampolines and/or any other item that fall into these categories are not permitted in a family child care facility. Smoking is prohibited in a licensed Family Child Care Home. Per Licensee, no one smokes in the home. LPA provided the licensee with a copy of A Child Care Provider’s Guide to Safe Sleep, by American Academy of Pediatrics. LPA also consulted and explained Child Abuse Reporting, Never Shake a Baby, and Safe Sleeping practices.
Incidental Medical Services (IMS):
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
SUPERVISORS NAME: Valarie Cook
LICENSING EVALUATOR NAME: Dayna Chambers
LICENSING EVALUATOR SIGNATURE:

DATE: 05/10/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/10/2023
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: RODRIGUEZ FAMILY CHILD CARE
FACILITY NUMBER: 198016966
VISIT DATE: 05/10/2023
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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


Licensee 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 the licensee Gabriela Rodriguez.

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.


At this time, the licensee is in compliance with California Code of Regulations Title 22. No deficiencies cited.
SUPERVISORS NAME: Valarie Cook
LICENSING EVALUATOR NAME: Dayna Chambers
LICENSING EVALUATOR SIGNATURE:

DATE: 05/10/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/10/2023
LIC809 (FAS) - (06/04)
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