198017475-6-30-2023-54-CC-MRIA-CTASVS-20230630141312

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 198017475
Report Date: 06/30/2023
Date Signed: 06/30/2023 02:13:28 PM

Document Has Been Signed on 06/30/2023 02:13 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:	CORNEJO FAMILY CHILD CARE		FACILITY NUMBER:	198017475
ADMINISTRATOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY: 8	TOTAL ENROLLED CHILDREN: 8	CENSUS: 4	DATE:	06/30/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	11:00 AM
MET WITH:	Dilcia Cornejo, Licensee		TIME COMPLETED:	02:25 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	On Friday, June 30, 2023, at 11:00 a.m., Licensing Program Analyst (LPA) Mayra Rivera conducted an unannounced annual and case management capacity increase inspection and met with licensee Dilcia Cornejo who guided LPA Rivera on a tour of the facility. Staff and family members residing in the home has been discussed with licensee and are cleared. Operating hours are Monday to Saturday from 12:00 a.m. to 11:59 p.m. and care for children ages 0 to 13. This facility is divided into two dwellings with the same address. The daycare is part of the first dwelling which consists of 3 bedrooms, 2 bathrooms, kitchen, dining room, living room, front yard, and backyard (fenced). Areas accessible to children include living room, dining room, middle bedroom (first dwelling) the restroom next to the kitchen and the backyard. Per licensee, areas off limits to children and parents include front yard, master bedroom (first dwelling), bedroom inside master bedroom, bathroom located by the living room and the entire second dwelling which consists of two bedrooms. Fire clearance has been granted for 14 children on June 27, 2023. At approximately 11:07 a.m LPA Rivera inspected the facility for safety, comfort, cleanliness, ventilation and working phone (cell phone). For ventilation, LPA Rivera observed a wall AC unit and fan heater located in the living room. LPA observed the furniture, children’s materials, play yard and sleeping mats to be in good condition and age appropriate. For ill/isolation area, children utilize the living room and bedroom. At approximately 11:15 a.m., LPA Rivera entered the restroom and observed the toilet, hand washing sink, hand soap and observed the bottom sink cabinet closed and with a child proof lock. LPA did not observe hazard materials and observed the restroom to be in good condition.

SUPERVISORS NAME: Karen Chambers
LICENSING EVALUATOR NAME: Mayra Rivera
LICENSING EVALUATOR SIGNATURE:	DATE: 06/30/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/30/2023

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: CORNEJO FAMILY CHILD CARE	FACILITY NUMBER: 198017475
	VISIT DATE: 06/30/2023

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At approximately 11:23 a.m. LPA Rivera observed a gate barrier installed between dining room and kitchen to prevent children access to the kitchen. LPA observed the knives stored inside the kitchen drawer with a child proof lock. LPA observed cleaning compounds items stored inside the bottom kitchen sink cabinet with a child proof lock making it inaccessible for children to open cabinet. LPA observe water gallons and per licensee, she stated she refills children’s cups. Licensee provides the meals for the children. LPA informed licensee food brought from the children's homes, the container shall be labeled with the child's name and properly stored or refrigerated.

LPA Rivera asked licensee if there are any pets, poisons, firearms, weapons, or bodies of water. Licensee stated she has one dog, no bodies of water, no firearms, weapons, or poisons. LPA did not observe the dog, firearms, weapons, poisons nor bodies of water. Licensee was advised that if any poisons (ex; drano, rat poison or items that fall into that category), firearms and weapons are purchased, it is required to be locked with a key or combination lock and firearm and ammunition must be stored separately.

At approximately 11:35 a.m., LPA Rivera observed the required 2A10BC fire extinguisher located in the living room with the valve on the green area indicating fully charged and serviced December 2, 2022. LPA observed carbon monoxide detector and smoke detector in the living room. At 11:39 a.m., Licensee tested the carbon monoxide and smoke alarm. LPA heard the sounds and are operable. LPA observed the first aid complete with band aids, gauzes, adhesive bandages, and antiseptic wipes and located in the kitchen. LPA observed the drill log and last drill conducted on June 30, 2023.

At approximately 11:54 a.m., LPA inspected the outdoor area used by children for safety, comfort, and cleanliness. LPA observed the backyard to be fenced all around and the side gates closed and locked. LPA observed the garage door closed and locked with a keypad lock. LPA observed the sliding door to the bedroom (second dwelling) closed and locked from the inside. LPA observed the play equipment to be age appropriate, in safe condition, free of sharp, no loose or pointed parts.

LPA observed licensee Dilcia Cornejo Pediatric First Aid/ CPR certification dated April 29, 2023, and Health and Safety certification dated March 5, 2023, and licensee has proof of immunization against Pertussis, MMR and Influenza declination. Licensee Dilcia has completed the mandated reporter (AB 1207) training dated March 16, 2022. Licensee was advised that the mandated reporter training must be completed every 2 years, and is available at www.mandatedreporterca.com

SUPERVISORS NAME: Karen Chambers
LICENSING EVALUATOR NAME: Mayra Rivera
LICENSING EVALUATOR SIGNATURE:	DATE: 06/30/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/30/2023

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: CORNEJO FAMILY CHILD CARE	FACILITY NUMBER: 198017475
	VISIT DATE: 06/30/2023

NARRATIVE

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LPA observed postings LIC 610A Emergency Disaster Plan, Pub 394 Notification of Parents Rights, and LIC 9148 Earthquake Disaster Plan. During this visit LPA reviewed Child #1, #2, #3 and staff files and children’s. roster. LPA observed the files to be complete and roster up to date.

The following was also discussed with licensee:

1. In the absence of the licensee a qualified adult must be present, supervising the children; a qualified adult is an individual who has a valid and current Pediatric first aid/ CPR-adult-child- infant certification and a valid criminal record clearance associated to the facility license.

2. A current roster of children enrolled must be available and maintained for a period of 3 years, even after children are no longer attending the facility.

4. Annual fees must be paid promptly and by the due date or a late fee shall be assessed and/or the license shall be terminated.

5. The fire extinguisher type 2A-10BC must be serviced annually or as often as necessary and smoke and carbon monoxide detectors should be checked, and batteries replaced as needed.

6. Changes should be reported to the Department as soon as they occur such as construction, remodeling, telephone number changes and/or if you move from your home.

7. Any unusual incidents or injuries must be reported to the Department within 24 hours via telephone and within seven (7) days in writing (refer to LIC 624B). Mandated reporter requirements were reviewed and explained.

8. Fire and safety drills must be performed every six (6) months and documented for review by the Department.

9. Smoking is prohibited in the family childcare home.

SUPERVISORS NAME: Karen Chambers
LICENSING EVALUATOR NAME: Mayra Rivera
LICENSING EVALUATOR SIGNATURE:	DATE: 06/30/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/30/2023

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: CORNEJO FAMILY CHILD CARE	FACILITY NUMBER: 198017475
	VISIT DATE: 06/30/2023

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10. Children and staff records must be maintained and updated as needed and be available for review by the Department

11. Immunization Requirement: H&S 1597.622: 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. The licensee and all adults working with children have proof of immunization's.

12. Inspection Authority: All adults living and working in the home shall be made of aware of the Department’s right to inspection the home, which includes, but is not limited to the right to enter the home when children are being cared for, interview children and adults and review documentation.

13. The facility license number must be on all advertisements, publications, or announcements with the intent to attract clients.

14. Isolation for Ill children: When a child is ill, he/she shall be separated from other children (reference 102417(e) Operation of a Family Child Care Home).

15. Liability Insurance was discussed; LPA advised applicant to review Title 22 Regulation 102417(m)(1) for additional information.

13. Dog(s) and/or pets are recommended to be isolated from children in care.

14. No baby bouncers, no infant walkers, no Johnny jumpers, no saucer chairs, and any other item that falls into this category is not permitted in the facility.

During this visit, LPA provided safe sleep log, LIC 9227 Individual Safe Sleep Plan, and LIC 9221 Parent Consent for Administration Medication.

Homes 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.

SUPERVISORS NAME: Karen Chambers
LICENSING EVALUATOR NAME: Mayra Rivera
LICENSING EVALUATOR SIGNATURE:	DATE: 06/30/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/30/2023

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: CORNEJO FAMILY CHILD CARE	FACILITY NUMBER: 198017475
	VISIT DATE: 06/30/2023

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Family Child Care Homes Licensee Dilcia Cornejo 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.

LPA discussed the safe sleep regulations with licensee Dilcia Cornejo 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 Dilcia Cornejo 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/.

Licensee Dilcia Cornejo 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, licensee Dilcia Cornejo, confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS.

Notice of Site Visit - Centers and Family Child Care Homes A notice of site visit was given and must remain posted for 30 days.

Exit interview conducted and report was reviewed with the licensee Dilcia Cornejo.

SUPERVISORS NAME: Karen Chambers
LICENSING EVALUATOR NAME: Mayra Rivera
LICENSING EVALUATOR SIGNATURE:	DATE: 06/30/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/30/2023

LIC809 (FAS) - (06/04)

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