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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198020095
Report Date: 04/02/2025
Date Signed: 04/02/2025 03:00:38 PM

Document Has Been Signed on 04/02/2025 03:00 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:INIGUEZ FAMILY CHILD CAREFACILITY NUMBER:
198020095
ADMINISTRATOR/
DIRECTOR:		ROSA INIGUEZFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(310) 864-4154
CITY:CARSONSTATE: CAZIP CODE:
90745
CAPACITY: 14TOTAL ENROLLED CHILDREN: 15CENSUS: 6DATE:
04/02/2025
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:15 PM
MET WITH:Rosa Iniguez, LicenseeTIME VISIT/
INSPECTION COMPLETED:
03:20 PM
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Licensing Program Analyst (LPA) Susann Sanchez conducted an unannounced annual required inspection at the above facility. LPA met with, Licensee Rosa Iniguez who guided analyst on a tour of the facility. There were six children present when LPA arrived. Licensee husband/ assistant was also present. Facility capacity is in compliance for a Large Family Child Care Home. Hours of operation are Mon-Fri 7:00 AM - 6:00PM.

This is a two story home which consists of four bedrooms and two bathrooms. Areas used by the children were inspected as follows: living room, kitchen, dining room, two downstairs bedrooms, downstairs bathroom, and back yard. Per Licensee, areas off limits to children and parents include: two bedrooms and one bathroom located upstairs, front yard, gated portion of the backyard, and garage. The stairs leading to the second floor are made inaccessible with a gate. Food is provided by Licensee. Licensee was reminded if children bring food from home it must be labeled with the child’s name and properly stored or refrigerated.

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 Licensing Form (LIC) 9148- Earthquake Preparedness form. Facility records were reviewed for LIC 9040- Facility Roster, LIC 610- Facility Disaster Plan and Disaster drill log, last drill conducted on 04/02/2025. Smoke and carbon monoxide detectors were tested and are operable. Fire extinguisher indicated fully charged and was serviced on 01/22/25. The home maintains telephone service via cell phone. There are toys and other age appropriate material available for children. LPA observed that detergents, cleaning compounds and medication are inaccessible to children.
NAME OF LICENSING PROGRAM MANAGER: Valarie Cook
NAME OF LICENSING PROGRAM ANALYST: Susann Sanchez
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 04/02/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/02/2025
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 CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME: INIGUEZ FAMILY CHILD CARE
FACILITY NUMBER: 198020095
VISIT DATE: 04/02/2025
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Licensee understands that all poisons must be lock, not only inaccessible to children. Isolation area for sick children waiting to be picked up is in one of the downstairs bedroom, away from the other children. Per Licensee there are no firearms or weapons stored in the home. Per Licensee, they are no providing any overnight care at this time.

Currently licensee cares for one infant. Per Licensee infant only comes once in a while. LPA observed a play yard visible in the living room. Napping equipment does not block entrances or exits. Infant mattresses were observed to be firm with tightly fitted sheets. LPA did not observe loose object, bumpers, objects hanging, or objects attached to the play yard. Per Licensee wet or soiled sheets are changed and washed immediately. LPA reminded Licensee of the new Safe sleep regulations, including LIC 9227 Infant Sleep Plan for infants under 12 months, and 15 minute sleep check documentation for infants 0-24 months.

Children are using a portion of the backyard 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.There are five chickens and one rooster in the backyard and are locked.

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, and documentation of 15 minute Infant Sleep Check (0-24 months) when infant is present. Staff records were reviewed for approved Pediatric First Aid and CPR certification (expires 02/09/27), LIC-501: Personnel Record, LIC 508- Criminal Record Statement, LIC 9052- Employee Rights, Proof of immunization against measles, pertussis and influenza or influenza declination, TB clearance or risk assessment, LIC 9108- Statement Acknowledging Requirement to Report Child Abuse and current Mandated Reporter Training Certificate (expires 02/24/27).

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.

NAME OF LICENSING PROGRAM MANAGER: Valarie Cook
NAME OF LICENSING PROGRAM ANALYST: Susann Sanchez
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 04/02/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/02/2025
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: INIGUEZ FAMILY CHILD CARE
FACILITY NUMBER: 198020095
VISIT DATE: 04/02/2025
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Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02- CCP. When any IMS is provided, an updated Plan of Operation that includes 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) 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-care-centers/.

Licensee 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.

During the exit interview, the LICENSEE R. Iniguez, confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS.

A notice of site visit was given and must remain posted for 30 days. Exit interview conducted and report was reviewed with the Licensee, R. Iniguez.
NAME OF LICENSING PROGRAM MANAGER: Valarie Cook
NAME OF LICENSING PROGRAM ANALYST: Susann Sanchez
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 04/02/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/02/2025
LIC809 (FAS) - (06/04)
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