198019571-11-15-2022-54-CC-WBIS-CL7QLN-20221115111613

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 198019571
Report Date: 11/15/2022
Date Signed: 11/15/2022 11:16:20 AM

Document Has Been Signed on 11/15/2022 11:16 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 CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME:	VALENZUELA FAMILY CHILD CARE		FACILITY NUMBER:	198019571
ADMINISTRATOR:	DOLORES ARELI VALENZUELA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(562) 303-7460
CITY:	LONG BEACH	STATE: CA	ZIP CODE:	90815
CAPACITY: 14	TOTAL ENROLLED CHILDREN: 14	CENSUS: 5	DATE:	11/15/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	09:09 AM
MET WITH:	Dolores Valenzuela		TIME COMPLETED:	11:30 AM

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) Warren Birks conducted an unannounced Required - 1 Year inspection. LPA met with Licensee Dolores Valenzuela who guided LPA on a tour of the facility. Upon arrival, LPA observed the Licensee and cleared assistant providing care for three infants and two preschool children. Per Licensee there are six children enrolled. Individuals residing in the home have been discussed and noted. At Approximately 9:30am LPA conducted an inspection of all areas of the facility sketch. This is a one story home consisting of three bedrooms, two restrooms, living room, kitchen, dining area, and back yard. The home has central air and the Licensee uses the living room, dining area, two front bedrooms, one bathroom, and backyard for childcare. All other areas are off limits to the children. Areas accessible to children were inspected to ensure that they are clean and orderly with ventilation and heating for the safety of the children. There is a working telephone maintained in the home. Licensee has no pets. LPA advised Licensee to provide extra care and supervision if Licensee gets a pet as animals may be unpredictable. Primary care takes place in the living room area and detergents, cleaning compounds, medications, and other items which can pose a danger to children are inaccessible. LPA observed the backyard is surrounded by fencing at least five feet high. The backyard appears to be free of hazards and has gated areas to prevent access to items such as tools and other equipment. LPA reminded Licensee to ensure medicines, cleaners, paints, sharp objects, grills, propane, and similar items must be inaccessible at all times. Poisons must also be locked with a key or combination lock. Per Licensee there are no firearms, weapons or bodies of water and LPA did not observe any on the premises. The License, Parents Rights Poster, and Earthquake Preparedness was posted. The valve on the required 2A 10BC fire extinguisher indicates fully charged and is due for service August 15, 2022. Smoke and carbon monoxide detectors in the family room were tested and are in operable condition. The children's roster and the Disaster drill is current (last date of drill August 31, 2022).

SUPERVISORS NAME: Karen Chambers
LICENSING EVALUATOR NAME: Warren Birks
LICENSING EVALUATOR SIGNATURE:	DATE: 11/15/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/15/2022

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: VALENZUELA FAMILY CHILD CARE	FACILITY NUMBER: 198019571
	VISIT DATE: 11/15/2022

NARRATIVE

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LPA observed the Licensee and staff have the current Mandated Reporter training which expires August 31, 2023. LPA observed the Licensee also has documentation indicating immunization regarding measles, pertussis and tuberculosis on file.

At approximately 10:10am LPA reviewed seven children's files which include the documentation such as: Parent's Rights, Personal, Affidavit for Liability insurance, Identification and Emergency, Consent for Emergency Treatment, Additional Children in Care and Immunization records.

The following was discussed: Individuals who are 18 years of age or older living in the home must obtain a criminal record clearance. Individuals within one month of their 18th birthday must be fingerprinted immediately. Failure to obtain a criminal record background check clearances prior to initial presence in the home will result in an immediate $100.00 dollar or more per day Civil Penalty. LPA advised to ensure all adults that come into the home are fingerprint cleared and associated.

No smoking, No infant walkers, No Johnny jumpers, No saucer chairs, and any other item that falls into that category are not permitted in the facility. Effective January 1, 2010, licensees of family child care homes are required to ensure that at least one staff member with current training in pediatric first aid and pediatric CPR is on site at all times when children are present. Licensee's CPR expires October 31, 2023

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 Centers and the ADA, available at: http://www.ada.gov/childqanda.htm

LPA advised the Licensee that infants shall be placed on their backs for sleeping and shall be supervised. Infants shall be checked on every 15 minutes and document the child's condition. The LIC 9227 Individual Infant Sleeping The plan shall be completed for each infant up to 12 months of age. LPA discussed the form and explained that the LIC 9227 form that is available on CCLD website.

SUPERVISORS NAME: Karen Chambers
LICENSING EVALUATOR NAME: Warren Birks
LICENSING EVALUATOR SIGNATURE:	DATE: 11/15/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/15/2022

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: VALENZUELA FAMILY CHILD CARE	FACILITY NUMBER: 198019571
	VISIT DATE: 11/15/2022

NARRATIVE

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The Licensee was advised on the inaccessibility of hazards, Sudden Infant Death Syndrome (SIDS) and Never-Shake-a-Baby were discussed. LPA informed Licensee regarding PIN 20-24-CCP. LPA discussed LIC 311D - Forms/Records to Keep in Your Family Child Care Home. Mandatory Forms for the children’s files and staff files, requirements for fire drills, earthquake drills and documentation were discussed. Role and responsibilities of being a Mandated Reporter were reviewed. The Licensee was advised how to access forms and Regulations online at www.ccld.ca.gov. Licensee was made aware that it is his/her responsibility to know the regulations as well as anyone who assists in providing care.

LPA consulted and explained Child Abuse Reporting, Updated Parent’s Rights Poster with Complaint Hotline information, Never Shake a Baby, Sudden Infant Death Syndrome (SIDS), and Safe Sleeping practices which always Baby is sleeping on his/her back. Capacity Handout (Small & Large) was provided during this inspection. Any unusual incidents or injuries must be reported to the Department within 24 hours via telephone and within seven (7) days in writing (use LIC624B for written report). Mandated reporter training must be completed every 2 years. www.mandatedreporterca.com. Licensee and staff have the required Mandated Reporter training.

LPA informed Licensee information regarding with Safe Sleep PIN 20-24-CCP. LPA also discussed Capacity and Ratio, and Items not Permitted. LPA explained these regulations and advised Licensee to ensure that she provides care and supervision adhering to the information provided.

The Notice of Site Visit (LIC 9213) – must remain posted for 30 days during the hours of operation after each site visit by a licensing representative. Failure to maintain posting as required will result in a civil penalty of $100.00. This report along with a copy of the appeal rights was provided. Exit interview was conducted with Licensee Dolores Valenzuela.

SUPERVISORS NAME: Karen Chambers
LICENSING EVALUATOR NAME: Warren Birks
LICENSING EVALUATOR SIGNATURE:	DATE: 11/15/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/15/2022

LIC809 (FAS) - (06/04)

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