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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198400653
Report Date: 10/07/2022
Date Signed: 10/07/2022 12:31:27 PM

Document Has Been Signed on 10/07/2022 12:31 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:CRUZ FAMILY CHILD CAREFACILITY NUMBER:
198400653
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 0CENSUS: DATE:
10/07/2022
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
11:25 AM
MET WITH:Rosa Cruz, LicenseeTIME COMPLETED:
01:00 PM
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Licensing Program Analyst (LPA) Katrina Chicote conducted an Announced – Prelicensing Inspection for a Change of Location on 10/07/2022 at 11:25 AM to the above facility. LPA met with Rosa Cruz, Licensee, and LPA was taken on a guided tour of the facility both indoors and outdoors. Adults in the home were discussed and all have criminal record clearance. Licensee is Native Spanish speaker. Licensee's Daughter was also present during today's inspection and provided English translation. The Licensee is requesting a small family child care home license. Per Licensee, operation hours will be 24 hours, 7 days a week. LPA discussed with Licensee that license limits providing care to a child no longer than 23 hours. Overnight care will be provided in Bedroom 1, LPA discussed overnight care procedures with Licensee.

This is a single-story home which consists of three bedrooms and two bathrooms, Kitchen, Living Room, Den, and detached garage. Areas used by the children include the Living room (located upon entry of the home), Dining Room (located next to Living Room), Bedroom 1 for Preschool Playroom/Napping Room (located through Dining Room to the right), Bathroom 1 (located in hallway right outside Bedroom 1), and Den for Activity Room (located down hallway past Bathroom 1). Kitchen and Laundry Room are only accessible to children as a walkway to backyard, LPA observed babygate blocking access to Kitchen and a door from hallway that has a hook up top to make areas inaccessible. Per Licensee, areas off limits to children and parents include entire rear area of home which consists of Bedrooms 2 and 3 and Bathroom 2. LPA observed that there is a door blocking rear area of home, per Licensee this door will remain locked when children are in care.

All areas identified on the facility sketch as accessible to children were inspected to ensure that they are clean and orderly with ventilation and heating for the safety of the children and free of hazards. There is a working telephone maintained in the home. At 11:17 AM, LPA observed Living Room to have couches and chairs with television hanging. Per Licensee, she will serve food to children in care and use Dining Room for eating. At 11:20 AM, LPA observed Dining Room to have rectangular table with six chairs. At 11:24 AM, LPA observed Bedroom 1 to have drawers with children's clothes, diaper changing table. LPA observed various Report Continues - Page 1 of 4
SUPERVISORS NAME: Trevino Cochran
LICENSING EVALUATOR NAME: Katrina Chicote
LICENSING EVALUATOR SIGNATURE: DATE: 10/07/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/07/2022
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 4
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: CRUZ FAMILY CHILD CARE
FACILITY NUMBER: 198400653
VISIT DATE: 10/07/2022
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age appropriate toys, free of loose and sharp parts available for children in care. At 11:26 AM, LPA observed Bathroom 1 to have operable toilet and sink, adequate handwashing and toileting supplies, and general sanitation. Per Licensee, medicines are stored in Bathroom 1, LPA observed medicines stored in locked cabinet in Bathroom 1 requiring key. LPA observed medicine cabinet to be empty and operable lock on under cabinet sink at time of inspection. At 11:30 AM, LPA observed Den, which Licensee states will be used for activity space for older children, to have large table, shelves filled with board games and art materials available for children. LPA observed electrical cover outlets all through the home. Per licensee, there are no pets and LPA did not observe any pets. Detergents, cleaning compounds, medications, and other items which can pose a danger to children are inaccessible. LPA observed these items in closets in Laundry Room with an operable lock requiring a key. At 11:31 AM, LPA observed Kitchen to have operable child safety locks on under cabinet sink with cleaning solutions and drawer where LPA observed knives to be stored.

Per Licensee, the children will have access to backyard area. LPA observed backyard is accessible through backdoor in Laundry Room. At 11:38 AM, LPA observed backyard has concrete area, grass and adequate perimeter fencing through-out the yard. LPA observed plastic play houses, ride along toys, and other age appropriate toys free of loose and sharp parts available for the children in the backyard. LPA observed all trees, shrubs, and plants are maintained. LPA observed detached garage in backyard that is off limits, LPA observed door to detached garage to be locked at time of inspection.

Per Licensee, there are no weapons, firearms in the home and there are no bodies of water around the premises. LPA observation did not see any bodies of water around the premises or firearms in the home at time of inspection.

At 11:20 AM, LPA observed the valve on the required 2A 10BC fire extinguisher indicates fully charged with receipt dated 08/22/2022. At 11:21 AM, LPA observed smoke and carbon monoxide detectors are in operable condition. Per Licensee, First Aid kit is kept in Bedroom 1, LPA observed First Aid kit. The Licensee has current Pediatric First Aid and CPR. Proof of immunization against influenza, pertussis, and measles was readily available during today’s inspection. The Licensee has also taken the Mandated Reporter Training
—CPR Card valid until: 03/05/2024
—Mandated Reporter AB1207 Completed: 07/30/2021
Report Continues - Page 2 of 4
SUPERVISORS NAME: Trevino Cochran
LICENSING EVALUATOR NAME: Katrina Chicote
LICENSING EVALUATOR SIGNATURE:

DATE: 10/07/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/07/2022
LIC809 (FAS) - (06/04)
Page: 2 of 4
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: CRUZ FAMILY CHILD CARE
FACILITY NUMBER: 198400653
VISIT DATE: 10/07/2022
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The following were discussed:
Incidental Medical Services (IMS)
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

Licensee (or facility representative) 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.

Rooms that are off-limits need to be made inaccessible during operating hours. NO smoking, NO infant walkers, NO Johnny jumpers, NO saucer chairs, NO incline sleepers and any other item that falls into that category are permitted in the facility. Effective January 1, 2010, licensees of family child care homes are required to ensure that at least one staff member with current training in pediatric first aid and pediatric CPR is on site at all times when children are present.



The Licensee was advised that inaccessibility of hazards must be constantly reassessed depending on the children in care.

LPA discussed the safe sleep regulations with licensee [or facility representative] 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 [facility representative] 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.
Report Continues - Page 3 of 4
SUPERVISORS NAME: Trevino Cochran
LICENSING EVALUATOR NAME: Katrina Chicote
LICENSING EVALUATOR SIGNATURE:

DATE: 10/07/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/07/2022
LIC809 (FAS) - (06/04)
Page: 3 of 4
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: CRUZ FAMILY CHILD CARE
FACILITY NUMBER: 198400653
VISIT DATE: 10/07/2022
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LPA reviewed and issued the LIC 311D - Forms/Records to Keep in Your Family Child Care Home. Mandatory Forms for the children’s files and staff files, requirements for fire drills, earthquake drills and documentation were discussed. Role and responsibilities of being a Mandated Reporter were reviewed. The Licensee was advised how to access forms and Regulations online at www.ccld.ca.gov. Licensee was made aware that it is his/her responsibility to know the regulations as well as anyone who assists in providing care.

AB 1207: Beginning on January 1, 2018, this law requires all licensed providers, applicants, directors and employees to complete training as specified on their mandated reporter duties and to renew their training every two years. Volunteers are encouraged but not required to take the training. Website: http://www.mandatedreporterca.com/

Senate Bill 792: this bill, commencing September 1, 2016, prohibits a person from being employed or volunteering at a child care facility or family day care if he or she has not been immunized against influenza, pertussis and measles. LPA discussed the influenza waiver during the visit.


Based on LPA's observation today, 10/07/2022, LPA will submit to Manager for review and approval for a small family child care home license. Pending approval, once licensed, the Licensee is required to comply with the terms and limitations stated on the license.

Exit interview was conducted and report was reviewed with the Licensee (or facility representative), Rosa Cruz.



Report Ends - Page 4 of 4
SUPERVISORS NAME: Trevino Cochran
LICENSING EVALUATOR NAME: Katrina Chicote
LICENSING EVALUATOR SIGNATURE:

DATE: 10/07/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/07/2022
LIC809 (FAS) - (06/04)
Page: 4 of 4