198021633-12-23-2024-33-CC-SLEE-DC8SQX-20241223130529

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 198021633
Report Date: 12/23/2024
Date Signed: 12/23/2024 01:05:42 PM

Document Has Been Signed on 12/23/2024 01:05 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
MONTEREY PARK CC RO, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME:	VARGAS FAMILY CHILD CARE		FACILITY NUMBER:	198021633
ADMINISTRATOR/ DIRECTOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY: 8	TOTAL ENROLLED CHILDREN: 8	CENSUS: 0	DATE:	12/23/2024
TYPE OF VISIT:	Prelicensing	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	10:30 AM
MET WITH:	Sandra Vargas		TIME VISIT/ INSPECTION COMPLETED:	12:30 PM

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) Seung Lee conducted a prelicensing inspection on this date. Upon arrival LPA Lee met with Applicant Sandra Vargas and applicant's adult daughter Vanessa Vasquez Vargas who provided translation to the applicant in Spanish. The inspection conducted was a for a pending change of location application. The Applicant is a Licensed for a small family child home. Facility number is 198020828. LPA Lee observed that the only two adults associated to the previous facility number was the applicant and her daughter. The hours of operation will be Monday-Friday 6AM until 10PM. Ages to be served will be ages 0 to 10 years old. The following was observed. All areas identified on the facility sketch were inspected. This is a one story home which consists of 3 bedrooms, 2 bathrooms, living room, kitchen, and back yard with a detached garage. Per applicant parents of children in care will enter the facility through the main front entrance located on 2nd St. Adults living in this home are the Applicant and her adult daughter. There were no pets or bodies of water observed. Applicant stated she does not own any fire arms. The heating and cooling of this home is done through central heating and air. There were no wall heaters or fire places observed. Areas that are accessible to children are as follows: Living room, 1 bathroom, and a part of the backyard. Areas off limits include: 3 bedrooms, 1 bathroom, kitchen, front yard, and a portion of the backyard where the detached garage is located. LPA observed that the backyard is separated into two parts using a wooden gate. The part of the garage containing the detached garage will be off limits. The detached garage is used for storage per applicant. Fire extinguisher was observed near the front entrance of the home with a service date of 08/30/2024. First Aide kit located in the kitchen. Smoke and Carbon monoxide detectors were observed in the living room and was in operating condition. The applicant own this home. A copy of the deed was provided by the applicant to LPA Lee prior to the inspection. .

SUPERVISORS NAME: Katrina Chicote
LICENSING EVALUATOR NAME: Seung Lee
LICENSING EVALUATOR SIGNATURE:	DATE: 12/23/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/23/2024

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: VARGAS FAMILY CHILD CARE	FACILITY NUMBER: 198021633
	VISIT DATE: 12/23/2024

NARRATIVE

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All areas of the family child care home, including the off limits areas, were inspected by LPA Lee during this inspection. Age appropriate toys and furniture was observed in the living area which will used by the children in care. The cabinets and drawers in the bathroom used by children were observed to be latched. The applicant stated all cleaning products and potentially hazardous materials are stored in the off limits Kitchen.
Cribs and playpen for infants were observed in the living room. Napping equipment such as mats were observed in the closet next to the restroom used by children.

LPA reviewed Sudden Infant Death Syndrome (SIDS), Shaken Baby Syndrome, and safe sleep practices with applicant. *Infants should always sleep on their backs, mouths facing up, light bedding.*

The following was reviewed during this inspection.
FORMS TO BE POSTED
LIC6101A Emergency Disaster Plan,
PUB394 Notification of Parents Rights Poster,
Facility License
Facility Records: LIC 624B Unusual Incident/Injury Report,LIC 9040 Child Care Facility Roster, LIC 9052 Employee Rights,LIC 9108 Statement Acknowledging Requirement to Report Child Abuse,
Staff Forms/Records - any assistant present must have the following on file: Proof of TB clearance (within one year), Immunization records. Notice of Employee Rights (LIC 9052), Criminal Record Statement (LIC 508), Statement Acknowledging Requirements to Report Suspected Child Abuse (LIC 9180).
Children’s records requirements: LIC 700 Identification And Emergency Information, LIC 627 Consent For Emergency Medical Treatment, LIC 282 Affidavit Regarding Liability Insurance, LIC 9150 Parent Notification Additional Children In Care, Immunization record, PUB 72- Family Child Care Consumer Guide, LIC 995A Notification of Parent’s Rights

Applicant is already familiar with the required forms for a family child care home since she is already licensed for a small family child care home before.

SUPERVISORS NAME: Katrina Chicote
LICENSING EVALUATOR NAME: Seung Lee
LICENSING EVALUATOR SIGNATURE:	DATE: 12/23/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/23/2024

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: VARGAS FAMILY CHILD CARE	FACILITY NUMBER: 198021633
	VISIT DATE: 12/23/2024

NARRATIVE

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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. 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,TB clearance, 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.
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.
Reporting Requirements: Any unusual incidents or injuries must be reported to the Department within 24 hours via telephone and within seven (7) days in writing. Mandated reporter requirements was reviewed and explained.
Fire and safety drills must be performed every 6 months and documented for review by the Department.
Smoking is prohibited in a family child care home, 24/7.
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 of aware of the Departments right to inspection authority.

Once licensed applicant was informed to contact the department 30 days prior to enrolling any child with IMS needs. LPA advised applicant to refer to Section 101173 and 101226 for further information on regulatory requirements. Regulation Interpretations and Procedures for Child Care Centers Section 102417. 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.

SUPERVISORS NAME: Katrina Chicote
LICENSING EVALUATOR NAME: Seung Lee
LICENSING EVALUATOR SIGNATURE:	DATE: 12/23/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/23/2024

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: VARGAS FAMILY CHILD CARE	FACILITY NUMBER: 198021633
	VISIT DATE: 12/23/2024

NARRATIVE

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LPA advised the applicant how to access forms, regulations and quarterly updates on the Child Care Licensing Website at: www.ccld.ca.gov

LPA Lee did not see any required corrections needed for this small family child care home. The applicant was advised that She may start providing caring for children after the application has been reviewed and approved by the Monterey Park Child Care office.

Exit interview conducted with applicant Sandra Vargas. Appeal rights discussed and explained.

SUPERVISORS NAME: Katrina Chicote
LICENSING EVALUATOR NAME: Seung Lee
LICENSING EVALUATOR SIGNATURE:	DATE: 12/23/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/23/2024

LIC809 (FAS) - (06/04)

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