198017744-7-24-2023-54-CC-ECHZ-CU2ULM-20230724154058

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 198017744
Report Date: 07/24/2023
Date Signed: 07/24/2023 03:41:13 PM

Document Has Been Signed on 07/24/2023 03:41 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:	MONTOYA FAMILY CHILD CARE		FACILITY NUMBER:	198017744
ADMINISTRATOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY: 8	TOTAL ENROLLED CHILDREN: 8	CENSUS: 6	DATE:	07/24/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	12:05 PM
MET WITH:	Ernestina Montoya		TIME COMPLETED:	04:00 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	Licensing Program Analyst (LPA) Elka Chavez conducted an unannounced 1-year required inspection to the above facility in Spanish on 07/24/2023. LPA arrived at the facility at 12:05 PM and met with Licensee, Ernestina Montoya who guided analyst on a tour of the facility. Entrance Checklist for Family Child Care Homes was provided to the licensee upon entry. There were 6 children present upon arrival. Hours of operation are at all hours of the day from Monday through Saturday. The Licensee understands that care for a child should not exceed 24 hours. This is a single-story home which consists of 3 bedrooms, 2 bathrooms, kitchen, dining room, living room, garage and backyard (fenced). Child care is mainly conducted out of the enclosed patio in the back yard. Areas accessible to children are: 2 bedrooms, bathroom next to the bedroom hallway, living room, dining room, enclosed patio and backyard (fenced). Areas off limits to children and parents are: Master bedroom, licensee’s bathroom and garage. All off-limit areas need to be made inaccessible to children in care. The licensee understands that licensing staff may have access to off-limit areas during inspection visits if necessary. Food is provided by Licensee. Individuals residing in the home have been discussed and noted. All adults present in the home have obtained a criminal record clearance or exemption. All areas identified on the facility sketch that are accessible for children to use were inspected for safety, comfort, and cleanliness. The following was observed and reviewed during this inspection: LPA reviewed required posted documentation for Facility License, Publication (PUB) 394- Notification of Parent Rights and LIC 999A Facility Sketch or equivalent sketch. Facility records were reviewed for LIC 9040- Facility Roster, LIC 610- Facility Disaster Plan and Disaster drill log, last drill conducted during today’s

SUPERVISORS NAME: Karen Chambers
LICENSING EVALUATOR NAME: Elka Chavez
LICENSING EVALUATOR SIGNATURE:	DATE: 07/24/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/24/2023

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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Document Has Been Signed on 07/24/2023 03:41 PM - It Cannot Be Edited

Created By: Elka Chavez On 07/24/2023 at 02:40 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 CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME: MONTOYA FAMILY CHILD CARE	FACILITY NUMBER: 198017744
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 07/24/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)

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 staff #1 and staff #2 did not have current Mandate Reporter Training the censee did not comply with the section cited above which poses a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 08/07/2023
	Plan of Correction
1 2 3 4	Licensee stated that she will start checking documents every few weeks. LPA provided LIC 311D in Spanish.

Type B

Section Cited

CCR

102425(j)(2)(D)

Infant Safe Sleep

Documentation shall be maintained in the infant’s file and be available to the Department for review. Documentation shall include the following: This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on record review child #2 & #3 were missing sleep log the licensee did not comply with the section cited above which poses a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 07/28/2023
	Plan of Correction
1 2 3 4	Licensee placed the sleep logs in a board to use as a reminder to log checks.

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:

Karen Chambers

LICENSING EVALUATOR NAME:

Elka Chavez

LICENSING EVALUATOR SIGNATURE:

DATE: 07/24/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/24/2023

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: MONTOYA FAMILY CHILD CARE	FACILITY NUMBER: 198017744
	VISIT DATE: 07/24/2023

NARRATIVE

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inspection.

At 1: 15 PM smoke and carbon monoxide detectors were tested and are operable in the living room and enclosed patio. Fire extinguisher indicated fully charged and was serviced July 2023. The home maintains telephone service via landline and cell phone. The home is observed to be clean and orderly. There are toys and other age-appropriate material available for children. LPA observed that detergents and cleaning compounds are kept in the laundry room inside the garage. Licensee understands that all poisons must be locked. Isolation area for sick children waiting to be picked up is in the living room, away from the other children. Per Licensee there are no firearms or weapons stored in the home.

Licensee cares for two infants. LPA observed play yards visible in the enclosed patio. Napping equipment does not block entrances or exits. LPA did not observe loose object, bumpers, objects hanging, or objects attached to the play yards. There are currently no infants with pacifiers. Per Licensee, overnight care if available upon request, but does not have any children enrolled for overnight care. LPA discussed the following: Licensee is aware that they must remain wake while children are awake. If children sleep in separate area from licensee, the door must remain open. If licensee cannot hear children when they wake up, video or audio device can be used.

Currently, children are using the back yard for outdoor play. 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 not observe any objects that could be hazardous to children in care. There are no pools or spas, or other bodies of water. The licensee states that supervision is always provided.

Children’s records were reviewed for (LIC) 282- Affidavit Regarding Liability Insurance, Immunization 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). LPA did not observe LIC 700 form for child #3. Licensee will have parent complete form during pick up.

Staff records were reviewed for approved Pediatric First Aid and CPR certification, LIC 508- Criminal Record Statement, LIC 9052- Employee Rights, Proof of immunization against measles, pertussis and influenza or

SUPERVISORS NAME: Karen Chambers
LICENSING EVALUATOR NAME: Elka Chavez
LICENSING EVALUATOR SIGNATURE:	DATE: 07/24/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/24/2023

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: MONTOYA FAMILY CHILD CARE	FACILITY NUMBER: 198017744
	VISIT DATE: 07/24/2023

NARRATIVE

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influenza declination, TB clearance or risk assessment, LIC 9108- Statement Acknowledging Requirement to Report Child Abuse and Mandated Reporter Training Certificate. LPA did not observe Mandated Reporter Training Certificate for staff #1 and staff #2.

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 Ernestina Montoya 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 Ernestina Montoya 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 Ernestina Montoya 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.

This facility provides Incidental Medical Services – IMS. LPA reviewed storage of medication and equipment/supplies, and reviewed children’s, personnel, and administrative records. For IMS information see PIN 22-02-CCP. The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice) or (800) 514- 0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA are available at: https://www.ada.gov/resources/child-carecenters/

SUPERVISORS NAME: Karen Chambers
LICENSING EVALUATOR NAME: Elka Chavez
LICENSING EVALUATOR SIGNATURE:	DATE: 07/24/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/24/2023

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: MONTOYA FAMILY CHILD CARE	FACILITY NUMBER: 198017744
	VISIT DATE: 07/24/2023

NARRATIVE

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Licensee Ernestina Montoya 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.

Based on the LPA’s observations and records review, 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 and safety.

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

Exit interview conducted and report was reviewed with the licensee Ernestina Montoya.

SUPERVISORS NAME: Karen Chambers
LICENSING EVALUATOR NAME: Elka Chavez
LICENSING EVALUATOR SIGNATURE:	DATE: 07/24/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/24/2023

LIC809 (FAS) - (06/04)

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