198020984-4-5-2023-33-CC-JMOA-CQLNPH-20230405103822

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 198020984
Report Date: 04/05/2023
Date Signed: 04/05/2023 10:38:35 AM

Document Has Been Signed on 04/05/2023 10:38 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 CARE		FACILITY NUMBER:	198020984
ADMINISTRATOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY: 8	TOTAL ENROLLED CHILDREN: 4	CENSUS: 4	DATE:	04/05/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	09:15 AM
MET WITH:	Elma Cruz		TIME COMPLETED:	10:45 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 an unannounced annual required inspection at the above facility on 04/05/23 at 9:15 AM. LPA met with Elma Cruz, Licensee, who guided LPA on a tour of the home. Licensee's assistant, Catalina Rodriguez, arrived a few minutes later. There were four infants present at the time of arrival, one infant being the Licensee's biological child. This inspection was conducted in Spanish. This facility is located on a duplex property and is the back house. The front house is also licensed, license # 198012272. Family members residing in the home are the Licensee (criminal record clearance on file) and 3 children. This is a one story home which consists of 2 bedrooms, 1 bathroom, kitchen, living room and front patio (fenced). The two bedrooms are off limits. The children use the front patio for outside play. Areas accessible to children were inspected to ensure that they are clean and orderly with ventilation and heating for safety and comfort. There are toys available for children. There is a wall ac and a wall heater which is inaccessible. There is a working telephone service maintained in the home. Detergents, cleaning compounds, medications, and other items which can pose a danger to children are inaccessible. Smoke and carbon monoxide detectors were tested and are operable. Fire extinguisher indicates fully charged, serviced 10/27/2022. All food is prepared by the Licensee. The Licensee does not provide transportation services. Currently children use front patio for outdoor play. The outdoor play area was observed to be fenced. LPA observed that the outdoor patio has toys and other materials for children to play with. LPA did not observe any objects that could be hazardous to children in care. *REPORT CONTINUES ON NEXT PAGE

SUPERVISORS NAME: Claudia Guangorena
LICENSING EVALUATOR NAME: Judy Mora
LICENSING EVALUATOR SIGNATURE:	DATE: 04/05/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/05/2023

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: CRUZ FAMILY CHILD CARE	FACILITY NUMBER: 198020984
	VISIT DATE: 04/05/2023

NARRATIVE

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LPA observed the following required posted documentation in the main entry way of the facility: Facility License, Publication (PUB) 394- Notification of Parent Rights and Licensing Form. LPA reviewed facility records for LIC 9040- Facility Roster, LIC 610- Facility Disaster Plan and Disaster drill log, last drill documented was 03/16/2023. Licensee states there are currently 4 children enrolled including her infant, children's roster was reviewed and is current.

Licensee states that there are no poisons stored in the home and understands that all poisons must be locked, not only inaccessible to children. Isolation area for sick children waiting to be picked up is in the kitchen area. Licensee will use a playpen so children can rest. Per Licensee there are no firearms or weapons stored in the home.

Infant Care: The facility is caring for one infant under 12 months and three infants under the age of two. LPA observed the sleeping equipment for each child. LPA informed licensee of the Safe sleep regulations, including LIC 9227 Infant Sleep Plan for infants under 12 months, 15-minute sleep check documentation for infants 0-24 months. LPA reviewed sleep checks for infants present.

Children’s records were reviewed for (LIC) 282- Affidavit Regarding Liability Insurance, Immunization's Records, LIC 700- Identification and Emergency Information, LIC 627- Consent for Medical Treatment, LIC 995A Notification of Parents’ Rights, LIC 9227- Infant sleep form (0-12 months, and documentation of 15-minute Infant Sleep Check (0-24 months). Children's records were observed to be complete.

Staff records were reviewed for approved Pediatric First Aid and CPR certification, the Licensee's certification expires 02/2024, the Licensee's Assistant's expires 02/2024. LPA reviewed the LIC 508- Criminal Record Statement, Proof of immunization's against measles, pertussis and influenza or influenza declination, TB clearance or risk assessment, LIC 9108- Statement Acknowledging Requirement to Report Child Abuse and current Mandated Reporter Training Certificate. The Licensee's certificate is dated 10/19/22 and Ms. Rodriguez's is dated 02/28/22. Staff records were observed to be complete.

*REPORT CONTINUES ON NEXT PAGE

SUPERVISORS NAME: Claudia Guangorena
LICENSING EVALUATOR NAME: Judy Mora
LICENSING EVALUATOR SIGNATURE:	DATE: 04/05/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/05/2023

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: CRUZ FAMILY CHILD CARE	FACILITY NUMBER: 198020984
	VISIT DATE: 04/05/2023

NARRATIVE

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Incidental Medical Services (IMS) policy was discussed. Per Ms.Cruz, there are no children on medications. 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 Center and the ADA, available at: http://www.ada.gov/childqanda.htm

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.

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.

LPA discussed the safe sleep regulations with licensee and discussed the Child Care Licensing Safe Sleep webpagehttps://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.

There were no deficiencies given during this inspection.

A notice of site visit was given and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

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

*END OF REPORT

SUPERVISORS NAME: Claudia Guangorena
LICENSING EVALUATOR NAME: Judy Mora
LICENSING EVALUATOR SIGNATURE:	DATE: 04/05/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/05/2023

LIC809 (FAS) - (06/04)

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