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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198019103
Report Date: 08/04/2022
Date Signed: 08/04/2022 05:29:24 PM

Document Has Been Signed on 08/04/2022 05:29 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:PEREZ FAMILY CHILD CAREFACILITY NUMBER:
198019103
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 8DATE:
08/04/2022
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
02:07 PM
MET WITH:Licensee Elia Perez TIME COMPLETED:
05:40 PM
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On 8/4/22 Licensing Program Analysts (LPA) Jeanette Estrada and Austin Estrada conducted an unannounced case management inspection for a capacity increase at the facility above. LPAs met with Licensee, Elia Perez who guided LPA on a tour of the facility. Operating hours are Monday to Friday 6AM to 6PM and care will be provided for children ages 6 months to 12 years old. All residents living in the home were discussed and verified. There were 8 children present when LPAs arrived. Fire clearance approval was approved on 7/13/22.

At LPAs arrival, the facility was not in compliance with capacity requirements for a small family child care home. There were 3 infants present and a total of 8 children. Child 1 (infant) was picked up at approximately 3:10PM.

This is a one story home with 4 bedrooms, 2 bathrooms, living room, kitchen, dining room, day care room, backyard and detached garage.

Off Limit Areas: Two of the bedrooms in the home are off limits and have safety knobs installed, the restroom in one of the off limit bedrooms and the detached garage.

On Limit Areas: Two bedrooms, hallway bathroom, day care room and backyard. The living room, kitchen and dining room are on limits in passing. Areas accessible to children were inspected for safety, comfort, cleanliness, ventilation and working phone (cell phone and landline). The main day care area is in the back of the home in the day care room. Children nap in two bedrooms. LPAs observed two cribs in one of the bedrooms. LPAs observed blankets and pillows in the two cribs while two infants were using the cribs. LPAs observed Licensee remove the items from the cribs. LPA observed children napping on mats in the second bedroom. The home has central air and heating. The kitchen is not off limits since the home has an open layout. Per Licensee, children mainly stay in the day care room. Detergents, cleaning compounds, sharp objects and hazardous items that can pose a danger to children are inaccessible to children in care. LPA observed that the stove in the kitchen has safety knobs installed, the knives are placed out of reach of children on top of the microwave which is installed in an upper cabinet and cleaning compounds are in a latched cabinet under the sink.

SUPERVISORS NAME: Valarie Cook
LICENSING EVALUATOR NAME: Jeanette Estrada
LICENSING EVALUATOR SIGNATURE: DATE: 08/04/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/04/2022
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
CCLD Regional Office, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME: PEREZ FAMILY CHILD CARE
FACILITY NUMBER: 198019103
VISIT DATE: 08/04/2022
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The bathroom children use is in the hallway. LPA did not observe hazards in the bathroom. LPA observed age appropriate furniture, toys and materials in the day care room and the backyard to be in good condition. Children use the backyard for outdoor play. LPAs observed a broken air vent protruding out from the garage, accessible to children.

Personal medicines are kept in an upper cabinet in the hallway. Per Licensee, currently no children enrolled require medications. Laundry detergent is kept in the garage which is off limits. LPA observed covered electrical outlets throughout the day care areas. Per Licensee, there are no poisons in the home. LPA advised that if any poisons are kept in the home at a later date to keep them in a locked cabinet or container. The isolation area for when a child is ill is in the bedroom where the older children nap . Per Licensee, children are provided with meals. Licensee was reminded that if food is brought from home, the container shall be labeled with the child's name and properly stored or refrigerated.


Per Licensee, there are no bodies of water on the property. LPA did not observe any bodies of water. Licensee states there are no weapons or firearms in the facility. LPA advised that if weapons or firearms are kept in the facility at a later date, they must be kept locked and the fire arm and ammunition must be stored separately. There are no pets in the home. LPA observed a first aid kit and a 2A10BC fire extinguisher indicating it is full and serviced in 12/2021. First aid kit is kept in the day care room and fire extinguisher is kept next to the dining room. There is also a fire extinguisher in the back yard. There is an operable smoke and carbon monoxide detector in the facility. LPA observed the required postings: Facility License, PUB 394 Parent's Rights Poster, LIC 9148 Earthquake preparedness poster . LPA observed LIC 610 Emergency Disaster Plan, LIC 999 Facility Sketch, Emergency drill log with last drill conducted on 8/3/22. Licensee had a current facility roster available.
Children's records were reviewed: 6 out of 8 children are missing proof of required immunizations, 2 infants are missing the LIC 9227 Infant Sleeping plan.

Licensee has current pediatric CPR/First Aid which expires 9/2023, Mandated Reporter training which expires 2/27/2024 and required Health & Safety plus one hour nutrition and lead component completed. Licensee has required immunization vaccines on file for pertussis and influenza. Licensee does not have proof of required vaccine for measles.
SUPERVISORS NAME: Valarie Cook
LICENSING EVALUATOR NAME: Jeanette Estrada
LICENSING EVALUATOR SIGNATURE:

DATE: 08/04/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/04/2022
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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: PEREZ FAMILY CHILD CARE
FACILITY NUMBER: 198019103
VISIT DATE: 08/04/2022
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Infant Care: Currently licensee cares for 3 infants. LPA observed 2 cribs in one of the bedrooms. Napping equipment does not block entrances or exits. Infant mattresses were observed to be firm. LPA observed a blanket covering one of the mattresses. LPA observed blankets and pillows in the two cribs while there were two infants in the cribs. Licensee removed items from cribs during inspection. One infant was observed to be asleep. One infant is over 12 months and uses a mat to nap. Per Licensee, 15-minute sleep check is not documented. There are currently no infants with pacifiers used during nap. Per licensee wet or soiled sheets are laundered at the facility. LPA and licensee discussed the new Safe sleep regulations, including LIC 9227 Infant Sleep Plan for infants under 12 months, 15-minute sleep check documentation for infants 0-24 months. Licensee states the following sleep supervision plan for infants: Infants nap during nap time and are supervised.
Incidental Medical Services (IMS):
Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual – Regulation Interpretations and Procedures for Family Child Care Homes Section 102417. 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 Center and the ADA, available at: http://www.ada.gov/childqanda.htm
Licensee was reminded that all adults 18 and over living or working in the home, including employees and volunteers, 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 up to $500.00 maximum per day/per person will be assessed if this regulation is violated.
LPA discussed the safe sleep regulations with Licensee and discussed the Child Care Licensing Safe Sleep webpage athttps://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep 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.
SUPERVISORS NAME: Valarie Cook
LICENSING EVALUATOR NAME: Jeanette Estrada
LICENSING EVALUATOR SIGNATURE:

DATE: 08/04/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/04/2022
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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: PEREZ FAMILY CHILD CARE
FACILITY NUMBER: 198019103
VISIT DATE: 08/04/2022
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The deficiencies listed on the following pages were observed by the LPA and are being cited in accordance with California Code of Regulations Title 22. Two type A citations were issued today for CCR 102425(b) Infant Safe Sleep for the objects observed in the cribs and Health and Safety Code 1597.44(b) Small family day care homes for the facility being out of compliance for capacity requirements for a small family child care home (. Please see attached LIC 809-D for all citations.
Deficiencies that are being cited need to be cleared to protect the children’s health & safety.
  • The notice of site visit was posted where the parent/guardian of children enter and exit the facility.
  • A copy of this report shall also be posted where the parent/guardian of children enter and exit the facility.
  • Both the notice of site visit and licensing report shall remain posted for 30 consecutive days. Failure to maintain posting as required will result in a $100.00 civil penalty.
  • A copy of this report shall be provided to the parent/guardian of children currently enrolled by the next business day or immediately upon their return.
  • A copy of this report shall also be provided to the parent/guardian of any newly enrolled child for the next 12 months.
  • A signed Acknowledgement of Receipt (LIC9224) shall be in each child’s file, acknowledging receipt.


A large family child care license will be granted upon LPM approval. Once licensed, the applicant is required to comply with the terms and limitations stated on the license.

Exit interview conducted and report was reviewed with the Licensee, Elia Perez. A notice of site visit was given and must remain posted for 30 days. Appeal rights were provided.
SUPERVISORS NAME: Valarie Cook
LICENSING EVALUATOR NAME: Jeanette Estrada
LICENSING EVALUATOR SIGNATURE:

DATE: 08/04/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/04/2022
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Document Has Been Signed on 08/04/2022 05:29 PM - It Cannot Be Edited


Created By: Jeanette Estrada On 08/04/2022 at 03:48 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: PEREZ FAMILY CHILD CARE
FACILITY NUMBER: 198019103

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/04/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
08/05/2022
Section Cited
CCR
102425(b)

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102425 Infant Safe Sleep (b)Cribs or play yards shall be free from all loose articles and objects
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Licensee removed items from the cribs during the inspection.
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Based on observation the Licensee did not comply with the section cited above. LPA observed 2 infants in 2 separate cribs.LPA observed blankets in both cribs and a pillow in one crib.A boppy pillow was hanging off the side of one crib. This poses an immediate risk to the health and safety of children in care.
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Type A
08/05/2022
Section Cited
HSC1597.44(b)

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1597.44(b)Small family day care homes; number of children A small family day care home may provide care for...up to eight children... if all of the following conditions are met:No more than two infants are cared for during any time when more than six children are cared for. This requirement is not met as evidenced by
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Licensee called parent of child 1 to pick up during inspection. Child 1 was picked up at approximately 3:10PM. Licensee will submit an attendance schedule for the children that will prevent the facility from being out of compliance with capacity requirements.
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Based on observation the licensee did not compy with the section cited above. When LPAs arrived there were 3 infants and 5 children over the age of 2 present. This poses an immediate risk to the health and safety of children 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:Valarie Cook
LICENSING EVALUATOR NAME:Jeanette Estrada
LICENSING EVALUATOR SIGNATURE:
DATE: 08/04/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/04/2022


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Document Has Been Signed on 08/04/2022 05:29 PM - It Cannot Be Edited


Created By: Jeanette Estrada On 08/04/2022 at 04:00 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: PEREZ FAMILY CHILD CARE
FACILITY NUMBER: 198019103

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/04/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
08/12/2022
Section Cited
HSC
1597.622(c)

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1597.622 (c) The family day care home shall maintain documentation of the required immunizations or exemptions from immunization, as set forth in this section, in the person’s personnel record that is maintained by the family day care home.
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Licensee will obtain proof of measles vaccine and will submit to LPA via picture.
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Based on record review the licensee did not comply with the section cited above. The Licensee does not have proof of mmunization against Measles. This poses a potential risk to the health and safey of children in care.
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Type B
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Section Cited
CCR102418(g)

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102418 Immunizations (g)The licensee shall document each child's immunizations... and shall maintain such documentation for as long as the child is enrolled. This requirement is not met as evidenced by
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Licensee will obtain immunization record for 6 out of 8 children. Licensee will submit proof to LPA via Picture.
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Based on record review the Licensee did not comply with the section cited above. 6 out of 8 children present did not have an immunization record on file.
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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:Valarie Cook
LICENSING EVALUATOR NAME:Jeanette Estrada
LICENSING EVALUATOR SIGNATURE:
DATE: 08/04/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/04/2022


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Document Has Been Signed on 08/04/2022 05:29 PM - It Cannot Be Edited


Created By: Jeanette Estrada On 08/04/2022 at 04:11 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: PEREZ FAMILY CHILD CARE
FACILITY NUMBER: 198019103

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/04/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
08/12/2022
Section Cited
CCR
102417(g)

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102417 Operation of a Family Child care home (g)The home shall be free from defects or conditions which might endanger a child. This requirement is not met as evidenced by
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Per Licensee, air vent will be replaced. Licensee will submit proof to LPA via picture.
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Based on observsation the Licensee did not comply with the section cited above. LPAs observed a broken air vent protruding fromt the side of the garage, accessible to children in the back yard. This poses a potential risk to the safety of children in care.
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Type B
08/12/2022
Section Cited
CCR102425

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102425 Infant Safe Sleep(c) An Individual Infant Sleeping Plan [LIC 9227 (3/20)] shall be completed for each infant up to 12 month of age the provider has in care and maintained at the facility in the infant’s file. This requirement is not met as evidenced by
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Licensee will provide LIC 9227 to parents and will submit proof of completed form to LPA via picture.
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Based on record review the Licensee did not comply with the section cited above. 2 out of 2 infants under 12 months did not have LIC 9227 on file. This poses a potential risk to the health and safety of children 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:Valarie Cook
LICENSING EVALUATOR NAME:Jeanette Estrada
LICENSING EVALUATOR SIGNATURE:
DATE: 08/04/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/04/2022


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Document Has Been Signed on 08/04/2022 05:29 PM - It Cannot Be Edited


Created By: Jeanette Estrada On 08/04/2022 at 04:17 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: PEREZ FAMILY CHILD CARE
FACILITY NUMBER: 198019103

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/04/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
08/12/2022
Section Cited
CCR
102425(j)(1)(D)

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(j)The provider shall supervise infants while they are sleeping and adhere to the following requirements(1) provider shall physically check on the infant every 15 minutes.(D) Documentation shall be...in the infant’s file and be available to the Department. This requirement is not met as evidenced by
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Licensee will review infant safe sleep regulation 102425 and will document 15 minute checks. Licensee will submit proof of 15 minute checks for 3 infants enrolled via picture
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Based on interview the licensee did not comply in the section cited above. Per Licensee, 15 minute sleep check is not documented. This poses a potential risk to the health and safety of children 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:Valarie Cook
LICENSING EVALUATOR NAME:Jeanette Estrada
LICENSING EVALUATOR SIGNATURE:
DATE: 08/04/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/04/2022


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