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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198020515
Report Date: 03/17/2022
Date Signed: 03/17/2022 03:57:01 PM

Document Has Been Signed on 03/17/2022 03:57 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 CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME:CARDENAS FAMILY CHILD CAREFACILITY NUMBER:
198020515
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 3CENSUS: 3DATE:
03/17/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:16 PM
MET WITH:Rosi Cardenas TIME COMPLETED:
04:25 PM
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Licensing Program Analyst (LPA) Cynthia Reyes conducted an unannounced 1 year annual inspection on this date. LPA met with Licensee Rosi Cardenas and a copy of the Entrance Checklist for Child Care homes form (LIC 126) was provided. The facility operating hours are from 7:30 AM to 5:30 PM, Monday through Friday. A risk assessment was conducted upon entry- Due to COVID- 19 precautionary measures were taken during the entire inspection and all individuals present wore appropriate personal protective equipment.

1:30PM Licensee guided analysts on a tour of the facility. Per Licensee, there are 3 infants currently enrolled. A current children’s roster was available for review. There were 3 infants present upon arrival. Licensee states she only cares for Infants.

The licensee states that 2 adults and 0 children currently live in the home. All adults present in the home have obtained a criminal record clearance or exemption prior to working, residing or volunteering in the licensed child care home. Licensee states that there are no firearms or weapons in the home.

Areas that are accessible to children are as follows: Front yard, family room W/Covered fire place, Kitchen W/Small dinning area, day care room, bathroom and back yard.

Areas off limits: Garage, Master bedroom W/Bath, Daughter bedroom, office, laundry room, shed in back yard, living room, and big dinning area. **Rooms that are off-limits need to be made inaccessible during operating hours** The Licensee does understand that licensing staff may have access to off-limit areas during inspection visit if necessary.

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SUPERVISORS NAME: Christina Gabelman
LICENSING EVALUATOR NAME: Cynthia Reyes
LICENSING EVALUATOR SIGNATURE: DATE: 03/17/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/17/2022
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 CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME: CARDENAS FAMILY CHILD CARE
FACILITY NUMBER: 198020515
VISIT DATE: 03/17/2022
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The following was observed and reviewed during this inspection.

2PM All areas identified on the facility sketch were inspected for safety, comfort, and cleanliness. There is telephone service via a land line and a cellphone that stays at the facility during operation hours. There is ventilation and heating (central).

Detergents, cleaning compounds, and medications were observed to be inaccessible to children. The restroom that children use was observed to be safe and sanitary.

LPA Reyes observed a fireplace in the home and is barricaded. The valve on the required 2A 10BC fire extinguisher indicates fully charged with last service date of 06/07/2021 and will be either purchase or have the existing Fire Extinguisher serviced as indicated on receipt/tag. Smoke and carbon monoxide detectors were tested and are operable. All small family day care 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 02/23/2022. Emergency Disaster Plan, Parent’s Rights Poster and the Facility License were observed to be posted on the parent board and visible to parents and all to see.

The home is observed to be clean and orderly. There are toys available for children. Appropriate sleeping arrangements which consist of pack-n-plays for each of the 3 infants in care. Safe Sleep consultation was conducted.



Licensee states that they are currently caring for infants. LPA discussed the safe sleep regulations with licensee and discussed the Child Care Licensing Safe Sleep web page 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: Christina Gabelman
LICENSING EVALUATOR NAME: Cynthia Reyes
LICENSING EVALUATOR SIGNATURE:

DATE: 03/17/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/17/2022
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 CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME: CARDENAS FAMILY CHILD CARE
FACILITY NUMBER: 198020515
VISIT DATE: 03/17/2022
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Smoking is prohibited in a licensed Family Child Care Home. Per Licensee, no one smokes in the home.
LPA did not observe any objects that can pose a danger to children in care. There are two small dogs on the premises outside. The licensee is observed to be operating within the license capacity limitations.

At 3 PM Children’s records were reviewed, including emergency information and were none were observed to have missing information.

The licensee and other personnel have completed training on preventive health practices including Pediatric First Aid and CPR. The licensee Pediatric First Aid and CPR expires on 09/11/2023. There are first aid supplies available.

LPA observed that the Licensee has proof of all immunization records for herself and the Mandated Reporter AB 1207 compliant Child Care Training Certificate on file. Mandated reporter training must be completed every 2 years. www.mandatedreporterca.com.

Licensing staff consulted with licensing regarding COVID-19 health and safety guidelines on this date. LPA Reyes observed no children over two years old in care. LPA informed Licensee, that the usage of mask is a mandate and that every adult and child over the age of two should be wearing a mask.



LPA advised the licensee to access forms, regulations and quarterly updates on line at: www.ccld.ca.gov.
Reporting Unusual Incidents: MPROIncidentReports@dss.ca.gov. CCL Resources for Parents & Providers: https://ccld.childcarevideos.org/ Provider Information Notices (PINs): https://www.cdss.ca.gov/inforesources/community-care-licensing/policy/provider-information-notices/child-care
SUPERVISORS NAME: Christina Gabelman
LICENSING EVALUATOR NAME: Cynthia Reyes
LICENSING EVALUATOR SIGNATURE:

DATE: 03/17/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/17/2022
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 CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME: CARDENAS FAMILY CHILD CARE
FACILITY NUMBER: 198020515
VISIT DATE: 03/17/2022
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IMS (Not at this time)
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.

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.

At this time, the licensee is in compliance with California Code of Regulations Title 22.



A notice of site visit was given and must remain posted for 30 days.

4:20 PM Exit interview conducted and report was reviewed with Licensee, Rosi Cardenas.

Licensee Email was verified on this date and is on file.

SUPERVISORS NAME: Christina Gabelman
LICENSING EVALUATOR NAME: Cynthia Reyes
LICENSING EVALUATOR SIGNATURE:

DATE: 03/17/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/17/2022
LIC809 (FAS) - (06/04)
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