<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198400568
Report Date: 05/13/2022
Date Signed: 05/13/2022 11:59:50 AM

Document Has Been Signed on 05/13/2022 11:59 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 CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME:WARREN FAMILY CHILD CAREFACILITY NUMBER:
198400568
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 0DATE:
05/13/2022
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
09:20 AM
MET WITH:Ryan Warren - LicenseeTIME COMPLETED:
12:05 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
This is an announced Pre-licensing Inspection conducted today by Alicia Bailey Licensing Program Analyst (LPA) on 05/13/2022 at 9:30 am conducted with the licensee Ryan Warren to inspect the facility for licensing. At 9:38 am during the inspection, LPA Bailey discussed, assessed, and noted individuals residing in the home. The licensee Warren is applying for a small family childcare home relocation from facility 198019942. This is a one-story home with a attached garage. The operating hours would be Sunday thru Saturday from 6:00 am to 5:59 AM 23 hours. The home was inspected for safety, comfort, cleanliness, telephone service, heating and ventilation, inaccessibility to poisons, detergents, cleaning compounds, medicines, and hazardous items that can pose a danger to children.

The licensee Warren owns the property. The licensee Warren provided a copy of the mortgage statement.

All areas identified on the facility sketch were inspected. This facility is a one story family home that consists of three (3) bedrooms, two (2) bathroom, living room, kitchen, backyard, and garage.

Areas used by the children were inspected as follows: (day care room) one bedroom, and one bathroom and backyard. Licensee Warren states the main day care in the day care room.

Areas off-limits include the Garage ( lock on the garage door to prohibited access during hours children are in care) two (2) bedrooms, one (1) bathroom and the kitchen.

**Rooms that are off-limits need to be made inaccessible during operating hours** The licensee Warren does understand that licensing staff may have access to off-limit areas during inspection visits if necessary.

SUPERVISORS NAME: Karen Chambers
LICENSING EVALUATOR NAME: Alicia Bailey
LICENSING EVALUATOR SIGNATURE: DATE: 05/13/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/13/2022
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 6
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: WARREN FAMILY CHILD CARE
FACILITY NUMBER: 198400568
VISIT DATE: 05/13/2022
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
26
27
28
29
30
31
32
Licensee Warren completed the Pediatric CPR/First Aid on 04/28/2022 and expires on 04/28/2024 as indicated on the certificates. Preventative Health practices and Lead component certification were completed on 05/01/2022. The mandated reporter training was completed on 05/02/2022. The licensee completed the COVID-19 Self-Assessment on 05/03/2022.

Per the licensee Warren, there are no firearms in the facility. There is no swimming pool, spa, or other bodies of water observed on the premises. LPA Bailey asks applicant Warren do you have any pets. licensee Warren stated no.

At 10:00 AM LPA Bailey asks the licensee to be guided on how the children will enter the facility. licensee Warren demonstrates the parents and children will walk thru the side gate to the backdoor.

At 10:06 AM LPA Bailey observed a parent board at the entrance of the facility with the required posting. LPA Bailey advised licensee Warren set up a wellness station at the entrance of the facility with the following items ( thermometer, hand sanitizer, extra mask, and gloves).

At 10:18 AM LPA Bailey observed age-appropriate furniture, toys, and equipment observed in the day care room. At 10:28 AM LPA Bailey observed all the electrical wall socket in the day care room was child proof and advised the licensee to check often to ensure that they are covered.

At 10:29 AM LPA Bailey inspected the kitchen. LPA Bailey observed the facility to need a fire extinguisher (2A 10BC). LPA Bailey advise licensee Warren to purchase a fire extinguisher , licensee Warren understood. LPA Bailey observed child proof latches on the kitchen cabinet. LPA Bailey asked the licensee where do you keep the knives. The licensee showed the knives on the counter top. LPA Bailey advise licensee Warren to place the knives in a higher cabinet. The licensee Warren stated she will move the knives to a higher cabinet with a safety latch.

LPA Bailey ask Licensee Warren will she provided meals for the children in care? Licensee Warren stated yes, Breakfast, Lunch, and Snack. Licensee Warren stated will provide meals outside the area following COVID-19 protocol when weather permits.

SUPERVISORS NAME: Karen Chambers
LICENSING EVALUATOR NAME: Alicia Bailey
LICENSING EVALUATOR SIGNATURE:

DATE: 05/13/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/13/2022
LIC809 (FAS) - (06/04)
Page: 2 of 6
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: WARREN FAMILY CHILD CARE
FACILITY NUMBER: 198400568
VISIT DATE: 05/13/2022
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
26
27
28
29
30
31
32
At 10:36 LPA Bailey ask Licensee Warren do you have medication in the cabinet, licensee Warren stated there is no medication in the cabinet. At 10:41 AM LPA Bailey asks the licensee Warren where do you keep your cleaning supplies? The applicant stated in the cabinet in the kitchen with a child proof latch.

At 10:55 AM the smoke detectors and carbon monoxide were tested by LPA and are in operable condition.

At 11 06 AM LPA Bailey reviewed the facility sketch ask Licensee Warren to guide on a tour of the children’s bathroom. LPA Bailey opens cabinet doors. At 11:08 AM LPA Bailey did not observe any accessible hazards. Licensee Warren state she will put child proof lock on the cabinet.. LPA Bailey requests to see a first aid kit. Licensee Warren did not have first aid kit at the time of request. LPA Bailey advise licensee Warren to purchase first aid kit for the facility. observed a first aid kit. Licensee Warren stated she understood.

After leaving the children’s and bathroom heading back down the hallway at 11:10 AM LPA Bailey reviewed the map of the facility asks Licensee Warren to bedroom the children in care will use. LPA Bailey observed napping equipment.

After leaving the children’s and bedroom heading back down the hallway at 11:15 AM LPA Bailey reviewed the map of the facility asks Licensee Warren about the off-limit bedrooms and bathroom.

LPA Bailey tour the off-limit bedrooms and bathroom and advise Licensee Warren that the doors need to be lock at all time during child care hours. Licensee Warren state she understood.

At 11:28 AM LPA Bailey requested to tour the outside play area. Licensee Warren guided LPA Bailey out the through kitchen out the back door day care room. At 11:30 AM LPA Bailey observed an outdoor backyard fence with shade canopy area. LPA Bailey observed age appropriateness toys.

Licensee Warren stated the garage is used for storage and will be locked during childcare hours.

SUPERVISORS NAME: Karen Chambers
LICENSING EVALUATOR NAME: Alicia Bailey
LICENSING EVALUATOR SIGNATURE:

DATE: 05/13/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/13/2022
LIC809 (FAS) - (06/04)
Page: 3 of 6
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: WARREN FAMILY CHILD CARE
FACILITY NUMBER: 198400568
VISIT DATE: 05/13/2022
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
26
27
28
29
30
31
32
At 11:39 AM LPA Bailey reviewed protocols with Licensee Warren regarding the COVID-19 for Family Child Care Home. LPA Bailey also consulted with the Licensee Warren regarding COVID-19 health and safety guidelines . The Licensee Warren was provided forms to post via email.

Licensee Warren state she will provide Transportation.


During the inspection at 11:45 AM LPA Bailey reviewed and advised Licensee Warren of the following:

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/process.



Infant Needs and Services Plan: The written infant needs and services plan shall be updated at least quarterly, or as often as necessary to assure its accuracy. Infant Care: LPA advised the licensee to sleep infants where they can be directly supervised at all times. LPA advised against sleeping 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. LPA discussed and provided an emailed copy of PIN 20-24-CCP.

APPLICANT WILL WAIT UNTIL FACILITY OPENS TO DETERMINE IMS NEEDS:

Incidental Medical Services (IMS) policy was discussed. For IMS information , see PIN 22-02-CCP. 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


SUPERVISORS NAME: Karen Chambers
LICENSING EVALUATOR NAME: Alicia Bailey
LICENSING EVALUATOR SIGNATURE:

DATE: 05/13/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/13/2022
LIC809 (FAS) - (06/04)
Page: 4 of 6
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: WARREN FAMILY CHILD CARE
FACILITY NUMBER: 198400568
VISIT DATE: 05/13/2022
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
26
27
28
29
30
31
32
Licensee Warren was reminded that all adults 18 and over living in the home, persons who provide care and supervision to children, and staff who have contact with children, 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 reviewed with an Licensee Warren the LIC 311D, Forms/Records To Keep In Your Family Child Care Homes, children’s forms/records, facility forms/records, and information to be posted:

Forms to be posted in the facility


LIC610A Emergency Disaster Plan,
PUB394 Notification of Parents Rights Poster,
Facility License
Consolidated COVID19 CHHS Postings

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), 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.
SUPERVISORS NAME: Karen Chambers
LICENSING EVALUATOR NAME: Alicia Bailey
LICENSING EVALUATOR SIGNATURE:

DATE: 05/13/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/13/2022
LIC809 (FAS) - (06/04)
Page: 5 of 6
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: WARREN FAMILY CHILD CARE
FACILITY NUMBER: 198400568
VISIT DATE: 05/13/2022
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
26
27
28
29
30
31
32
No smoking, No infant walkers, Johnny jumpers, exersaucers and any other item that falls into that category, earthquake – fire, disaster drills and safety, posting requirements, children records requirements, mandated child abuse and injury/ death reporting, criminal records, child abuse clearance and criminal records transfer requirements, SIDS, Never Shake A Baby,

The following items must be corrected within thirty (30) days before the issuance of a license:

1. Hand Sanitizer, mask, gloves

2. Dog Gate (for outdoor area side of the house)

3. Fire extinguisher (2A 10BC)

4. First Aid Kits

5. Safety lock for bathroom

Licensure is contingent upon completion of the above corrections.



An exit interview was conducted with Licensee. Appeal Rights procedures issues and explained.
A copy of this report and all other Licensing reports must be made available to the public for 3 years.

SUPERVISORS NAME: Karen Chambers
LICENSING EVALUATOR NAME: Alicia Bailey
LICENSING EVALUATOR SIGNATURE:

DATE: 05/13/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/13/2022
LIC809 (FAS) - (06/04)
Page: 6 of 6