198400568-5-25-2023-54-CC-MRIA-CS6VJR-20230525162910

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 198400568
Report Date: 05/25/2023
Date Signed: 05/25/2023 04:29:21 PM

Document Has Been Signed on 05/25/2023 04:29 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:	WARREN FAMILY CHILD CARE		FACILITY NUMBER:	198400568
ADMINISTRATOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY: 8	TOTAL ENROLLED CHILDREN: 8	CENSUS: 4	DATE:	05/25/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	01:40 PM
MET WITH:	Ryan Warren, Licensee		TIME COMPLETED:	04:43 PM

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On Thursday, May 25, 2023, at 1:40 p.m., Licensing Program Analyst (LPA) Mayra Rivera conducted an unannounced annual and case management capacity increase inspection and met with licensee Ryan Warren who guided LPA Rivera on a tour of the facility.

Family members residing in the home has been discussed with applicant and are cleared. Operating hours are Monday to Sunday from 12:00 a.m. to 11:59 p.m. and care for children ages 0 to 13.

This facility is a one-story single home that consists of 3-bedrooms, 2- bathrooms, kitchen, living room, daycare room (back room) attached garage and front and backyard. All areas identified on the facility sketch were inspected. Areas that are accessible to children and identified on the facility sketch include daycare room, bedroom #1 (facing front yard) bathroom next to bedroom #1 and backyard. Fire clearance has been granted for 14 children on May 18, 2023.

Areas off limits to children include- front yard, and bedrooms #2, #3, master bathroom, kitchen, living room, garage and front yard.

At approximately 1:45 p.m LPA Rivera inspected the facility for safety, comfort, cleanliness, ventilation and working phone (cell phone). For ventilation, LPA Rivera observed central AC/Heater and vents located on the ceiling. LPA observed the furniture, children’s materials, and playpen to be in good condition and age appropriate. For ill/isolation area, children utilize the living room.

At approximately 1:53 p.m., LPA Rivera entered the restroom and observed the toilet, hand washing sink, hand soap and observed the bottom sink cabinet closed and with a child proof lock. LPA did not observe hazard materials and observed the restroom to be in good condition.

SUPERVISORS NAME: Karen Chambers
LICENSING EVALUATOR NAME: Mayra Rivera
LICENSING EVALUATOR SIGNATURE:	DATE: 05/25/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/25/2023

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: WARREN FAMILY CHILD CARE	FACILITY NUMBER: 198400568
	VISIT DATE: 05/25/2023

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At approximately 2:14 p.m. LPA Rivera observed knives stored inside the cabinet above the refrigerator. LPA observed cleaning compounds items stored inside the bottom kitchen sink cabinet with a child proof lock making it inaccessible for children to open and inside the cabinet located in the laundry room. LPA observed a gate barrier between the laundry room and kitchen to prevent children entering the laundry room. LPA observe water gallons and per licensee, she stated she refills children’s sippy cups. Licensee provides the meals for the children. LPA informed licensee food brought from the children's homes, the container shall be labeled with the child's name and properly stored or refrigerated.

LPA Rivera asked licensee if there are any pets, poisons, firearms, weapons or bodies of water. Licensee stated she has no pets, no bodies of water, no firearms, weapons or poisons. LPA did not observe pets, firearms, weapons, poisons nor bodies of water. Licensee was advised that if any poisons (ex; drano, rat poison or items that fall into that category), 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 2:20 p.m. LPA Rivera observed the required 2A10BC fire extinguisher located in the kitchen with the valve on the green area indicating fully charged and purchased receipt dated May 18, 2023. LPA observed carbon monoxide detector in the hallway and smoke detector in the daycare room. LPA Rivera tested the carbon monoxide and Licensee tested the smoke alarm. LPA Rivera heard the sounds and are operable. LPA observed the first aid complete with band aids, gauzes, adhesive bandages and antiseptic wipes and located in the kitchen. LPA observed the drill log and last drill conducted on May 23, 2023.

LPA Rivera was not able to conduct a full inspection of the outdoor play area due to backyard is currently under construction. LPA informed Licensee, when upgrades are being done, licensee needs to notify the department of any changes. LPA observed the equipment to be age appropriate, and good condition and free of sharp, no loose or pointed parts. LPA observed the two side gates closed and locked. LPA observed the garage door closed and locked.

LPA observed licensee Ryan Warren Pediatric First Aid/ CPR certification dated April 30, 2022, and Health and Safety certification dated May 1, 2022, and licensee has proof of immunization against Pertussis, MMR and Influenza declination. Licensee has completed the mandated reporter (AB 1207) training dated May 2, 2022. Licensee was advised that the mandated reporter training must be completed every 2 years, and is available at www.mandatedreporterca.com

SUPERVISORS NAME: Karen Chambers
LICENSING EVALUATOR NAME: Mayra Rivera
LICENSING EVALUATOR SIGNATURE:	DATE: 05/25/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/25/2023

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: WARREN FAMILY CHILD CARE	FACILITY NUMBER: 198400568
	VISIT DATE: 05/25/2023

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LPA observed postings LIC 610A Emergency Disaster Plan, Pub 394 Notification of Parents Rights, and LIC 999 Facility sketch. During this visit LPA reviewed Child #1, #2, and #3 files and children’s roster. During this visit, child #3 medication expires 11/2023.

The following was also discussed with licensee:

1. 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 Pediatric first aid/ CPR-adult-child- infant certification and a valid criminal record clearance associated to the facility license.

2. 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

SUPERVISORS NAME: Karen Chambers
LICENSING EVALUATOR NAME: Mayra Rivera
LICENSING EVALUATOR SIGNATURE:	DATE: 05/25/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/25/2023

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: WARREN FAMILY CHILD CARE	FACILITY NUMBER: 198400568
	VISIT DATE: 05/25/2023

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11. Immunization Requirement: H&S 1597.622: Commencing September 1, 2016, a person shall not be employed or volunteer at a family day care home if he or she has not been immunized against influenza, pertussis, and measles. The licensee and all adults working with children have proof of immunizations.

12. Inspection Authority: All adults living and working in the home shall be made of aware of the Department’s right to inspection the home, which includes, but is not limited to the right to enter the home when children are being cared for, interview children and adults and review documentation.

13. The facility license number must be on all advertisements, publications or announcements with the intent to attract clients.

14. Isolation for Ill children: When a child is ill, he/she shall be separated from other children (reference 102417(e) Operation of a Family Child Care Home).

15. Liability Insurance was discussed; LPA advised applicant to review Title 22 Regulation 102417(m)(1) for additional information.

13. Dog(s) and/or pets are recommended to be isolated from children in care.

14. No baby bouncers, no infant walkers, no Johnny jumpers, no saucer chairs, and any other item that falls into this category is not permitted in the facility.

Criminal Record Statement
Licensee Ryan 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.

SUPERVISORS NAME: Karen Chambers
LICENSING EVALUATOR NAME: Mayra Rivera
LICENSING EVALUATOR SIGNATURE:	DATE: 05/25/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/25/2023

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: WARREN FAMILY CHILD CARE	FACILITY NUMBER: 198400568
	VISIT DATE: 05/25/2023

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Safe Sleep
LPA discussed the safe sleep regulations with licensee Ryan Warren 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 Ryan Warren 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.

This facility provides Incidental Medical Services – IMS. For IMS information, see PIN 22-02-CCP. 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

During this visit, LPA provided safe sleep log, LIC 9221 Parent Consent for Administration Medication.

During this visit, licensee Ryan Warren has been given two technical violations for not having documentation of the safe sleep log. No citations given during this visit.

A notice of site visit was given and must remain posted for 30 days. Exit interview conducted and report was reviewed with licensee Ryan Warren.

SUPERVISORS NAME: Karen Chambers
LICENSING EVALUATOR NAME: Mayra Rivera
LICENSING EVALUATOR SIGNATURE:	DATE: 05/25/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/25/2023

LIC809 (FAS) - (06/04)

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