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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198400040
Report Date: 08/26/2022
Date Signed: 08/26/2022 12:28:17 PM

Document Has Been Signed on 08/26/2022 12:28 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 CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME:CASTELLANOS & LOPEZ MENDEZ FAMILY CHILD CAREFACILITY NUMBER:
198400040
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 4CENSUS: 2DATE:
08/26/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:45 AM
MET WITH:Kenia Castellanos, LicenseeTIME COMPLETED:
12:45 PM
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Licensing Program Analyst (LPA) Alicia Mooberry conducted a Required Annual Inspection in Spanish on this date. Upon arrival at 9:45 LPA met with Kenia Castellanos who allowed LPA entry, LPA explained the purpose of the inspection and tour of facility. LPA inspected rooms/areas on the facility sketch in which child-care services are provided and to which children have access. LPA provided the inspection Entrance Checklist, LIC 126. Per licensee the hours of operation are Monday-Sunday 3pm - 7:00am.

LPA discussed Overnight care regulations and reminded licensee care provided during the day and overnight combined shall not exceed 24 hours from the time the child entered into care.

There were 2 children present. Also present was licensee's adult daughter. All adults present have been cleared and associated. Individuals residing in the home were discussed and noted.

This is a single story home with 2 bedrooms and 1 bath. All areas of the home are accessible to children in care. The main daycare are is located in the living room, The bedroom is used for sleeping, LPA observed individual mattresses for each child in care. Per licensee sheets are washed weekly.

Off limit areas are: Font yard and detached one (1) car garage/laundry room located in the backyard. Areas that are used by children were inspected for safety, comfort, cleanliness, telephone service, ventilation and heating. The licensee provides food for children in care.

The following was observed and reviewed during this inspection:


LPA observed the facility license, Publication (PUB) 394- Notification of Parent Rights and Licensing Form (LIC) 9148- Earthquake Preparedness form. LPA observed completed facility records including; LIC 9040- Facility Roster, LIC 610- Facility Disaster Plan posted in the living room, where parents drop of children. .
Last disaster drill on 8/1/22.

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SUPERVISORS NAME: Valarie Cook
LICENSING EVALUATOR NAME: Alicia Mooberry
LICENSING EVALUATOR SIGNATURE: DATE: 08/26/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/26/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.

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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 CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME: CASTELLANOS & LOPEZ MENDEZ FAMILY CHILD CARE
FACILITY NUMBER: 198400040
VISIT DATE: 08/26/2022
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Smoke and carbon monoxide detectors were tested and are operable. Fire extinguisher indicated fully charged and was purchased on 06/21, Licensee was reminded that fire extinguisher needs to be serviced yearly. The home maintains telephone service via cell phone. There are toys and other age appropriate material available for children. LPA observed that cleaning compounds are in locked kitchen inaccessible to children. The bathroom that children use is located in the hallway observed to be clean and free of hazards.
Licensee states that there are no poisons stored in the home and understands that all poisons must be lock, not only inaccessible to children.

Per Licensee there are no firearms or weapons stored in the home.


Isolation area for sick children waiting to be picked up is in living room, away from the other children.

Infant Care: Per licensee, there are no infants enrolled. LPA informed licensee of the new Safe sleep regulations, discussed PIN 20-24-CCP, LIC 9227 Infant Sleep Plan for infants under 12 months, 15-minute sleep check documentation for infants 0-24 months. Licensee states there is a crib in storage available for infants if/when needed.

LPA discussed the safe sleep regulations with licensee 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 licensee 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.

Currently, children are using the back yard for outdoor play. The outdoor play area was observed to be fenced. LPA observed that the outdoor yard has toys and other materials for children to play with including a large trampoline with safety netting that zips and locks, swings which is anchored to the ground with grass that cushions under structure. LPA discussed play structures to be used according to the manufacturer recommendations. Per licensee, the children are supervised when playing outside. LPA observed preschool ages plastic structure with slides. LPA did not observe any objects that could be hazardous to children in care. LPA observed 3 locked storage shed at the rear of the back yard.

Facility does not have a pool or similar bodies of water. Per licensee, there are no pets in the home.

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SUPERVISORS NAME: Valarie Cook
LICENSING EVALUATOR NAME: Alicia Mooberry
LICENSING EVALUATOR SIGNATURE:

DATE: 08/26/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/26/2022
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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 CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME: CASTELLANOS & LOPEZ MENDEZ FAMILY CHILD CARE
FACILITY NUMBER: 198400040
VISIT DATE: 08/26/2022
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Children’s records were reviewed for (LIC) 282- Affidavit Regarding Liability Insurance, Immunization's Records, LIC 700- Identification and Emergency Information, LIC 627- Consent for Medical Treatment, LIC 995A Notification of Parents’ Rights. Child #1 is missing immunization records, this poses a potential risk to the health and safety of children in care.

Staff records were reviewed for required documents including approved Pediatric First Aid and CPR certification Expires on 05/2023, and current Mandated Reporter Training Certificate. Licenses have not completed the Mandated Reporter Training. LPA advised licensee how to access Mandated Reporter website and informed that the training is available in their preferred language.

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

Licensee was reminded that all adults 18 and over living or working in the home, 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.

To improve the quality and value of the new inspection process, a survey will be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or tools, please send them by email to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/inspection-process.

Based on the LPA's observations and records review the following deficiencies will be cited today in accordance with California Title 22 Regulations, See LIC 809D

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

Exit interview conducted and report was reviewed with the Licensee, Kenia Castellanos

SUPERVISORS NAME: Valarie Cook
LICENSING EVALUATOR NAME: Alicia Mooberry
LICENSING EVALUATOR SIGNATURE:

DATE: 08/26/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/26/2022
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 08/26/2022 12:28 PM - It Cannot Be Edited


Created By: Alicia Mooberry On 08/26/2022 at 11:12 AM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME: CASTELLANOS & LOPEZ MENDEZ FAMILY CHILD CARE
FACILITY NUMBER: 198400040

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/26/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102418(g)
Immunizations
(g) The licensee shall document each child's immunizations as required by the California Code of Regulations, Title 17, Section 6070, and shall maintain such documentation for as long as the child is enrolled.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, the licensee did not comply with the section cited above in 1 out of 2 files reviewed were missing the immunization records which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 09/02/2022
Plan of Correction
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Per licensee, the immunization records for Child #1 will be obtained from the parent and a copy will be sent to LPA via email by POC due date.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Valarie Cook
LICENSING EVALUATOR NAME:Alicia Mooberry
LICENSING EVALUATOR SIGNATURE:
DATE: 08/26/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/26/2022


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