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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198017182
Report Date: 09/21/2023
Date Signed: 09/21/2023 12:31:45 PM

Document Has Been Signed on 09/21/2023 12:31 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 CC RO, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME:ROA FAMILY CHILD CAREFACILITY NUMBER:
198017182
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 10CENSUS: 2DATE:
09/21/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
08:30 AM
MET WITH:Assistant Dulce GarciaTIME COMPLETED:
12:50 PM
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This inspection was conducted in Spanish

Licensing Program Analyst (LPA) Veronica Martinez Garza conducted an unannounced Required-1 year at the above facility on 09/21/23 at 08:30 a.m. The purpose of the inspection is also for an increase in capacity. The home is currently licensed for 8 children and a request for a capacity of 14 children was received. A COVID risk assessment was conducted upon entry- appropriate PPE was used. LPA met with Dulce Garcia, assistant who guided analyst on a tour of the facility. Per assistant, Licensee is at a doctor’s appointment. There were 02 children present during this inspection. Per Licensee, 7 children are enrolled. Operation hours are Monday – Sunday 23 hours a day. Licensee arrived from her doctor's appointment at 11:04 a.m.

This is a one-story home which consists of 3 bedrooms, 2 bathrooms, living room, kitchen, front yard (fenced), and back yard (fenced). Per Licensee, family members residing in the home are 3 adults and 4 minors. All individuals present in the home have obtained a criminal record clearance or exemption prior to working, residing, or volunteering in a licensed home. Individuals living in the home are identified on the attached LIC811.

Areas accessible to children include living room, 2 bedrooms, bathroom, and front yard (fenced). The bathroom children use was observed to be safe and sanitary.

Per Licensee, areas off limits to children and parents include Licensee's bedroom with bathroom, kitchen, and back yard (fenced). LPA observed a kiddie gate located between the living room and kitchen to make it inaccessible. Licensee has 2 dogs kept in the off-limit backyard (fenced). The Licensee does understand that licensing staff may have access to off-limit areas during inspection visit if necessary.

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SUPERVISORS NAME: Ana Chico
LICENSING EVALUATOR NAME: Veronica Martinez-Garza
LICENSING EVALUATOR SIGNATURE: DATE: 09/21/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/21/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.

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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
MONTEREY PARK CC RO, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME: ROA FAMILY CHILD CARE
FACILITY NUMBER: 198017182
VISIT DATE: 09/21/2023
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**Rooms that are off-limits need to be made inaccessible during operating hours**

All areas identified on the facility sketch that are accessible for children to use were inspected for safety comfort, and cleanliness. LPA toured all areas used by children during this visit. LPA observed and inspected sleeping equipment for infants. LPA observed a 2 cribs available used for napping: 1 in the living room and 1 in bedroom #1. LPA observed that the cribs are free from loose articles and objects. There are no objects hanging above or attached to the side of the cribs. LPA observed that the cribs do not hinder the entrance or exit to and from the space they are sleeping in. Mattresses were observed to be firm and covered with a fitted sheet that is appropriate to the mattress size. LPA observed a baby walker in the living room. LPA did not observe any children in care using the baby walker. Per Licensee, a parent of a child in care brought the baby walker for use. Licensee stated she will return the baby walker to the parent.

Per Licensee, food is provided to all children in care. There is telephone service via a landline and cell phone. There is a wall unit for ventilation and heating.

Detergents, cleaning compounds, medications, and other items which could pose a danger to children were observed to be accessible to children. LPA observed 3 Lysol spray cans in the living room on top of the sofa along with a small Clorox wipes container accessible to children in care. Assistant removed all items and placed them away to make it inaccessible to children. 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. At 09:01 a.m., smoke and carbon monoxide detectors were tested and are operable. The valve on the required 2A 10BC fire extinguisher indicates fully charged and was serviced on 10/31/22, as indicated on service tag. Per State Fire Marshall standards, fire extinguishers shall be serviced annually.

Licensee has a first aid kit readily available. Isolation area for sick children waiting to be picked up is in the kitchen or bedroom #1 of the home with supervision. Per Licensee, there are no firearms or weapons stored in the home.

LPA observed the following required posted documentation in the living room: Facility License, Publication (PUB) 394- Notification of Parent Rights and Licensing Form (LIC) 9148- Earthquake Preparedness form. LPA reviewed facility records for LIC 9040- Facility Roster and LIC 610- Facility Disaster Plan. All homes shall conduct fire and disaster drills at least once every six months and document the date and time of each drill. There was not fire and disaster drill available during this inspection. Per Licensee, she has not conducted a fire and disaster drill for approximately a year. Children's roster was reviewed and is current.

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SUPERVISORS NAME: Ana Chico
LICENSING EVALUATOR NAME: Veronica Martinez-Garza
LICENSING EVALUATOR SIGNATURE:

DATE: 09/21/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/21/2023
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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
MONTEREY PARK CC RO, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME: ROA FAMILY CHILD CARE
FACILITY NUMBER: 198017182
VISIT DATE: 09/21/2023
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Currently children use the front yard for outdoor play with adequate shade and age-appropriate play equipment for children in care. LPA observed 2 little tikes cozy coups, slide, and other play equipment dirty with spider webs. LPA also observed, 1 can of industrial primer and 1 can of protective enamel spray in the playground accessible to children in care. Licensee has an exersaucer in the playground. LPA did not observe any children in care using the exersaucer. LPA took pictures and provided consultation.

LPA did not observe any pools, spas, hot tubs, fishponds, or similar bodies of water during the inspection.

Smoking is prohibited in a licensed Family Child Care Home. Per Licensee, no one smokes in the home.

Children’s records were reviewed for (LIC) 282- Affidavit Regarding Liability Insurance, Immunization's Records, LIC 700- Identification and Emergency Information, LIC 627- Consent for Medical Treatment, LIC 995A Notification of Parents’ Rights, LIC 9227- Infant sleep form (0-12 months, and documentation of 15-minute Infant Sleep Check (0-24 months). Children's records were observed to be complete.

Staff records were reviewed for approved Pediatric First Aid and CPR certification, expires 02/24/25, Proof of immunizations 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. Licensee's mandated reporter training expires 03/15/25. LPA observed assistant is missing proof of MMR vaccine.

AB1207 Mandated Child Abuse Reporting – On or before March 30, 2018, any person who works in a child care facility shall complete the training and renew the training every 2 years. Website provided: https://www.mandatedreporterca.com/training/child-care-providers

The licensee is operating within proper capacity and ratios. LPA observed licensee to be present at the home and providing adequate care and supervision.

Licensee is caring for infants. 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-andresources/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. LPA provided PIN 20-24-CCP SP and PUB 217 Never Shake a Baby Brochure.

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SUPERVISORS NAME: Ana Chico
LICENSING EVALUATOR NAME: Veronica Martinez-Garza
LICENSING EVALUATOR SIGNATURE:

DATE: 09/21/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/21/2023
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
MONTEREY PARK CC RO, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME: ROA FAMILY CHILD CARE
FACILITY NUMBER: 198017182
VISIT DATE: 09/21/2023
NARRATIVE
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No infant walkers, No baby bouncers, No Johnny jumpers, No exersaucers and any other item that falls into that category.

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/.

Licensee 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.

To improve the quality and value of the new inspection process, a survey may 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 CARE tools, please send email inquiries 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.

Licensee 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.

Licensee Rosaura Roa confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS.

Exit interview conducted and report was reviewed with the Licensee Rosaura Roa. The facility has requested an increase of capacity from 8 to 14 on 06/22/23. Fire clearance was granted on 09/11/23; however, fire clearance was only approved for a maximum of 12 children. Capacity Increase will be granted, pending final file review. License will be amended to reflect new capacity of fourteen (14) children; however, Licensee may only care for 12 children. Increase is contingent upon a Licensing Program Manager review and approval.

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SUPERVISORS NAME: Ana Chico
LICENSING EVALUATOR NAME: Veronica Martinez-Garza
LICENSING EVALUATOR SIGNATURE:

DATE: 09/21/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/21/2023
LIC809 (FAS) - (06/04)
Page: 4 of 8
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MONTEREY PARK CC RO, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME: ROA FAMILY CHILD CARE
FACILITY NUMBER: 198017182
VISIT DATE: 09/21/2023
NARRATIVE
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The following deficiencies were cited in accordance with Title 22 of the California Code of Regulations and Health & Safety Codes. Please see 809D for documentation of deficiencies.

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

Exit interview conducted and report was reviewed with the Licensee Rosaura Roa.

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SUPERVISORS NAME: Ana Chico
LICENSING EVALUATOR NAME: Veronica Martinez-Garza
LICENSING EVALUATOR SIGNATURE:

DATE: 09/21/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/21/2023
LIC809 (FAS) - (06/04)
Page: 5 of 8
Document Has Been Signed on 09/21/2023 12:31 PM - It Cannot Be Edited


Created By: Veronica Martinez-Garza On 09/21/2023 at 11:24 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 CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME: ROA FAMILY CHILD CARE
FACILITY NUMBER: 198017182

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/21/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102417(g)
Operation of A Family Child Care Home
(g) The home shall be free from defects or conditions which might endanger a child. Safety precautions shall include but not limited to:

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation the licensee did not comply with the section cited above in LPA observed play equipment was dirty and had spider webs, which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 10/05/2023
Plan of Correction
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Per Licensee, she always cleans all play equipment prior to children use. Licensee will ensure all play equipment is clean and will submit proof to LPA by POC due date.
Type B
Section Cited
CCR
102417(g)(4)
Operation of A Family Child Care Home
(g) The home shall be free from defects or conditions which might endanger a child. Safety precautions shall include but not limited to: (4) Poisons, detergents, cleaning compounds, medicines, firearms and other items which could pose a danger if readily available to children shall be stored where they are inaccessible to children.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, the licensee did not comply with the section cited above in Licensee had 3 Lysol spray cans, 1 small clorox wipe container, 1 can of industrial primer and 1 can of protective enamel spray accessible to children in care. which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 09/22/2023
Plan of Correction
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Assistant immediately removed 3 Lysol spray cans and 1 small clorox wipes container. Per Licensee, she will remove primer and enamel sprays and will make sure it's inaccessible to children in care.
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:Ana Chico
LICENSING EVALUATOR NAME:Veronica Martinez-Garza
LICENSING EVALUATOR SIGNATURE:
DATE: 09/21/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/21/2023


LIC809 (FAS) - (06/04)
Page: 6 of 8
Document Has Been Signed on 09/21/2023 12:31 PM - It Cannot Be Edited


Created By: Veronica Martinez-Garza On 09/21/2023 at 11:24 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 CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME: ROA FAMILY CHILD CARE
FACILITY NUMBER: 198017182

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/21/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102417(g)(9)(A)
Operation of A Family Child Care Home
(g) The home shall be free from defects or conditions which might endanger a child. Safety precautions shall include but not limited to: (9) Each family child care home shall have a written disaster plan of action prepared on a form approved by the Department. All children, age and ability permitting, and the provider, the assistant provider, and other members of the household, shall be instructed in their duties under the disaster plan. As their age and ability permit, newly enrolled children shall be informed promptly of their duties as required in the plan. (A) Each family child care home shall conduct fire drills and disaster drills at least once every six months.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation and record review, the licensee did not comply with the section cited above in Licensee's own admission has not conducted a fire and disaster drill for approximately a year, which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 10/05/2023
Plan of Correction
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Per Licensee, she will conduct a fire and disaster drill and will submit proof to LPA by POC due date.
Type B
Section Cited
CCR
102417(g)(10)
Operation of A Family Child Care Home
(g) The home shall be free from defects or conditions which might endanger a child. Safety precautions shall include but not limited to: (10) A baby walker shall not be allowed on the premises of a family child care home in accordance with Health and Safety Code Sections 1596.846(b) and (c).

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, the licensee did not comply with the section cited above in Licensee has a baby walker in the living room and 1 exersaucer in the playground which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 10/05/2023
Plan of Correction
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Per Licensee, the baby walker was brought by a parent and will return to the parent. Licensee remove the exersaucer from the playground, day care and will submit proof to LPA by POC due date.
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:Ana Chico
LICENSING EVALUATOR NAME:Veronica Martinez-Garza
LICENSING EVALUATOR SIGNATURE:
DATE: 09/21/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/21/2023


LIC809 (FAS) - (06/04)
Page: 7 of 8
Document Has Been Signed on 09/21/2023 12:31 PM - It Cannot Be Edited


Created By: Veronica Martinez-Garza On 09/21/2023 at 11:24 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 CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME: ROA FAMILY CHILD CARE
FACILITY NUMBER: 198017182

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/21/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
HSC
1597.622(a)(1)
General Provisions and Definitions
(1) Commencing September 1, 2016, a person shall not be employed or volunteer at a family day care home if he or she has not been immunized against influenza, pertussis, and measles. Each employee and volunteer shall receive an influenza vaccination between August 1 and December 1 of each year.

This requirement is not met as evidenced by:
Deficient Practice Statement
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4
Based on observation and record review, the licensee did not comply with the section cited above in Licensee's assistant does not have proof of MMR vaccine which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 10/20/2023
Plan of Correction
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Per Licensee, she will submit proof of MMR vaccine to LPA by POC due date.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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4
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:Ana Chico
LICENSING EVALUATOR NAME:Veronica Martinez-Garza
LICENSING EVALUATOR SIGNATURE:
DATE: 09/21/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/21/2023


LIC809 (FAS) - (06/04)
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