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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198018986
Report Date: 07/14/2021
Date Signed: 07/14/2021 11:07:30 AM

Document Has Been Signed on 07/14/2021 11:07 AM - 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 CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME:RIVEROS FAMILY CHILD CAREFACILITY NUMBER:
198018986
ADMINISTRATOR:RIVEROS, NAYELIFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(323) 401-5639
CITY:LOS ANGELESSTATE: CAZIP CODE:
90022
CAPACITY: 14TOTAL ENROLLED CHILDREN: 0CENSUS: 3DATE:
07/14/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:33 AM
MET WITH:Nayeli RiverosTIME COMPLETED:
11:17 AM
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Licensing Program Analyst (LPA) Lissete Gonzalez conducted an unannounced annual inspection to the above facility on 07/14/2021. LPA met with Licensee, Nayeli Riveros, who guided analyst on a tour of the facility. Also present was Licensee’s Assistant/husband, Ever Chavez. Per Licensee, there are 10 children currently enrolled. A current children’s roster was available for review. There were 3 children present.

This is a one story home which consists of 3 bedrooms, 2 bathrooms, kitchen, living room, dining room, front and backyard. The children have access to the first bedroom, living room, dining room, and front yard. Per licensee, areas off limits to children and parents include: 2 bedrooms, 1 bathroom, and the back yard. LPA toured all areas used by children during this visit. Licensee provides breakfast, lunch, and snacks.

Individuals who reside in the home were noted and discussed. All adults present in the home have obtained a criminal record clearance. Licensee states that there are no firearms in the home.

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 a cell phone that is used and the cellphone stays at the facility during operation hours. There is ventilation and heating (central). 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 2A 10BC fire extinguisher indicates fully charged and was serviced on 8/25/2020. REPORT CONTINUES ON NEXT PAGE: 1 OF 4
SUPERVISORS NAME: Christina Gabelman
LICENSING EVALUATOR NAME: Lissete Gonzalez
LICENSING EVALUATOR SIGNATURE: DATE: 07/14/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/14/2021
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 4
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 CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME: RIVEROS FAMILY CHILD CARE
FACILITY NUMBER: 198018986
VISIT DATE: 07/14/2021
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Smoke and carbon monoxide detectors were tested and are operable.

Licensee states that she is not currently caring for infants. Appropriate sleeping arrangements and cots were discussed. LPA advised cribs or play yards cannot hinder the entrance or exit from the sleeping space, mattresses shall be firm and covered with a fitted sheet that overlaps the underside it cannot be dislodged. Infant cribs must be free of loose articles and objects. Objects cannot be hung above or attached to the side of the crib. LPA advised the Licensee that infants cannot be swaddled, 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.

Currently, children are using the front 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 not observe any objects that can pose a danger to children on the outdoor yard. The licensee states that supervision is always provided.

The licensee is observed to be operating within the license capacity limitations. LPA did not observe any children left in parked vehicles. Car seats shall only be used for transportation. LPA did not observe any children sleeping in car seats.

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 6/2023. Assistant, Ever Chavez’s Pediatric First Aid and CPR expires on 8/2021. 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. The licensee has proof of immunization against influenza, pertussis, and measles.

LPA observed that the Licensee and assistant have a current Mandated Reporter AB 1207 Compliant Child Care Training Certificate on file. REPORT CONTINUES ON NEXT PAGE: 2 OF 4
SUPERVISORS NAME: Christina Gabelman
LICENSING EVALUATOR NAME: Lissete Gonzalez
LICENSING EVALUATOR SIGNATURE:

DATE: 07/14/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/14/2021
LIC809 (FAS) - (06/04)
Page: 2 of 4
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 CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME: RIVEROS FAMILY CHILD CARE
FACILITY NUMBER: 198018986
VISIT DATE: 07/14/2021
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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 6/16/2021.

There is one dog on the premises. LPA observed the dog to be kept in a fenced area in the off limits backyard. LPA observed an inaccessible above ground pool located in the off limits back yard. LPA observed a fence measuring five feet with a self-latching door that swings out. 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):
The licensee states that she is providing IMS at this time (see LIC857 for child information).
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 Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Section 102417. 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: http://www.ada.gov/childqanda.htm.

LPA advised the licensee to access forms, regulations and quarterly updates online at: www.ccld.ca.gov. LPA also discussed the Provider Information Notices (PINS) on Safe Sleep Awareness: PIN 19-02-CCP, COVID FAQ - PIN 20-11-CCP, Required Lead Testing: PIN 20-01 CCP Effects of Lead Exposure, and Guardian User Account Access - PIN 20-20-CCLD.



No deficiencies cited during today’s visit.
REPORT CONTINUES ON NEXT PAGE: 3 OF 4
SUPERVISORS NAME: Christina Gabelman
LICENSING EVALUATOR NAME: Lissete Gonzalez
LICENSING EVALUATOR SIGNATURE:

DATE: 07/14/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/14/2021
LIC809 (FAS) - (06/04)
Page: 3 of 4
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 CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME: RIVEROS FAMILY CHILD CARE
FACILITY NUMBER: 198018986
VISIT DATE: 07/14/2021
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Exit interview was conducted with Licensee, Nayeli Riveros, including, but not limited to Appeal Procedures, Site Visit and Initial Appeal Rights.

The Notice of Site Visit (LIC 9213) – must remain posted for 30 days during the hours of operation after each site visit made by a licensing representative. Failure to maintain posting as required will result in a civil penalty of $100.00.

END OF REPORT PAGE: 4 OF 4
SUPERVISORS NAME: Christina Gabelman
LICENSING EVALUATOR NAME: Lissete Gonzalez
LICENSING EVALUATOR SIGNATURE:

DATE: 07/14/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/14/2021
LIC809 (FAS) - (06/04)
Page: 4 of 4