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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198020159
Report Date: 12/22/2022
Date Signed: 12/22/2022 12:56:13 PM

Document Has Been Signed on 12/22/2022 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 S WEST, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME:CRUZ FAMILY CHILD CAREFACILITY NUMBER:
198020159
ADMINISTRATOR:ISELA CRUZFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(323) 736-9982
CITY:SOUTH GATESTATE: CAZIP CODE:
90280
CAPACITY: 14TOTAL ENROLLED CHILDREN: 9CENSUS: 2DATE:
12/22/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:20 AM
MET WITH:Isela CruzTIME COMPLETED:
01:15 PM
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An unannounced Annual Random Required Inspection was conducted on Thursday, Dec 22, 2022 by Licensing Program Analyst (LPA’s) Patricia Medel and Raul Navarro. LPA Medel showed her badge and provided her business card 9:20am when meeting licensee Isela Cruz at the door.

LPA asked if anyone was sick with Covid19 in the home and response was none at this time. At entering home, LPA Medel provided to licensee an entrance check list for child-care homes, a copy of PIN-20-24-CCP regarding recently approved safe sleep regulations in effect, an individual infant sleeping plan and an infant sleep chart. LPA briefly reviewed these materials and asked if there were any questions and there was none.

Currently residing in the home are 6 adults and 1 minor. There is 1 Staff and all were present during the inspection. Upon arrival, LPAs observed 2 children in care, a 12 month old and a 9 year old. The hours of operation are Monday to Friday 6:00 AM to 6:00PM. The ages that License cares for are 12 months-11 years. Licensee stated there are no children enrolled who require medication me. Areas accessible to children were inspected as follows: Living room, 1 floor bathroom, and one bedroom converted into playroom. Areas off limits include: Entire second Level (3 bedrooms, 2 bathrooms) staircase leading to the second level is blocked with a rail not accessible to children in care.front yard, kitchen, detached garage and back yard.

At 9:40am, LPA asked where the postings were and LPA Medel observed that POSTING REQUIREMENTS: Facility License, Parent’s Rights Poster, Fire Drill, Earthquake Drill, Emergency Disaster Plan. Earthquake check List poster, Facility Roster were posted, reviewed and discussed. LPA reminded licensee that Fire and safety drills must be performed every six months and documented for review by the Department. Last drill documented was conducted on 10/12/22.
SUPERVISORS NAME: Karen Chambers
LICENSING EVALUATOR NAME: Patricia Medel
LICENSING EVALUATOR SIGNATURE: DATE: 12/22/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/22/2022
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
MONTEREY PARK S WEST, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME: CRUZ FAMILY CHILD CARE
FACILITY NUMBER: 198020159
VISIT DATE: 12/22/2022
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LPA observed at 10:15am, All areas used by children were inspected for safety, comfort, cleanliness, ventilation and heating. While inspecting bathroom, LPA observed 10:25am, that Detergents, cleaning compounds, medicines, sharp objects, hazardous items that can pose a danger to children are inaccessible. The licensee understands that any poisons must be locked with a key or combination lock.

In the kitchen, knives are kept in a drawer away from children. Kitchen is off-limits to the children. Everything in the kitchen was also clean. Cleaning materials are kept underneath the sink with child proof lock. Per Licensee, no one in the home smokes. Smoking is prohibited in a family child-care home. Licensee said she provides water from a central water system through dispenser kept in the kitchen in designated sippy cups. Licensee prepares and provides all meals for children.

Per licensee, there are no weapons or firearms. LPAs did not observed any bodies of water on the premises. LPAs did not observe a swimming pool or spa on the premises. The backyard is adequately fenced. There are age- appropriate toys and equipment on the premises. At 10:25am, LPAs tested the smoke detectors and carbon monoxide detectors and all were in good operational condition. The required 2A-10BC fire extinguisher was serviced on 05/2022. There are emergency supplies on the premises and a first aid kit. Licensee was reminded that the fire extinguisher type 2A-10BC must be serviced annually or as often as necessary. Smoke and Carbon Monoxide detectors should be checked for battery replacement as needed.

At 10:35am, children and staff records were reviewed. All were in order. Required licensing forms as well as mandated child abuse reporting and criminal record clearance requirement were also discussed. Children and Staff records must be maintained and updated as needed and must be available for review by the Department. Licensee was reminded that all forms of children and staff enrolled must be available and maintained for a period of three years, even after children no longer are attending the facility.



LPAs did not observe the following items during the inspection: Baby walkers, saucer chairs, bouncers, Johnny Jumpers or any similar items which are prohibited.
SUPERVISORS NAME: Karen Chambers
LICENSING EVALUATOR NAME: Patricia Medel
LICENSING EVALUATOR SIGNATURE:

DATE: 12/22/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/22/2022
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
MONTEREY PARK S WEST, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME: CRUZ FAMILY CHILD CARE
FACILITY NUMBER: 198020159
VISIT DATE: 12/22/2022
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Licensee was reminded:
In the absence of the Licensee, a qualified adult must be present supervising the children; a qualified adult is an individual who has a valid and current adult/infant CPR & Pediatric First Aid certification and a valid criminal record clearance associated to the facility license.

Licensee was also reminded that any unusual incidents or injuries must be reported to the Department within 24 hours via telephone and in writing within seven (7) days.

Changes should be reported to the Department as soon as they occur such as construction, remodeling, telephone number changes and/or if you move from your home. Annual fees must be paid promptly and by the due date or a late fee shall be assessed and/or the License shall be terminated. Smoking is prohibited in a family child-care home.



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

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.



LPAs 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
SUPERVISORS NAME: Karen Chambers
LICENSING EVALUATOR NAME: Patricia Medel
LICENSING EVALUATOR SIGNATURE:

DATE: 12/22/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/22/2022
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
MONTEREY PARK S WEST, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME: CRUZ FAMILY CHILD CARE
FACILITY NUMBER: 198020159
VISIT DATE: 12/22/2022
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At this time, the Licensee is in compliance with California Title 22 Regulations. Therefore, there are no citations being issued today. Exit interview conducted with the Licensee, Isela Cruz . A notice of site visit was given and must remain posted for 30 days.

To improve the quality and value of the new inspection process, a survey will be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or tools, please send them by email to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/process.

End of report

SUPERVISORS NAME: Karen Chambers
LICENSING EVALUATOR NAME: Patricia Medel
LICENSING EVALUATOR SIGNATURE:

DATE: 12/22/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/22/2022
LIC809 (FAS) - (06/04)
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