198021053-9-28-2022-33-CC-MGAA-CJPUGZ-20220928153511

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 198021053
Report Date: 09/28/2022
Date Signed: 09/28/2022 03:35:29 PM

Document Has Been Signed on 09/28/2022 03:35 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:	SANTOS FAMILY CHILD CARE		FACILITY NUMBER:	198021053
ADMINISTRATOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY: 8	TOTAL ENROLLED CHILDREN: 0	CENSUS: 0	DATE:	09/28/2022
TYPE OF VISIT:	Prelicensing	ANNOUNCED	TIME BEGAN:	01:28 PM
MET WITH:	Joel Forteza Santos, Applicant		TIME COMPLETED:	03:40 PM

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This was an announced pre-licensing inspection conducted by Licensing Program Analyst (LPA) Mireya Garcia. Due to COVID- 19 precautionary measures were taken, individuals present during inspection wore appropriate personal protective equipment.

At 1:28 p.m., LPA met with Joel Santos, Applicant who guided analyst on a tour of the facility. Per applicant, there are no family members residing in the home applicant is the only one (1) adult and no children. The applicant is requesting a small family child care home license. Per applicant, operation hours will be Monday to Friday, 8:30AM to 5:30PM. Applicant states that he will care for children 2 months-5 years of age.

At 1:34 p.m., LPA Garcia toured through the interior of the home. This is a one-story home located in the back side of the property lot. This property lot has 2 separate dwellings with each property having individual addresses. This home consists of one (1) bedroom, one (1) restroom, living room/dining room/kitchen (one open space), driveway, shared storage shed, backyard (fenced) and shared front yard (fenced). Per Applicant front yard is the back yard of the front property which residents of 3658 Valleybrink Rd will use only during the non-operating hours of the day care. LPA observed a laundry room attached to the front house with the address of 3658 Valleybrink Rd, per applicant laundry room is shared with applicant and 3658 Valleybrink Rd residents. The laundry room is accessible the outdoor play area where children in care will use. Per applicant laundry room is for the property lot tenants use. LPA obtained a Declaration (LIC855) from applicant which explains plan for use of laundry room/shared yard and also explains that adult tenants from 3658 Valleybrink Rd will be fingerprinted and associated to the facility prior to having children in care.

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SUPERVISORS NAME: Brandi VanOosten
LICENSING EVALUATOR NAME: Mireya Garcia
LICENSING EVALUATOR SIGNATURE:	DATE: 09/28/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/28/2022

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: SANTOS FAMILY CHILD CARE	FACILITY NUMBER: 198021053
	VISIT DATE: 09/28/2022

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All areas identified on the facility sketch were inspected. Areas that are accessible to daycare children will be the drive way (main day care entrance), one (1) restroom, living room/ dining room/kitchen, bedroom, shared front yard (fenced). Based on the Facility Sketch submitted, areas off-limits to children and parents will be the laundry room, shed and backyard (unfenced).

**Rooms that are off-limits need to be made inaccessible during operating hours** The Applicant does understand that licensing staff may have access to off-limit areas during inspection visit if necessary.

LPA did not observe any hazards inside the home. LPA asked to be shown the electrical outlets in the areas used by the children and observed to be covered. Detergents, cleaning compounds, medicines, sharp objects, and hazardous items that can pose a danger to children was observed inaccessible in areas designated for children. The Applicant states that there are no poisons in the home. The Applicant was advised that any poisons must be locked with a key or combination lock. LPA also observed appropriate equipment, toys, and games for children.

The value on the 2A10BC fire extinguisher indicates fully charged, as indicated on receipt of purchase dated 09/26/2022. There is a first aid kit located in the kitchen. There are smoke detectors throughout the home and a carbon monoxide detector located in the ceiling between the living/dining room/kitchen. At 1:52 p.m., LPA Garcia tested both alarms and found them to be operational. At 1:53 p.m., LPA Garcia toured through the exterior of the home. Per applicant, the shared front yard will be used for daycare outdoor play. LPA obtained a Declaration (LIC855) from applicant which explains the outdoor activity plan and also states that adult residents 3658 Valleybrink Rd will be fingerprinted and associated to the facility prior to applicant having children in care. LPA observed the front and back-yard area to be fenced.

Per Applicant, there are no pets, no firearms, weapons, or bodies of water on the premises.

The applicant states he will provide food for children in care. Applicant was advised at that if food is brought from the children’s homes, all containers must be labeled with child’s name and properly stored or refrigerated.

The applicant has completed the required Health and Safety Training, Nutrition Training, and Pediatric First Aid and CPR. The applicant’s Pediatric First Aid and CPR expires on May of 2024. The applicant has completed the required Mandated Reporter Training.

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SUPERVISORS NAME: Brandi VanOosten
LICENSING EVALUATOR NAME: Mireya Garcia
LICENSING EVALUATOR SIGNATURE:	DATE: 09/28/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/28/2022

LIC809 (FAS) - (06/04)

Page: 2 of 5

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: SANTOS FAMILY CHILD CARE	FACILITY NUMBER: 198021053
	VISIT DATE: 09/28/2022

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The following was discussed with the applicant:
-Individuals who are 18 years of age or older living in the home must obtain a criminal record clearance. Individuals within one month of their 18th birthday must be fingerprinted immediately. Civil Penalty will be assessed if not in compliance.
-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 with the facility license.
-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 2A-10BC must be serviced annually or as often as necessary and smoke and carbon monoxide detectors should be checked, and batteries replaced as needed.
-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.
-Any unusual incidents or injuries must be reported to the Department within 24 hours via telephone and within seven (7) days in writing. (use LIC624B for written report).
-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.
- No smoking, No infant walkers, No Johnny jumpers, No saucer chairs, No trampolines, and any other item that falls into that category are not permitted in the facility.
-All adults living and working in the home shall be made aware of the Department's right to inspection authority, which includes but is not limited to the right to enter the home when children are being cared for, interview children and adults, and review documentation.
- Licensees shall reveal each facility license number in all advertisements, publications, or announcements with the intent to attract clients.
- 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: Mireya Garcia
LICENSING EVALUATOR SIGNATURE:	DATE: 09/28/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/28/2022

LIC809 (FAS) - (06/04)

Page: 3 of 5

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: SANTOS FAMILY CHILD CARE	FACILITY NUMBER: 198021053
	VISIT DATE: 09/28/2022

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Infant Care:

LPA observed and inspected sleeping equipment for infants. LPA observed two play yards. All equipment meets the US Consumer Product Safety Commission safety standards. LPA observed that play yards are free from loose articles and objects. There are no objects hanging above or attached to the side of the play yard. Licensing staff advise when the applicant cares for infants to sleep infants where they can be directly supervised and advised against sleeping infants in a separate room. Infants under 12 months should sleep mouth up, on their backs, free of clutter surrounding their sleeping space. LIC 9227 (Individual Sleeping Plan) for infants up to 12 months and PIN 20-24-CCP: Recently Approved Safe Sleep Regulations in Effect was explained and issued to the applicant. Title 22 Regulation Section 102425(j) Infant Safe Sleep was discussed with the applicant, including but not limited to documentation that shall be maintained.

Medication: 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 the publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: http://www.ada.gov/childqanda.htm

Per Applicant, he currently does not carry liability insurance or a bond in accordance with the standard established by the Family Child Care statute. The law requires a Family Child Care provider to carry liability insurance or bond in the amount of $300,000 annually or to maintain the signed statement in the facility file. Signed statements (LIC282) shall be in the children’s files.

LPA Garcia consulted and explained Child Abuse Reporting, Effects of Lead Exposure Flyer, Updated Patent’s Rights Poster with Complaint Hotline information, Capacity Handout (Small & Large) was provided during this inspection. LPA Garcia advised the applicant how to access forms, regulations and quarterly updates, and Provider Information Notices (PIN) on the Child Care Licensing website at: www.ccld.ca.gov. LPA reviewed and issued the Forms/Records to Keep in Your Family Child Care Home (LIC 311D) and provided the following forms: Children forms/records, Facility forms/records, facility forms/ records, and Information to be posted in the Family Child Care Home.

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SUPERVISORS NAME: Brandi VanOosten
LICENSING EVALUATOR NAME: Mireya Garcia
LICENSING EVALUATOR SIGNATURE:	DATE: 09/28/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/28/2022

LIC809 (FAS) - (06/04)

Page: 4 of 5

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: SANTOS FAMILY CHILD CARE	FACILITY NUMBER: 198021053
	VISIT DATE: 09/28/2022

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During this inspection, Licensing staff consulted with applicant regarding COVID-19 health and safety guidelines on this date, applicant was provided CCP- COVID 19 Self- Assessment and forms to post. Per applicant, the following safety precautionary measures will be taken during the pickup and drop off of children: Children will be pick up and drop off from the front gate by the end of the driveway of the home where daily health checks and screening upon entry will be conducted by day care staff.

The following corrections need to be corrected prior to completing the application process for a small family child care license. Corrections are due by 10/28/2022.

-Applicant will submit proof of installed child safety stove knobs.

-Applicant will install a safety gate on the side of the residence to make side area inaccessible to children.

-Applicant will install a safety gate on the outdoor AC Unit to make area inaccessible to children.

-Applicant will install a cover on wall heater (living room) to make area inaccessible to children.

A small family child care license will be granted upon receipt of proof of corrections for the above and will be submitted for approval. Once licensed, the applicant is required to adhere to the terms and limitations stated on the license. A copy of this report and all other Licensing reports must be made available to the public for 3 years.

At 3:00 p.m., an exit interview conducted, and report was reviewed with Applicant, Joel Forteza Santos.

SUPERVISORS NAME: Brandi VanOosten
LICENSING EVALUATOR NAME: Mireya Garcia
LICENSING EVALUATOR SIGNATURE:	DATE: 09/28/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/28/2022

LIC809 (FAS) - (06/04)

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