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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198400478
Report Date: 01/19/2023
Date Signed: 01/19/2023 02:53:31 PM

Document Has Been Signed on 01/19/2023 02:53 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:CASTRO PINEDA & AMAYA FAMILY CHILD CAREFACILITY NUMBER:
198400478
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 3CENSUS: 3DATE:
01/19/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:30 PM
MET WITH:Licensee - Ana CastroTIME COMPLETED:
03:10 PM
NARRATIVE
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Licensing Program Analyst (LPA) R. Derraco conducted a required one year annual inspection to the above facility on 01/19/23. LPA arrived at the facility at 12:30 PM and met with licensee, Ana Castro, who guided analyst on a tour of the facility. Also present during this inspection was co licensee and S3. Per Licensee, there are 3 children that are currently enrolled. There were 3 children present upon arrival.

This is a one-story home which consists of 2 bedrooms, 1 bathrooms, kitchen/dining room, living room, laundry room/shed front yard and backyard (fenced). The off limit areas include 1 bedroom, laundry room/shed, front yard and back yard.

The main care area is located in the living room. LPA observed a wall mounted television, age appropriate toys, a cubby storage locker for children's personal belongings, wall mounted heater/air conditioning unit, and a futon couch. Emergency Disaster Plan, Parent’s Rights Poster and the Facility License were observed to be posted in the main care area. A wooden gate was observed at the entrance of the off limits kitchen and the hallway. Bedroom 1 was observed with sleeping cots, a baby changing station and a wooden crib. Per licensee, wooden crib is not used because infant can climb out. The bathroom designated for children use was observed to have an operable sink, faucet and toilet. LPA observed a covered fire place in the living room. The licensee states that she provides food for children in care. Per licensee, isolation area for children showing signs of illness will be located in bedroom 1. LPA did not observe the following items during the inspection: Infant Walkers, Johnny Jumpers, Saucer Chairs. No bodies of water were observed in the back yard play area. There are no pets on the premises. The valve on the required 2A 10BC fire extinguisher indicates fully charged and was serviced on 10/03/22, as indicated on service tag. Smoke and carbon monoxide detectors were tested and are operable. Smoking is prohibited in a licensed Family Child Care Home. Per Licensee, no one smokes in the home.
(page 1 of 3)
SUPERVISORS NAME: Trevino Cochran
LICENSING EVALUATOR NAME: Randy Derraco
LICENSING EVALUATOR SIGNATURE: DATE: 01/19/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/19/2023
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 8
Document Has Been Signed on 01/19/2023 02:53 PM - It Cannot Be Edited


Created By: Randy Derraco On 01/19/2023 at 02:01 PM
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: CASTRO PINEDA & AMAYA FAMILY CHILD CARE
FACILITY NUMBER: 198400478

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/19/2023

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 observation, interview and record review, the licensee did not document children's immunzations, which poses and potential Health, safety and/or personal rights risk to persons in care.
POC Due Date: 01/30/2023
Plan of Correction
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Licensees state they will complete a declaration indicating that LIC 311D has been reviewed and implemented.
Type B
Section Cited
CCR
102419(d)
Admission Procedures and Parental and Authorized Representative's Rights
(d) At the time of acceptance of each child into care, the licensee shall provide the child's parent or authorized representative with a copy of the notice Family Child Care Home Notification of Parent's Rights, LIC 995A (8/06), the Caregiver Background Check Process, LIC 995E (6/05), and the Family child Care Consumer Awareness Information, LIC 9212 (10/05).

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, interview and record review, the licensee did not provide the children's parents with a copy of the notice Family CHild Care Home Notification of Parents rights, LIC995A, which poses and potential Health, safety and/or personal rights risk to persons in care.
POC Due Date: 01/30/2023
Plan of Correction
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Licensees state they will complete a declaration indicating that LIC311D has been reviewed and implemented at the facility.
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:Trevino Cochran
LICENSING EVALUATOR NAME:Randy Derraco
LICENSING EVALUATOR SIGNATURE:
DATE: 01/19/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/19/2023


LIC809 (FAS) - (06/04)
Page: 3 of 8
Document Has Been Signed on 01/19/2023 02:53 PM - It Cannot Be Edited


Created By: Randy Derraco On 01/19/2023 at 02:01 PM
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: CASTRO PINEDA & AMAYA FAMILY CHILD CARE
FACILITY NUMBER: 198400478

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/19/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102421(a)
Child's Records
(a) The licensee shall maintain, in each child's record, the signed and dated notice form required in Section 102419(d).

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, interview and record review, the licensee did not maintain in each child's record the signed and dated notice form required in Section 102419(d), which poses a potential Health, safety and/or personal rights risk to persons in care.
POC Due Date: 01/30/2023
Plan of Correction
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Licensees state they will complete a declaration indicating that LIC311D has been reviewed and implemented at the facility.
Type B
Section Cited
CCR
102421(b)
Child's Records
(b) The licensee shall maintain, in each child's record, a copy of the emergency information card as required
in Section 102417(g)(7).

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, interview and record review, the licensee did not maintain a copy of the emergency information card for each child, which poses and potential Health, safety and/or personal rights risk to persons in care.
POC Due Date: 01/30/2023
Plan of Correction
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Licensees state they will complete a declaration indicating that LIC311D has been reveiwed and implemented at the facility.
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:Trevino Cochran
LICENSING EVALUATOR NAME:Randy Derraco
LICENSING EVALUATOR SIGNATURE:
DATE: 01/19/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/19/2023


LIC809 (FAS) - (06/04)
Page: 4 of 8
Document Has Been Signed on 01/19/2023 02:53 PM - It Cannot Be Edited


Created By: Randy Derraco On 01/19/2023 at 02:01 PM
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: CASTRO PINEDA & AMAYA FAMILY CHILD CARE
FACILITY NUMBER: 198400478

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/19/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102417(g)(7)
Operation of A Family Child Care Home
(7) An emergency information card shall be maintained for each child and shall include the child's full name, telephone number and location of a parent or other responsible adult to be contacted in an emergency, the name and telephone number of the child's physician and the parent's authorization for the licensee or registrant to consent to emergency medical care.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, interview and record review, the licensee did not maintain emergency information card for each child in care which poses a potential Health, safety and/or personal rights risk to persons in care.
POC Due Date: 01/30/2023
Plan of Correction
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Licensees state they will complete a declaration indicating that LIC311D has been reviewed and implemented at the facility.
Type B
Section Cited
CCR
102417(g)(8)
Operation of A Family Child Care Home
(8) Each family child care home shall have a current roster of children as specified in Health and Safety Code Section 1596.841.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, interview and record review, the licensee did not have a current roster of children, which poses and potential Health, safety and/or personal rights risk to persons in care.
POC Due Date: 01/30/2023
Plan of Correction
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.Licensees state they will complete a declaration indicating that LIC311D has been reviewed and implemented at the facility.
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:Trevino Cochran
LICENSING EVALUATOR NAME:Randy Derraco
LICENSING EVALUATOR SIGNATURE:
DATE: 01/19/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/19/2023


LIC809 (FAS) - (06/04)
Page: 5 of 8
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: CASTRO PINEDA & AMAYA FAMILY CHILD CARE
FACILITY NUMBER: 198400478
VISIT DATE: 01/19/2023
NARRATIVE
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Individuals who reside in the home were noted and discussed. 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.

All areas identified on the facility sketch that are accessible for children to use were inspected for safety, comfort, and cleanliness. There is telephone service via a cellphone that is used and the cellphone stays at the facility during operation hours. Licensee states that there are no firearms stored in the home. Detergents, cleaning compounds, and other items which could pose a danger to children were observed to be locked in a cabinet located in the kitchen. The licensee states that there are no poisons in the home and understands that storage areas for poisons must be locked, not just inaccessible.

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.

The licensee and other personnel have completed training on preventive health practices including Pediatric First Aid and CPR. The licensee's Pediatric First Aid and CPR expires on 07/25/2023. LPA observed that the Licensee and assistant do have proof of the Mandated Reporter AB 1207 compliant Child Care Training Certificate on file. File review was observed to have proper mandated immunization records. Children’s records were reviewed. LPA observed that two children in care (C2 and C3) did not have any documentation on file. LPA advised licensee that a citations under California Code of Regulation Sections 102419(d), 102421(a), 102421(b), 102417(g)(7), 102418(g) will be issued. A current children’s roster was not available for review. LPA advised licensee that a citation under CCR Section 102417(g)(8) will be issued.



Incidental Medical Services (IMS):
IMS was discussed with licensee. Per licensee, there are no children enrolled that require IMS at this time. Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual -
(page 2 of 3)
SUPERVISORS NAME: Trevino Cochran
LICENSING EVALUATOR NAME: Randy Derraco
LICENSING EVALUATOR SIGNATURE:

DATE: 01/19/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/19/2023
LIC809 (FAS) - (06/04)
Page: 7 of 8
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: CASTRO PINEDA & AMAYA FAMILY CHILD CARE
FACILITY NUMBER: 198400478
VISIT DATE: 01/19/2023
NARRATIVE
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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.

LPA advised the licensee to access forms, regulations and quarterly updates online at: www.cdss.ca.gov. LPA also discussed and provided LIC 311D - Forms/Records to be kept in your Family Child Care Home.

The following deficiencies listed on the attached LIC 809 (deficiency page) are being cited in accordance with California Code of Regulations Title 22. Deficiencies that are being cited need to be cleared to protect the children’s health & safety.

A notice of site visit was given and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

Exit interview conducted and report was reviewed with the licensees Ana Castro and Iris Amaya Castro.

(page 3 of 3)

SUPERVISORS NAME: Trevino Cochran
LICENSING EVALUATOR NAME: Randy Derraco
LICENSING EVALUATOR SIGNATURE:

DATE: 01/19/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/19/2023
LIC809 (FAS) - (06/04)
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