<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198020984
Report Date: 03/07/2022
Date Signed: 03/07/2022 10:02:59 AM

Document Has Been Signed on 03/07/2022 10:02 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:CRUZ FAMILY CHILD CAREFACILITY NUMBER:
198020984
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 0DATE:
03/07/2022
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
08:45 AM
MET WITH:Elma Cruz TIME COMPLETED:
10:20 AM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
Licensing Program Analyst (LPA) Judy Mora conducted a pre-licensing inspection today. LPA met with applicant, Elma Cruz, who guided analyst on a tour of the facility at approximately 9:15 AM. This inspection was conducted in Spanish. The Licensee was the only adult living in the home. There are 2 minors living in the home, who are the Applicant’s biological children. There is one cat that is kept in a bedroom. The Entrance Checklist for the CARE Tool was provided to the Applicant at the time of inspection.

All areas identified on the facility sketch were inspected. This is a one story home located on a triplex property. The home consists of 2 bedrooms, 1 bathroom, kitchen, living room (day care room), and front patio which is fenced. The children will use the bathroom, kitchen, the living room and the front patio will be used for outside play. These areas were inspected for safety, comfort, cleanliness, telephone service, ventilation and heating. There is a wall AC/heater which is inaccessible to children.

Areas off limits to children and parents include. 2 bedrooms. The applicant does understand that licensing staff may have access to off-limit areas during inspection visit if necessary.

Detergents, cleaning compounds, medicines, sharp objects and hazardous items that can pose a danger to children are inaccessible. Per applicant, there are no poisons in the home. Per applicant there are no weapons, firearms or bodies of water on the premises.

There are toys that are clean and safe for children. The valve on the required 2A 10BC fire extinguisher indicates fully charged, purchased 11/2021. Smoke detector and carbon monoxide detector in the kitchen were tested and are in operable condition.

*REPORT CONTINUES ON NEXT PAGE

SUPERVISORS NAME: Claudia Guangorena
LICENSING EVALUATOR NAME: Judy Mora
LICENSING EVALUATOR SIGNATURE: DATE: 03/07/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/07/2022
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 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: CRUZ FAMILY CHILD CARE
FACILITY NUMBER: 198020984
VISIT DATE: 03/07/2022
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
LPA discussed the requirement of the following documents in the main entry way of the facility: Facility License, Publication (PUB) 394- Notification of Parent Rights and Licensing Form (LIC) 9148- Earthquake Preparedness form. LPA also discussed the requirement of the following facility records for LIC 9040- Facility Roster, LIC 610- Facility Disaster Plan and Disaster drill log which is required every 6 months.

Applicant has completed the Health and Safety Training, including Nutrition requirement, completed 02/25/22. Pediatric First Aid and CPR for Elma Cruz expires 02/05/24. There are first aid supplies on the premises. Applicant has completed the AB1207 Mandated Child Abuse Reporting training, certificate is on file dated 11/25/20.

Infant Care: Per Applicant, she does plan to care for infants. The applicant has an infant crib and a play yard for infant sleep purposes. LPA informed licensee of the new Safe sleep regulations, including LIC 9227 Infant Sleep Plan for infants under 12 months, 15-minute sleep check documentation for infants 0-12 months.

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.

Incidental Medical Services (IMS) policy was discussed. For IMS information , see PIN 22-02-CCP. 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


*REPORT CONTINUES ON NEXT PAGE

SUPERVISORS NAME: Claudia Guangorena
LICENSING EVALUATOR NAME: Judy Mora
LICENSING EVALUATOR SIGNATURE:

DATE: 03/07/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/07/2022
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: CRUZ FAMILY CHILD CARE
FACILITY NUMBER: 198020984
VISIT DATE: 03/07/2022
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
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.

Control of property was submitted to the Department. Per applicant, there are no dual licenses at this address.



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

The applicant will be approved for a small family child care license upon a final file review.

Once licensed, the applicant is required to adhere to the terms and limitation as stated on the license.

Exit interview conducted and report was reviewed with the applicant, Elma Cruz.

*END OF REPORT

SUPERVISORS NAME: Claudia Guangorena
LICENSING EVALUATOR NAME: Judy Mora
LICENSING EVALUATOR SIGNATURE:

DATE: 03/07/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/07/2022
LIC809 (FAS) - (06/04)
Page: 3 of 3