198021144-1-27-2023-33-CC-NTCG-CNGPX6-20230127104147

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 198021144
Report Date: 01/27/2023
Date Signed: 01/27/2023 10:41:57 AM

Document Has Been Signed on 01/27/2023 10:41 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:	CAUDILLO FAMILY CHILD CARE		FACILITY NUMBER:	198021144
ADMINISTRATOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY: 8	TOTAL ENROLLED CHILDREN: 8	CENSUS: 1	DATE:	01/27/2023
TYPE OF VISIT:	Prelicensing	UNANNOUNCED	TIME BEGAN:	08:50 AM
MET WITH:	Brenda Caudillo - Applicant		TIME COMPLETED:	10:50 AM

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Licensing Program Analyst (LPA) Nolan Tcheng conducted a pre-licensing inspection today. Upon arrival at 8:50am, LPA met with Brenda Caudillo, Applicant who guided analyst on a tour of the facility. Persons residing in the home are 1 adult and 3 children. The applicant is requesting a small family child care home license. Per applicant operation hours will be Monday to Friday, 6:00a.m. to 6:00 p.m.. Applicant states she will care for children 0-12 years old.

All areas identified on the facility sketch were inspected. The home is located behind a home addressed 2627 Pomeroy Ave. There is a side walkway to access the applicant's home. There is also a back alley entrance accessible. This home consists of 2 bedrooms, 1 bathroom, living room, kitchen, laundry room, and small yard. In the living room is an open wall heater which is screened to prevent access.

Areas that are accessible to children are as follows: Bedroom 1, kitchen, living room, bathroom, and small yard.

Areas off limits based on facility sketch submitted to children and parents include: Bedroom 2 and laundry room.

**Rooms that are off-limits need to be made inaccessible during operating hours**

At 9am, the applicant began touring LPA’s though the home starting with the entry way which lead directly to the living room. The living room was inspected and electrical outlets were observed to be covered. This room will be used as the main play area. There were age appropriate toys and equipment for children to use. Next to the living room was a crib for an infant if applicant were to enroll. There is a small storage section next to the crib that has napping equipment in the form of cots. There is also a changing table available. The kitchen was inspected, and LPA observed a latch on the cabinet under the sink and observed that sharp knives are kept in a high up cabinet out of reach. LPA advised that should the applicant have older children in care that may reach the cabinet, that they be secured. No poisons are kept in the home.
REPORT CONTINUES PAGE 1 of 4

SUPERVISORS NAME: Claudia Guangorena
LICENSING EVALUATOR NAME: Nolan Tcheng
LICENSING EVALUATOR SIGNATURE:	DATE: 01/27/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/27/2023

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: CAUDILLO FAMILY CHILD CARE	FACILITY NUMBER: 198021144
	VISIT DATE: 01/27/2023

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The tour continued to bedroom 1. Adjacent to the bedroom was the bathroom for children in care to use. There was safety latches on the cabinet underneath the sink. Both rooms were observed to be safe and free of hazards. Per applicant, there are no pets, firearms, and weapons on the premises. At 9:15am, applicant showed LPA the fire extinguisher. LPA observed a 1A10BC Fire Extinguisher was anchored to the wall next to the kitchen. LPA discussed with applicant that a 2A10BC fire extinguisher is required and informed them of where they could pick one up. Applicant also tested the carbon monoxide detector next to the kitchen and smoke detectors in the bedroom. Both sounded off the alarms and heard by LPA to be functional. There are emergency supplies available. The small yard was reviewed last. There are playhouses, bikes, and balls for children in care to use. There is a fence that completely surrounds the play area.

Applicant has proof of CPR and First Aid training as indicated on the certificate. The applicant does have proof of Health and Safety training (completion date: 10/07/2022), Pediatric First Aid and CPR (ex. 06/2024).

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. Failure to obtain a criminal record background check clearances prior to initial presence in the home will result in an immediate $100.00 dollar or more per day Civil Penalty.
-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 to 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 check 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)
REPORT CONTINUES PAGE 2 of 4

SUPERVISORS NAME: Claudia Guangorena
LICENSING EVALUATOR NAME: Nolan Tcheng
LICENSING EVALUATOR SIGNATURE:	DATE: 01/27/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/27/2023

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: CAUDILLO FAMILY CHILD CARE	FACILITY NUMBER: 198021144
	VISIT DATE: 01/27/2023

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-Fire and safety drills must be performed every six months and documented for review by the Department.
-Children and Staff records must be maintained and updated as needed and must be available for review by the Department.
-Dog(s) and or pets are recommended to be isolated from children in care.
- 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 of aware of the Departments right to inspection authority, which includes but not limited to the right to enter the home when children are being cared for, interview children and adults and review documentation.
- Applicant 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.

Infant Care: Applicant states that she plans to care for infants. LPA advised the applicant to sleep infants where the infant can be directly supervised and advised against sleeping infants in a separate room. The applicant states that she will not sleep infants in a separate room. LPA reviewed SIDs, Never Shake A Baby, and safe sleeping practices. Infants should sleep mouth up, on their backs, free of clutter surrounding their sleeping space. Safe sleep concepts were provided.

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

Per applicant, there are no dual licenses at this address. Applicant’s email address was obtained during this inspection. The applicant was advised that email may be public information.

The applicant does have proof of immunization against influenza, pertussis, and measles.

Applicant completed required mandated reporter training on 07/31/2022. Mandated reporter training must be completed every 2 years. www.mandatedreporterca.com
REPORT CONTINUES PAGE 3 of 4

SUPERVISORS NAME: Claudia Guangorena
LICENSING EVALUATOR NAME: Nolan Tcheng
LICENSING EVALUATOR SIGNATURE:	DATE: 01/27/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/27/2023

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: CAUDILLO FAMILY CHILD CARE	FACILITY NUMBER: 198021144
	VISIT DATE: 01/27/2023

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During this inspection LPA discussed PIN 20-06 CCP, Social And Physical Distancing Guidance And Healthy Practices For Child Care Facilities In Response To The Global Coronavirus (COVID-19) Pandemic Written In Collaboration With The California Department Of Education and reviewed Child Care Covid-19 Self Assessment.

Per applicant, they do not carry liability insurance or a bond in accordance with standard established by Family Child Care statue. Signed statements (LIC282) will be on children’s files. The law requires 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.

LPA consulted and explained Child Abuse Reporting, Effects of Lead Exposure Flyer, Updated Parent’s Rights Poster with Complaint Hotline information, Capacity Handout (Small & Large) was provided during this inspection.

LPA 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 , INFORMATION TO BE POSTED IN YOUR FAMILY CHILD CARE HOME

The following corrections need to be corrected prior to obtaining a small family child care license. Corrections are due by 02/03/2023:

1. Applicant will purchase a new 2A10BC fire extinguisher.

A small family child care license will be granted upon receipt of proof of correction for the above and pending final review. 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.

The applicant’s signature on this report acknowledges that they have signed the Application for a Family Child Care Home License (LIC 279) under the penalty of perjury that the statements on the application and any attachments are correct.

Exit interview was conducted with Brenda Caudillo, Applicant, at 10:20am, who is in agreement with the above. END OF REPORT PAGE 4 of 4

SUPERVISORS NAME: Claudia Guangorena
LICENSING EVALUATOR NAME: Nolan Tcheng
LICENSING EVALUATOR SIGNATURE:	DATE: 01/27/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/27/2023

LIC809 (FAS) - (06/04)

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