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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198020564
Report Date: 10/27/2021
Date Signed: 10/27/2021 11:47:23 AM

Document Has Been Signed on 10/27/2021 11:47 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 CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME:NUNEZ CERVANTES FAMILY CHILD CAREFACILITY NUMBER:
198020564
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 6CENSUS: 4DATE:
10/27/2021
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
10:44 AM
MET WITH:Alejandra Nunez CervantesTIME COMPLETED:
12:02 PM
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An unannounced Case Management Inspection was conducted today by Licensing Program Analyst (LPA) Lissete Gonzalez regarding a pending application for an increase in capacity. LPA met with Licensee Alejandra Nunez Cervantes who guided LPA on an indoor and outdoor tour of the facility. Also present was Licensee’s husband/assistant, Abraham Zuniga. There were four (04) children present.

The licensee is requesting an increase in capacity from 8 to 14 children. The Licensing Department received a granted Fire Clearance for a capacity of 14 children on 10/21/2021. During today's inspection, LPA toured the facility and did not observe any deficiencies during today’s inspection.

This is a one story home that consists of 3 bedrooms, 1 restroom, dining room, living room, kitchen, and front yard. 1 Bedroom is currently used as the playroom. Areas used for day-care: Kitchen/dining room, living room, playroom, restroom, and front yard (fenced). LPA observed a gate on Southside Drive used by parents and children. Off limit areas include: 2 bedrooms that are maintained locked during operating hours. LPA observed a secondary gate entrance through the side of home on Fairfield Street used by other residents with a different address. Per licensee, children and parents will not have access to the side entrance which was observed to be blocked by an infant gate.

The valve on the required 2A 10BC fire extinguisher indicates fully charged and was serviced on 02/11/21, as indicated on service tag. Smoke and carbon monoxide detectors were tested and are operable. Licensee, Alejandra Nunez’s First Aid/CPR Card is valid through 2/28/2022. Licensee's Assistant, Abraham Zuniga's First Aid/CPR Card is valid through 2/28/2022.

The following was discussed with the Licensee:
LPA discussed the safe sleep regulations with licensee and discussed the Child Care Licensing Safe Sleep REPORT CONTINUES ON NEXT PAGE: 1 OF 3
SUPERVISORS NAME: Christina Gabelman
LICENSING EVALUATOR NAME: Lissete Gonzalez
LICENSING EVALUATOR SIGNATURE: DATE: 10/27/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/27/2021
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 3
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: NUNEZ CERVANTES FAMILY CHILD CARE
FACILITY NUMBER: 198020564
VISIT DATE: 10/27/2021
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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.

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.

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.

All adults living and working in the home shall be made of aware of the Departments right to inspection authority, which includes but not limited to the right to enter the home when children are being cared for, interview children and adults and review documentation.

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 Pediatric First Aid and CPR certification and a valid criminal record clearance associated to the facility license.

LPA discussed ongoing COVID-19 precautionary measures with applicant including indoor face mask requirements; all staff and children over the age of 2 years old are required to wear a face mask while indoors except for activities such as eating or sleeping.

REPORT CONTINUES ON NEXT PAGE: 2 OF 3
SUPERVISORS NAME: Christina Gabelman
LICENSING EVALUATOR NAME: Lissete Gonzalez
LICENSING EVALUATOR SIGNATURE:

DATE: 10/27/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/27/2021
LIC809 (FAS) - (06/04)
Page: 2 of 3
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: NUNEZ CERVANTES FAMILY CHILD CARE
FACILITY NUMBER: 198020564
VISIT DATE: 10/27/2021
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LPAs advised the applicant how to access forms, regulations and quarterly updates on the Child Care Licensing website at: www.ccld.ca.gov including the Forms/Records to Keep in Your Family Child Care Home (LIC 311D).

There were no deficiencies cited during today's visit. LPA will recommend approval of the increase in capacity as the home meets Title 22 Code of Regulations.

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

Exit interview conducted and report was reviewed with the licensee, Alejandra Nunez Cervantes.

END OF REPORT PAGE: 3 OF 3
SUPERVISORS NAME: Christina Gabelman
LICENSING EVALUATOR NAME: Lissete Gonzalez
LICENSING EVALUATOR SIGNATURE:

DATE: 10/27/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/27/2021
LIC809 (FAS) - (06/04)
Page: 3 of 3