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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198400504
Report Date: 01/25/2022
Date Signed: 01/25/2022 11:57:51 AM

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:VALENCIA FAMILY CHILD CAREFACILITY NUMBER:
198400504
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY:8CENSUS: 0DATE:
01/25/2022
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
09:45 AM
MET WITH:Sandra Valencia, ApplicantTIME COMPLETED:
12:10 PM
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On Tuesday, January 25 at 9:50 AM, Licensing Program Analyst (LPA) Mayra Rivera conducted a pre-licensing inspection and met with applicant Sandra Valencia who guided LPA Rivera on a tour of the facility. The applicant is requesting a small family child care home license.

Family members residing in the home has been discussed with applicant and are cleared. Operating hours are Monday to Friday, 7:00 AM to 6:00 PM and care for children ages 0 to 12. Entrance and sign in and out will take place at the front door. Prior to children entering the facility, applicant will conduct health screening and temperature checks.

This facility is a duplex one story home that consists of three bedrooms, one bathroom, kitchen, living room, dinning area and front yard and backyard (fenced and gated). All areas identified on the facility sketch were inspected. Areas that are accessible to children and identified on the facility sketch include; living room, bathroom, dinning area and front yard.
Areas off limits to children include- kitchen, all bedrooms, attic and backyard. LPA observed all off limits areas closed and a child proof round ball in placed on the door knobs making it inaccessible to children to open the doors.

At approximately 10:00 AM LPA Rivera inspected the facility for safety, comfort, cleanliness, ventilation and working phone (cell phone). For ventilation, LPA Rivera observed wall AC unit and portable fan heater with a fire proof screen cover in the living room. LPA observed the furniture, children materials, cots and a crib to be in good condition and age appropriate. LPA observed a safety gate in place between the daycare area and kitchen to prevent children entering the kitchen area.

At approximately 10:06 AM, LPA Rivera entered the restroom and observed the toilet, hand washing sink, and hand soap. LPA observed the bottom cabinet closed and with a child proof lock in place making it inaccessible to children to open cabinet door. LPA observed the restroom to be in good condition.

SUPERVISOR'S NAME: Karen ChambersTELEPHONE: (323) 981-3368
LICENSING EVALUATOR NAME: Mayra RiveraTELEPHONE: (323) 629-7782
LICENSING EVALUATOR SIGNATURE:

DATE: 01/25/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/25/2022
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 CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME: VALENCIA FAMILY CHILD CARE
FACILITY NUMBER: 198400504
VISIT DATE: 01/25/2022
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At approximately 10:15 AM LPA observed cleaning compounds items stored inside the bottom kitchen sink cabinet with a child proof lock in place making it inaccessible to children to open. Knives and sharp objects are stored inside the kitchen drawer and LPA observed all drawers with child proof locks in place making it inaccessible to children to open the drawers. For drinking water, applicant will be providing water bottles and also assign each child with their own personal water cup. Also, applicant will be providing meals and snack and will be enrolling for the food program (California Adult Child Care Food Program ).

LPA Rivera asked applicant if there are any pets, poisons, firearms, weapons or bodies of water. Applicant stated he has no pets, body of waters, firearms, weapons or poisons. LPA did not observe firearms, weapons, poisons nor bodies of water. Applicant was advised that if any poisons (ex; drano, rat poison or items with skull hazard symbol), firearms and weapons are purchased, it is required to be locked with a key or combination lock and firearm and ammunition must be stored separately.



At approximately 10:20 AM LPA Rivera observed the required 2A10BC fire extinguisher located in the living room, kitchen and the valve on the green area indicating fully charged and serviced on 9-3-2021. LPA observed the carbon monoxide detector and smoke detector in the kitchen and LPA tested the detector and heard the alarm sound. The smoke and carbon detectors are in good condition.

At approximately 10:30 AM, LPA Rivera inspected the outdoor area for safety, comfort and cleanliness. LPA observed the yard to be fenced and gated. LPA also observed the side gates closed and a self latch lock in place. The porch provides adequate shade. LPA observed play equipment to be in good condition and age appropriate.

LPA observed applicant Pediatric First Aid/ CPR certification with expiration date March, 2022 and Health and Safety certification dated 9/6/21 and lead component 5/4/2021. Licensee has proof of immunization against Pertussis, MMR and Influenza. Licensee has completed the mandated reporter (AB 1207) training on 11/12/2021. Licensee was advised that the mandated reporter training must be completed every 2 years, and is available at www.mandatedreporterca.com

LPA observed LIC 610A Emergency Disaster Plan, Pub 394 Notification of Parents Rights, LIC 999 Facility sketch, child car seat law posted on a bulletin board by the main entrance.

SUPERVISOR'S NAME: Karen ChambersTELEPHONE: (323) 981-3368
LICENSING EVALUATOR NAME: Mayra RiveraTELEPHONE: (323) 629-7782
LICENSING EVALUATOR SIGNATURE:

DATE: 01/25/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/25/2022
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 CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME: VALENCIA FAMILY CHILD CARE
FACILITY NUMBER: 198400504
VISIT DATE: 01/25/2022
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The following was also discussed with the applicant Sandra Valencia:
1. Individuals who are 18 years of age or older and 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 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.
2. 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 and Pediatric First Aid certification and a valid criminal record clearance associated to the facility license.
3. A current roster of children enrolled must be available and maintained for a period of 3 years, even after children are no longer attending the facility.
4. 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.
5. 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.
6. 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.
7. Any unusual incidents or injuries must be reported to the Department within 24 hours via telephone and within seven (7) days in writing (refer to LIC 624B). Mandated reporter requirements were reviewed and explained.
8. Fire and safety drills must be performed every six (6) months and documented for review by the Department.
9. Smoking is prohibited in the family childcare home.
10. Children and staff records must be maintained and updated as needed and be available for review by the Department.
11. Dog(s) and/or pets are recommended to be isolated from children in care.
12. No baby bouncers, No infant walkers, No Johnny jumpers, No saucer chairs, No trampolines and any other item that falls into this category is not permitted in the facility.
13.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.
14. Applicant shall reveal each facility license number in all advertisements, publications or announcements with the intent to attract clients.
SUPERVISOR'S NAME: Karen ChambersTELEPHONE: (323) 981-3368
LICENSING EVALUATOR NAME: Mayra RiveraTELEPHONE: (323) 629-7782
LICENSING EVALUATOR SIGNATURE:

DATE: 01/25/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/25/2022
LIC809 (FAS) - (06/04)
Page: 3 of 5
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: VALENCIA FAMILY CHILD CARE
FACILITY NUMBER: 198400504
VISIT DATE: 01/25/2022
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LPA Rivera discussed with applicant Sandra Valencia the protocol in place in regards COVID 19. Applicant stated protocol in place is having parents not fully enter the facility and sign in and out will take place at the front door entrance. Applicant will scan the children for any symptoms such as fever, running nose, cough or child's behavior and will inform parent child cannot stay if any symptoms related to Covid 19 or if symptoms appear during the day. Applicant will isolate the child and call parent for pick up. Isolation will take place in the front of the living room. Children will wash their hands during arrival, entering the facility from outdoor play, meal times, covering their cough and using the restroom. Applicant stated she is aware of cleaning, disinfecting and sanitizing and the importance of the constant hand washing.

Safe Sleep: LPA discussed the safe sleep regulations with applicant Sandra Valencia 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 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.

LPA Rivera also reviewed Sudden Infant Death Syndrome (SIDS), Never Shake A Baby, and Lead Exposure information with licensee. LPA also explained to applicant that car seat, stroller are only and only for transportation, highchair is only and only for feeding and stated items cannot be misused.



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
SUPERVISOR'S NAME: Karen ChambersTELEPHONE: (323) 981-3368
LICENSING EVALUATOR NAME: Mayra RiveraTELEPHONE: (323) 629-7782
LICENSING EVALUATOR SIGNATURE:

DATE: 01/25/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/25/2022
LIC809 (FAS) - (06/04)
Page: 4 of 5
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: VALENCIA FAMILY CHILD CARE
FACILITY NUMBER: 198400504
VISIT DATE: 01/25/2022
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Criminal Record Statement: Applicant Sandra Valencia 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.

LPA informed applicant how to access forms, regulations and quarterly updates, and Providers Information Notices (PIN) online at: www.ccld.ca.gov



LPA Rivera explained in detailed to applicant and provided forms: LIC 311 Forms/Records to Keep in Your Family Child Care Home, LIC 9221 Parent Consent for Administration of Medications and medication chart, LIC 9040 Child Care Facility Roster, LIC 624 Unusual Incident Report, LIC 9227 Individual Infant Sleeping Plan, Safe sleep practices, safe sleep log the California Car Seat Law Changes (effective February 2018), Effects of Lead Exposure, Shaken Baby Syndrome, and Sudden Infant Death Syndrome (SIDS).

There is no corrections needed.

A final review of the application will be completed prior to licensure. Once licensed, the applicant is required to adhere to the terms and limitations stated on the license. Exit interview was conducted with applicant Sandra Valencia.

SUPERVISOR'S NAME: Karen ChambersTELEPHONE: (323) 981-3368
LICENSING EVALUATOR NAME: Mayra RiveraTELEPHONE: (323) 629-7782
LICENSING EVALUATOR SIGNATURE:

DATE: 01/25/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/25/2022
LIC809 (FAS) - (06/04)
Page: 5 of 5