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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198017744
Report Date: 09/05/2024
Date Signed: 09/05/2024 12:56:07 PM

Document Has Been Signed on 09/05/2024 12:56 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 SW RO, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME:MONTOYA FAMILY CHILD CAREFACILITY NUMBER:
198017744
ADMINISTRATOR/
DIRECTOR:		FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 9CENSUS: 2DATE:
09/05/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:30 AM
MET WITH:Licensee - Ernestina MontoyaTIME VISIT/
INSPECTION COMPLETED:
01:15 PM
NARRATIVE
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Licensing Program Analyst (LPA) Randy Derraco and Peter Bishop conducted an unannounced case management visit to the above mentioned address on 09/05/24 at 9:30 AM. LPA met with licensee, Ernestina Montoya, who guided LPA on a tour of the home. LPA observed no additional adults and 2 children present during inspection. Individuals residing in the home have been discussed and noted. The licensee is requesting a capacity increase to her family childcare home license. Per licensee, operation hours will be Monday through Friday, 6:00 AM - 6:00 PM. Applicant states that they will care for children 0-15 years old

All areas identified on the facility sketch were inspected, including but not limited to, off limit areas. This is a single story that consists of 3 bedrooms, 2 bathrooms, living room, dining room, kitchen, enclosed patio, front yard and backyard (fenced) An off limits room was observed to be separate from the home located in the backyard play area. Off limit areas include 3 bedrooms, 1 bathroom, garage, and separate room located in backyard play area. The licensee understands that licensing staff may have access to off-limit areas during inspection visit if necessary.

Main care area is located in an enclosed patio towards the back of the home. LPAs observed child sized tables, child sized chairs, age appropriate toys, two couches, a baby changing station, 1 Graco pack and play, 1 crib, a wooden cubby drawer with diapering supplies, a wall mounted air conditioning unit, and a wall mounted television. The bedroom was observed with a queen sized bed, wall mounted television, and a dresser drawer. The bathroom was observed to be clean with an operable sink, faucet and toilet. The living room was observed with a "L" shaped couch and wall mounted television. The dining area was observed with a child sized table and chairs. LPAs observed required postings at the front of the home and on the wall in the living room. Outdoor play area is located in the back yard and was observed with perimeter fencing,
SUPERVISORS NAME: Denise Gibbs
LICENSING EVALUATOR NAME: Randy Derraco
LICENSING EVALUATOR SIGNATURE: DATE: 08/16/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/16/2024
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 09/05/2024 12:56 PM - It Cannot Be Edited


Created By: Randy Derraco On 09/05/2024 at 12:27 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: 09/05/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
09/13/2024
Section Cited
CCR
102417(g)(4)

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102417 Operation of a Family Childcare home (g) home will free of defects or condition that may endager a child...(4) poisons, detergents, cleaning compounds...shall be stored where they are inaccessible to children...the requirement is not met as evidenced by:
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Licensee states she will fix lock leading to the storage shed to make contents inaccessible.
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Based on observation and interview the licensee did not store cleaning compounds where they are inaccessible to children which poses a potential health, safety and/or personal rights risk to persons in care.
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Type B
09/13/2024
Section Cited
HSC1597.46(f)

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1597.46 Large Family Day Care Homes (f) Large family day care homes ...contain a fire extinguisher or smoke detector device, or both, that meets standards established by the State Fire Marshal;... this requirement is not met as evidenced by:
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Licensee states she will have fire extinguisher serviced or purchase a new one by POC date.
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Based on observation and interview, the licensee did not contain a fire extinguisher that meets standardsd established by the State Fire Marshal which poses a pototench health, safety and/or personal rights risk to persons in care.
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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:Denise Gibbs
LICENSING EVALUATOR NAME:Randy Derraco
LICENSING EVALUATOR SIGNATURE:
DATE: 09/05/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/05/2024


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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 SW RO, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME: MONTOYA FAMILY CHILD CARE
FACILITY NUMBER: 198017744
VISIT DATE: 09/05/2024
NARRATIVE
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outdoor play equipment, and a storage shed. A gate with a latch was observed at the side of the home. LPA observed the area to contain trash cans and a gas barbeque grill. LPA observed the off limit's room located in the backyard play area to be locked.

Areas that will be used by children were inspected for safety, comfort, cleanliness. LPA observed operable telephone service, ventilation and heating (central). Detergents, cleaning compounds and hazardous items that can pose a danger to children are kept in a bucket located in the storage shed in the outdoor play area. LPAs observed the storage shed to not be locked. LPAs advised licensee that a citation under California Code of Regulation (CCR) 102417(g)(4) will be issued. Per licensee there are no pets, there are no firearms or weapons stored in the home and there are no bodies of water. LPAs did not observe any of the above items. LPAs observed that the licensee has a 3A-40 BC fire extinguisher in the home with a service tag dated 07/24/24. LPA advised licensee that a citation under Health and Safety Code section 1597.46 will be issued. Smoke and carbon monoxide detector were tested and are operable. The licensee states that they will provide food for children in care. Any food brought from the children’s homes shall be labeled with child’s name and properly stored or refrigerated.

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.

The licensee has completed the required Health and Safety Training, Nutrition, and Lead Training, Mandated Reporter Training and Pediatric First Aid and CPR. Licensee has proof of required immunization records. There are first aid supplies available.

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)
SUPERVISORS NAME: Denise Gibbs
LICENSING EVALUATOR NAME: Randy Derraco
LICENSING EVALUATOR SIGNATURE:

DATE: 09/05/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/05/2024
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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 SW RO, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME: MONTOYA FAMILY CHILD CARE
FACILITY NUMBER: 198017744
VISIT DATE: 09/05/2024
NARRATIVE
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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.

LPA advised the applicant how to access forms, regulations and quarterly updates on the Child Care Licensing website at: www.cdss.ca.gov

Licensee is requesting a large family child care license. Fire clearance was approved on 03/19/24. A large family childcare license may be granted upon Licensing Program Manager (LPM) Approval. Once licensed, the licensee is required to comply with the terms and limitations stated on the license.

Prior to approval of a capacity increase for a family child care license, the licensee must make the following corrections:
-Fire extinguisher must be serviced or new fire extinguisher purchased
-Cleaning supplies must be made inaccessible

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: Denise Gibbs
LICENSING EVALUATOR NAME: Randy Derraco
LICENSING EVALUATOR SIGNATURE:

DATE: 09/05/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/05/2024
LIC809 (FAS) - (06/04)
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