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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198020947
Report Date: 04/29/2022
Date Signed: 04/29/2022 05:30:19 PM

Document Has Been Signed on 04/29/2022 05:30 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:MARQUEZ FAMILY CHILD CAREFACILITY NUMBER:
198020947
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 0CENSUS: 0DATE:
04/29/2022
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
02:00 PM
MET WITH:Applicant, Olivia MarquezTIME COMPLETED:
05:45 PM
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On 4/29/22 at 2:00 p.m., Licensing Program Analysts (LPAs) Lilli Babcock and Brandi Van Oosten conducted an announced Pre-Licensing inspection. A COVID risk assessment was conducted prior to entry and appropriate personal protective equipment were used. The purpose of today’s visit is to inspect and evaluate the facility for initial licensure. Applicant is applying for a Small Family Child Care Home.

Individuals residing in the home are 4 adults and 2 children. Operation hours will be Monday through Friday, from 6:30 am to 5:30 pm. Ages to be served are 2 to 13 years.

Facility is a single-story home, containing 3 bedrooms, 2 bathrooms, den, kitchen, living room, dining room, garage, east side yard, and backyard with in-ground swimming pool. Side yard on west side of home contains a built-in storage shed and is locked with a key lock. Backyard is fenced and side yards are enclosed with metal gates and fencing.

Per Applicant, off-limit areas to the children and parents will be 3 bedrooms, 1 bathroom, kitchen, living room, dining room, garage, west side yard with shed, and backyard with in-ground swimming pool.

Per Applicant, areas accessible to children and parents will be den, bathroom located in hallway, and east side yard for outdoor play.
Page 1
SUPERVISORS NAME: Brandi VanOosten
LICENSING EVALUATOR NAME: Lilli Babcock
LICENSING EVALUATOR SIGNATURE: DATE: 04/29/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/29/2022
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 8
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: MARQUEZ FAMILY CHILD CARE
FACILITY NUMBER: 198020947
VISIT DATE: 04/29/2022
NARRATIVE
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Upon arrival at 2:00 PM, LPAs met with Applicant, Olivia Marquez who guided LPAs on a tour of the facility both indoors and outdoors. Also present in the facility at the time of inspection was applicants’ spouse. All areas identified on the facility sketch were inspected, including all off-limit areas. Areas that will be used for children were inspected for safety, comfort, cleanliness, heating, and ventilation, as well as inaccessibility to detergents, cleaning compounds, medicines, and sharp or hazardous items that can pose a danger to children. Per Applicant, poisons are kept in the garage, which is locked with a key. Applicant understands that any poison must be locked with a key or combination lock. LPA’s observed all 3 bedrooms contain locks on the doors and applicant understands that all 3 bedrooms must remain locked during hours of operation.

At 2:08 pm, LPAs observed a fire extinguisher in the den. The valve on the 2A10BC fire extinguisher indicates fully charged and is operable. Date on the receipt shows 11/16/21. LPA’s observed a combination smoke and carbon monoxide detector in the den that was tested and operable. LPA observed a fireplace in the facility, located in the den. The fireplace has a glass screen and also contains a chain with padlock, making it inaccessible to children. The home has electrical outlet covers throughout and maintains a First Aid and Emergency Kit located in the den by the fire extinguisher. LPA’s observed age appropriate toys. Sleeping equipment in the form of mats were observed on this day.

At 2:20 pm, LPAs observed a built-in swimming pool on the premises. Pictures were taken and pool checklist was completed by LPA.

The children will use the east side yard for outdoor play, which is fenced and contains a metal gate on each end. Age appropriate toys were observed.

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SUPERVISORS NAME: Brandi VanOosten
LICENSING EVALUATOR NAME: Lilli Babcock
LICENSING EVALUATOR SIGNATURE:

DATE: 04/29/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/29/2022
LIC809 (FAS) - (06/04)
Page: 2 of 8
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: MARQUEZ FAMILY CHILD CARE
FACILITY NUMBER: 198020947
VISIT DATE: 04/29/2022
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The facility has a working cell phone and landline. LPA’s reminded Applicant that there must always be a working phone at the facility while children are in care.

The applicant has completed the required Health and Safety Training, and Nutrition Training. Mandated Reporter Training is valid until 12/4/22. Pediatric First Aid and CPR are valid until 4/2/24. Proof of immunization against influenza, pertussis, and measles for applicant was readily available during today's inspection.

Per applicant there are no firearms or pets in the home, and none were observed by LPA’s on this day. The applicant states that they will provide food for children in care.

The following was discussed with the applicant:



· 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.
· Commencing September 1, 2016, a person shall not be employed or volunteer at a family day care home if he or she has not been immunized against influenza, pertussis, and measles. Each employee and volunteer shall receive an influenza vaccination between August 1 and December 1 of each year. The family day care home shall maintain documentation of the required immunization or exemptions from immunization, as set forth in this section, in the person’s pesonnel record that is maintained by the family day care home.

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SUPERVISORS NAME: Brandi VanOosten
LICENSING EVALUATOR NAME: Lilli Babcock
LICENSING EVALUATOR SIGNATURE:

DATE: 04/29/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/29/2022
LIC809 (FAS) - (06/04)
Page: 7 of 8
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: MARQUEZ FAMILY CHILD CARE
FACILITY NUMBER: 198020947
VISIT DATE: 04/29/2022
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A current roster of children enrolled must be available and maintained for a period of three years, even after children no longer are attending the facility.
· 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.
· The fire extinguisher type 2A10BC must be serviced annually or as often as necessary and smoke and carbon monoxide detectors should be checked and batteries replaced as needed.
· Reporting Requirement: 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.

· Reporting Requirement: Any unusual incidents or injuries must be reported to the Department within 24 hours via telephone and within seven (7) days of the incident


in writing.
· Fire and safety drills must be performed every six months and documented for review by the Department.
· Smoking is prohibited in a family child care home.
· Children and Staff records must be maintained and updated as needed and must be available for review by the Department.
· Saucer chairs, bouncers, infant walkers, Johnny Jumpers, trampolines or any similar items are prohibited.
· Inspection Authority: 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.
· Emergency Disaster Plan, Parent’s Rights Poster and the Facility License are required to be posted.

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SUPERVISORS NAME: Brandi VanOosten
LICENSING EVALUATOR NAME: Lilli Babcock
LICENSING EVALUATOR SIGNATURE:

DATE: 04/29/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/29/2022
LIC809 (FAS) - (06/04)
Page: 8 of 8
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: MARQUEZ FAMILY CHILD CARE
FACILITY NUMBER: 198020947
VISIT DATE: 04/29/2022
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· The facility license number must be on all advertisements, publications or announcements with the intent to attract clients.
· Isolation for Ill children: When a child is ill he/she shall be separated from other children (reference 102417(e) Operation of a Family Child Care Home).
· Liability Insurance was discussed; LPA advised applicant to review Title 22 Regulation 102417(m)(1) for additional information.

· Mandated Reporter Training: H&S 1596.8662: Beginning January 1, 2018, all licensed providers, applicants, directors and employees to complete training as specified on mandated reporter duties. Training is available at: www.mandatedreporterca.com

LPA reviewed and issued the LIC 311D - Forms/Records to Keep in Your Family Child Care Home. All required forms listed were explained and were provided to the applicant during the visit.



LPA advised the applicant how to access forms, regulations and quarterly updates on the Child Care Licensing website at: www.ccld.ca.gov.

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SUPERVISORS NAME: Brandi VanOosten
LICENSING EVALUATOR NAME: Lilli Babcock
LICENSING EVALUATOR SIGNATURE:

DATE: 04/29/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/29/2022
LIC809 (FAS) - (06/04)
Page: 3 of 8
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: MARQUEZ FAMILY CHILD CARE
FACILITY NUMBER: 198020947
VISIT DATE: 04/29/2022
NARRATIVE
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OTHER INFORMATION AND FORMS PROVIDED:
· Handouts provided for Never Shake a Baby, Sudden Infant Death Syndrome (SIDS) and Safe Sleeping practices
· Capacity Handout for a Small Family Child Care Home and Large Family Child Care Home was provided.
· Lead Exposure Flyer

LPA consulted with applicant regarding COVID-19 health and safety guidelines on this date, applicant was provided forms to post via email.

Per applicant, there are no dual licenses at this address. Applicant’s email address was obtained during this inspection. The applicant was advised that email may be public information.

The applicant’s signature on this report acknowledges that they have signed the Application for a Family Child Care Home License (LIC 279) under the penalty of perjury that the statements on the application and any attachments are correct.

Applicant is seeking to provide care for 8 children, ages 2-13 years old. Based upon today’s inspection, the following corrections needs to be completed by 5/13/22.

-Alarm installed on sliding glass door in master bedroom leading to pool. Applicant will email LPA to schedule a proof of correction visit.
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SUPERVISORS NAME: Brandi VanOosten
LICENSING EVALUATOR NAME: Lilli Babcock
LICENSING EVALUATOR SIGNATURE:

DATE: 04/29/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/29/2022
LIC809 (FAS) - (06/04)
Page: 4 of 8
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: MARQUEZ FAMILY CHILD CARE
FACILITY NUMBER: 198020947
VISIT DATE: 04/29/2022
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The application will be submitted for final review to the department once the corrections have been received. Once licensed, the Licensee is required to adhere to the terms and limitations stated on the license.

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

Applicant was reminded that all adults 18 and over living in the home, persons who provide care and supervision to children, and staff who have contact with children, 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.

LPA discussed the safe sleep regulations with applicant 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 [applicant, licensee, or facility representative] 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.

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SUPERVISORS NAME: Brandi VanOosten
LICENSING EVALUATOR NAME: Lilli Babcock
LICENSING EVALUATOR SIGNATURE:

DATE: 04/29/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/29/2022
LIC809 (FAS) - (06/04)
Page: 6 of 8
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: MARQUEZ FAMILY CHILD CARE
FACILITY NUMBER: 198020947
VISIT DATE: 04/29/2022
NARRATIVE
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LPA reviewed with applicant the LIC 311D, Forms/Records To Keep In Your Family Child Care Homes, children’s forms/records, facility forms/records, and information to be posted.

Community Care Licensing Division (CCLD) regularly sends information to licensed facilities, providers, and stakeholders by way of Provider Information Notices (PIN), Program Quarterly Update Newsletters and other important information communication platform.

To receive important licensed-related information to licensed facilities, visit the CCLD Important Information website at https://www.cdss.ca.gov/inforesources/community-care-licensing/subscribe and select the Child Care option to receive email communication.

Exit interview conducted and report was reviewed with the applicant Olivia Marquez.

Page 8

SUPERVISORS NAME: Brandi VanOosten
LICENSING EVALUATOR NAME: Lilli Babcock
LICENSING EVALUATOR SIGNATURE:

DATE: 04/29/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/29/2022
LIC809 (FAS) - (06/04)
Page: 5 of 8