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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198400667
Report Date: 10/28/2022
Date Signed: 10/28/2022 11:23:33 AM

Document Has Been Signed on 10/28/2022 11:23 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
MONTEREY PARK S WEST, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME:ROBLES FAMILY CHILD CAREFACILITY NUMBER:
198400667
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 0DATE:
10/28/2022
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
09:35 AM
MET WITH:Licensee Lorraine RoblesTIME COMPLETED:
11:35 AM
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On 10/28/2022 Licensing Program Analysts (LPAs) Austin Estrada and Alicia Mooberry conducted an announced pre-licensing inspection. LPAs met wit Applicant Lorraine Robles who provided a tour of the facility. Operating hours will be seven days a week, 6 AM to 6 PM and care will be provided for children ages newborn to 12 years old. Applicant stated that she will also offer overnight care. All residents living in the main home were discussed and verified and have obtained a criminal record clearance. The day care facility is a 2 bedroom, 1 bathroom duplex with a front yard (fenced), living room, dining area, kitchen.

Off Limit areas: one bedroom and front yard

On Limit areas: Living room, kitchen, dining area, hallway, bathroom, one bedroom (nap room).

The day care areas that will be used by children were observed for safety, comfort, cleanliness, telephone service (cell phone), ventilation and heating. LPAs observed age appropriate materials and toys available for children. LPAs observed napping mats and an infant crib are available. Per Licensee, food will be provided for children in care through a nutritional program. Licensee was advised that if food is brought from the children’s homes, the container shall be labeled with the child’s name and properly stored or refrigerated. Detergents, cleaning compounds, sharp objects and hazardous items that can pose a danger to children are inaccessible to children in care. Knives and sharp objects are kept in an upper cabinet in the kitchen. Per Licensee, personal medication is kept in a cabinet in the kitchen inaccessible to children.

LPAs observed cleaning compounds to be locked in a cabinet under the kitchen sink. LPAs observed the hallway closet to be locked. Per the Licensee, there are no poisons in the home. LPAs advised that if any poisons are kept in the home at a later date must be locked and inaccessible to children in care. LPAs observed an operable smoke detector and carbon monoxide detector

SUPERVISORS NAME: Valarie Cook
LICENSING EVALUATOR NAME: Austin Estrada
LICENSING EVALUATOR SIGNATURE: DATE: 10/28/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/28/2022
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 3
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MONTEREY PARK S WEST, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME: ROBLES FAMILY CHILD CARE
FACILITY NUMBER: 198400667
VISIT DATE: 10/28/2022
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 LPA observe a 2A10BC fire extinguisher with a service tag date of August 2022. LPAs observed electrical outlets covered throughout the day care area. LPAs did not observe any fireplaces. LPAs observed a wall heater in the hallway to be inaccessible. Children will use the bathroom in the hallway. LPAs observed the cabinets in the bathroom had latches installed. First Aid and emergency supplies are available located in the kitchen area.

Per Applicant children will walk through the kitchen to access the nap room and bathroom. Per Licensee, children will be supervised while doing so.

Per the Applicant there are no bodies of water on the premises such as pools/ hot tubs or spas. Licensee stated there are no weapons or firearms in the home. Per Applicant, there are no pets in the home. Per Applicant, The isolation area for a child that is ill waiting to be picked up will be in the napping room away from other children

LPAs discussed the safe sleep regulations with Applicant. Currently Applicant does not have infants enrolled at facility. LPAs 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. LPAs also informed Licensee 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. LPAs reviewed the overnight care regulations with Applicant.

Incidental Medical Services (IMS) policy was discussed. At this time, the Applicant does not have any children enrolled that require medication. 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


LPAs reviewed with Applicant 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. Entrance Checklist was provided to the applicant.

pg. 2

SUPERVISORS NAME: Valarie Cook
LICENSING EVALUATOR NAME: Austin Estrada
LICENSING EVALUATOR SIGNATURE:

DATE: 10/28/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/28/2022
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
MONTEREY PARK S WEST, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME: ROBLES FAMILY CHILD CARE
FACILITY NUMBER: 198400667
VISIT DATE: 10/28/2022
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Community Care Licensing Division (CCLD) regularly sends information to licensed facilities, providers, and stakeholders by way of Provider Information Notices (PIN), Program Quarterly Update Newsletters and other important information communication platform. To receive important licensing 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.

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

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 & Pediatric First Aid certification, TB clearance, immunization, Mandated Reporter training certificate www.mandatedreporterca.gov, and a valid criminal record clearance associated to the facility license.

A current roster of children enrolled must be available and maintained for a period of three years, even after children are no longer attending the facility.



Unusual incident or any changes will be reported to Licensing within 24 hours and an LIC 624B will be submitted within 7 days.

A small family child care license will be granted upon Department approval. Once licensed, the Licensee is required to comply with the terms and limitations stated on the license.



Exit interview conducted and report was reviewed with Applicant Lorraine Robles.
SUPERVISORS NAME: Valarie Cook
LICENSING EVALUATOR NAME: Austin Estrada
LICENSING EVALUATOR SIGNATURE:

DATE: 10/28/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/28/2022
LIC809 (FAS) - (06/04)
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