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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198020984
Report Date: 12/07/2023
Date Signed: 12/07/2023 09:01:20 AM

Document Has Been Signed on 12/07/2023 09:01 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
MONTEREY PARK CC RO, 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: 4DATE:
12/07/2023
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
08:00 AM
MET WITH:Elma Cruz, LicenseeTIME COMPLETED:
09:20 AM
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On December 7, 2023, Licensing Program Analysts (LPAs) Staicy Perry and Monique Ayala conducted a case management - licensee initiated inspection. A COVID-19 risk assessment was conducted. The home is currently licensed for 8 children and a request for a capacity of 14 children was received. All areas identified on the facility sketch were toured. Hours of operation are Monday through Friday 6:00am to 6:00pm. Licensee states she is working with children ages 3 months - 12 years old. LPAs observed a census of 4 children in care during the visit.

The facility has requested an increase of capacity from 8 to 14 on 10/24/2023. Fire clearance was granted on 11/01/2023. Capacity Increase will be granted, pending final file review. License will be amended to reflect new capacity of fourteen (14) children. Increase is contingent upon a Licensing Program Manager review and approval.

The day care area is provided in the living room, kitchen, 1 bedroom, 1 bathroom and back yard.

The LPA inspected the facility and found the facility to be clean and safe. telephone service was verified. Heating, lighting, and ventilation are adequate. LPA observed age-appropriate toys and materials.

LPA reviewed infant safe sleep regulation and ratios with licensee. A copy of the Safe Sleep Regulation was provided to the licensee along with Safe Sleep Plan LIC9227. LPA provided recall website, https://www.cpsc.gov/Recalls. Licensee was provided a sample of the 15-minute sleep log.



Carbon/Smoke Detectors were tested and found to be operable. There is currently a fire extinguisher observed with a service date of 10/5/23.

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SUPERVISORS NAME: Claudia Guangorena
LICENSING EVALUATOR NAME: Staicy Perry
LICENSING EVALUATOR SIGNATURE: DATE: 12/07/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/07/2023
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
MONTEREY PARK CC RO, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME: CRUZ FAMILY CHILD CARE
FACILITY NUMBER: 198020984
VISIT DATE: 12/07/2023
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CPR/1st Aid will expire 11/2025 and Mandated reporting Certificate will expire 2/28/2024.

LPAs reviewed if there are any weapons or pets Licensee states there are no weapons or pets present at the facility and LPAs did not observe any. There were no Bodies of Water observed on the premises. LPAs provided a Unusual Incident Report (UIR) and reviewed regulations of self-reporting. Cleaning products are kept in the kitchen under the sink with a child proof lock. No children are currently on medication, but Incidental Medical Services (IMS) policy was discussed.

Licensee provided LPA with assistants CPR/ 1st Aid certification with an expiration date of 11/4/25, Mandated Reporter training with an expiration date of 2/28/24 along with all immunization's at the time she requested for a capacity increase.

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

Exit interview conducted and report was reviewed with the Licensee, Elma Cruz.
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SUPERVISORS NAME: Claudia Guangorena
LICENSING EVALUATOR NAME: Staicy Perry
LICENSING EVALUATOR SIGNATURE:

DATE: 12/07/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/07/2023
LIC809 (FAS) - (06/04)
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