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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198021118
Report Date: 11/29/2022
Date Signed: 11/29/2022 09:40:25 AM

Document Has Been Signed on 11/29/2022 09:40 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:MADRIGAL FAMILY CHILD CAREFACILITY NUMBER:
198021118
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 0CENSUS: 0DATE:
11/29/2022
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
08:45 AM
MET WITH:Rebeca Madrigal TIME COMPLETED:
10:00 AM
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Licensing Program Analyst (LPA) Judy Mora conducted a pre-licensing inspection today. LPA met with applicant, Rebeca Madrigal, who guided analyst on a tour of the facility at approximately 8:55 AM. The applicant and her spouse, Joseph Madrigal, are the only adults living in the home; criminal record clearances are on file. There are no pets in the home. The Entrance Checklist for the CARE Tool was provided to the Licensee at the time of inspection.

All areas identified on the facility sketch were inspected. This is a one story home which consists of 3 bedrooms, 1 bathroom, kitchen, living room (day care room), and front and back yards. The home has a basement with the entrance located in the back yard. The applicant is going to install a latch on the door. The children will use the bathroom, kitchen, the living room and the back yard 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 in the living room which is inaccessible to children.

Areas off limits to children and parents include. 3 bedrooms and basement. 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 10/2022. Smoke detector in the kitchen was tested and is in operable condition. LPA was unable to determine if the detector also has the carbon monoxide component. LPA asked applicant for verification of the device. Applicant will send verification by close of business day today 11/29/22.

*REPORT CONTINUES ON NEXT PAGE

SUPERVISORS NAME: Claudia Guangorena
LICENSING EVALUATOR NAME: Judy Mora
LICENSING EVALUATOR SIGNATURE: DATE: 11/29/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/29/2022
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 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: MADRIGAL FAMILY CHILD CARE
FACILITY NUMBER: 198021118
VISIT DATE: 11/29/2022
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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 03/29/22. Pediatric First Aid and CPR for Rebeca Madrigal expires 08/28/23. There are first aid supplies on the premises. Applicant has completed the AB1207 Mandated Child Abuse Reporting training, certificate is on file dated 04/24/22.

Infant Care: Per Applicant, she does plan to care for infants. The applicant has an infant 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 0-24 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 Ms. Madrigal 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.

This facility plans to provide Incidental Medical Services – IMS. For IMS information , see PIN 22-02-CCP. 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: 11/29/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/29/2022
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: MADRIGAL FAMILY CHILD CARE
FACILITY NUMBER: 198021118
VISIT DATE: 11/29/2022
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LPA reviewed with Ms. Madrigal, 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.

Entrance Checklist was provided to the applicant.

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 Rebeca Madrigal.

*END OF REPORT

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

DATE: 11/29/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/29/2022
LIC809 (FAS) - (06/04)
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