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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198400618
Report Date: 08/29/2022
Date Signed: 08/29/2022 11:27:45 AM

Document Has Been Signed on 08/29/2022 11:27 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:
198400618
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 0CENSUS: 0DATE:
08/29/2022
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
09:15 AM
MET WITH:Riley Warren, LicenseeTIME COMPLETED:
11:48 AM
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On August 29, 2022 at 9:15 am, Licensing Program Analyst (LPA) Susann Sanchez conducted an announced prelicensing inspection to the above facility. LPA met with Applicant Riley Warren who guided analyst on a tour of the facility. The Licensee is requesting to operate a small Family Day Care Home. The operating hours would be Monday through Friday from 6:00 AM to 6:00 PM and Saturday to Sundays 7:00AM to 4:00PM The applicant is applying to care for children ages: infant to 12 years old. Pre-licensing Entrance Checklist (LIC 9280) was provided to the Licensee upon arrival. Individuals residing in the home were discussed and noted. Also present during inspection was applicants mother Jennifer Warren.

This is a two story home. The home consists of 4 bedrooms, 3 restrooms, living room, kitchen, day care room, backyard, garage, and front yard. Areas that are accessible to children include: one bathroom, day care room, part of the living room, and backyard. Areas off limits to children and parents include: All bedrooms upstairs (4) and bathrooms (2), kitchen, half of the living room, garage, and front yard.

Areas used by children were inspected for safety, comfort, heating, cleanliness and telephone service. The home has central air and heating. Detergents, cleaning compounds, medicines, sharp objects and hazardous items that can pose a danger to children are made inaccessible and are kept in lock cabinets in the kitchen and in the garage. Applicant was advised that if any poisons are purchased, it is required to be locked with a key or combination lock.

Per applicant, there are no pets, firearms, weapons or bodies of water on the premises. LPA observed age appropriate toys and napping equipment for children. LPA observed electrical outlet covers throughout the facility. Smoke and carbon monoxide detectors were tested and are operable. A First Aid kit and emergency supplies are available and located in the day care room. The applicant was advised that if food is brought from the children’s home, all containers must be labeled with the child’s name and properly stored or refrigerated.
SUPERVISORS NAME: Valarie Cook
LICENSING EVALUATOR NAME: Susann Sanchez
LICENSING EVALUATOR SIGNATURE: DATE: 08/29/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/29/2022
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: WARREN FAMILY CHILD CARE
FACILITY NUMBER: 198400618
VISIT DATE: 08/29/2022
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At 9:45am LPA observed the required fire extinguisher that is fully charged however fire extinguisher did not have a service tag or receipt attached. Per applicant fire extinguisher was purchased sometime in July. Applicant was informed to have the fire extinguisher serviced yearly.

The applicant has proof of pediatric First Aid/CPR certification and expires April 2024. Applicant has proof of immunization against pertussis and measles. Applicant has a declination for influenza on record. Applicant completed the required Preventative Health and Safety training, including the Nutrition and Lead components on May 1, 2022, and Mandated Reporter training (AB 1207) on May 6, 2022. Applicant was advised that the mandated reporter training must be completed every 2 years and is available at www.mandatedreporterca.com.

LPA discussed the safe sleep regulations with applicant 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.

Applicant plans to provide care to infants. LPA advised the applicant to sleep infants where they can be directly supervised at all times and advised against sleeping infants in a separate room. The applicant states the following supervision plan for infants: applicant states that infants will sleep in the living room where they will be provided direct supervision. LPA provided the applicant with a copy of Provider Information Notice (PIN) 20-24-CCP and the Individual Infant Sleeping Plan (LIC 9227) to the applicant.

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

LPA provided the Forms and Records to Keep in your Family Child Care Home (LIC 311D). LPA also provided Technical Assistance for COVID-19. Applicant completed the COVID-19 Self Assessment.
SUPERVISORS NAME: Valarie Cook
LICENSING EVALUATOR NAME: Susann Sanchez
LICENSING EVALUATOR SIGNATURE:

DATE: 08/29/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/29/2022
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: WARREN FAMILY CHILD CARE
FACILITY NUMBER: 198400618
VISIT DATE: 08/29/2022
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Applicant 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.

Community Care Licensing Division (CCLD) regularly sends information to licensed facilities, providers, and stakeholders by way of Provider Information Notices (PINs), Program Quarterly Update Newsletters and other important information communication platform.

LPA provided assistance to the applicant on how to access forms, regulations and quarterly updates on the Child Care Licensing website at: www.ccld.ca.gov.

To receive important licensed-related information to licensed facilities, visit the CCLD Important Information website at https://www.cdss.ca.gov/inforesources/community-care-licensing/subscribe and select the Child Care option to receive email communication.

Per applicant, there are no dual licenses at this address. Applicant’s email address was obtained during this inspection. The applicant was advised that email may be public information.

During inspection LPA collected the following or the following was emailed to LPA during ispection:
  • Mandated Reporter Training (AB1207)
  • Immuinizations: Measles for Jennifer Warren
  • Unity bill from Reggie Warren and photo ID
  • Updated Emergency Disaster Plan
  • Criminal Record Statement
  • Updated Application (hours, email, phone number)


Paperwork and physical corrections needed:
  • Proof of current service tag or receipt for fire extinguisher
  • Update Facility Sketch
SUPERVISORS NAME: Valarie Cook
LICENSING EVALUATOR NAME: Susann Sanchez
LICENSING EVALUATOR SIGNATURE:

DATE: 08/29/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/29/2022
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: WARREN FAMILY CHILD CARE
FACILITY NUMBER: 198400618
VISIT DATE: 08/29/2022
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Also discussed during inspection and consult was given for:
  • fingerprints
  • side businesses
  • guns
  • hot tubs

A final review of the application will be conducted by the Department once all corrections have been made. Due date for corrections will be 09/12/22. Once licensed, the applicant is required to adhere to the terms and limitations stated on the license. Exit interview conducted and report was reviewed with the applicant, Riley Warren.
SUPERVISORS NAME: Valarie Cook
LICENSING EVALUATOR NAME: Susann Sanchez
LICENSING EVALUATOR SIGNATURE:

DATE: 08/29/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/29/2022
LIC809 (FAS) - (06/04)
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