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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198400667
Report Date: 04/10/2024
Date Signed: 04/10/2024 11:38:27 AM

Document Has Been Signed on 04/10/2024 11:38 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 SW RO, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME:ROBLES FAMILY CHILD CAREFACILITY NUMBER:
198400667
ADMINISTRATOR/
DIRECTOR:		FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 5DATE:
04/10/2024
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:15 AM
MET WITH:Lorraine RoblesTIME VISIT/
INSPECTION COMPLETED:
12:30 PM
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Licensing Program Analysts (LPAs) Claudia Kam and Katrina Chicote conducted an Unannounced Annual inspection to the above facility. LPAs disclosed the purpose of the inspection and met with Licensee, Lorraine Robles who guided the LPAs on a tour of the facility. There were 5 day care children present during today’s inspection. Licensee states that there are currently 7 children enrolled. The children's roster was reviewed and is current. Licensee reports that the facility’s hours of operation are 6:00 AM to 6:00 PM, Monday thru Friday. Emergency Disaster Plan, License, and Parents’ Rights were posted at the time of inspection. Per Licensee, disaster drill was last conducted on 4/9/24 and 4/10/24.

This is a single-story home which consists of two bedrooms and one bathroom, kitchen, and living room. LPAs observed a wall heater in the home that is barricaded by a gate. Areas used by the children include the living room, bathroom, and Bedroom 1 that is for infant sleep only. Bedroom 1 will be used for isolation of sick children. Per Licensee, areas off limits to children and parents is the master bedroom and kitchen which is used as a pathway to the bathroom but is otherwise off limits. LPAs observed that there is a child safety gate making it inaccessible to children in care at time of inspection. Per licensee, off limit bedrooms are locked during operating hours, LPAs observed doors to be locked.

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. Main Care Area for day care children will be the living room. Main care area is located at the entrance. LPAs observed ceiling fans in the living room of the home for ventilation. There is a working telephone maintained in the home. LPAs discussed any other individuals living in the home and licensee has confirmed that there are no other residents of the home other than licensee.
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SUPERVISORS NAME: Denise Gibbs
LICENSING EVALUATOR NAME: Claudia Kam
LICENSING EVALUATOR SIGNATURE: DATE: 04/10/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/10/2024
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
MONTEREY PARK SW RO, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME: ROBLES FAMILY CHILD CARE
FACILITY NUMBER: 198400667
VISIT DATE: 04/10/2024
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Per licensee, the children play inside and for outdoor play when feasible they go to the park near the facility within walking distance.
The valve on the required 2A 10BC fire extinguisher indicates fully charged, it has been tagged as serviced on August 1, 2023. LPAs checked Smoke and carbon monoxide detectors are in operable condition at time of inspection. LPAs observed First Aid kit on wall of kitchen easily accessible in emergency and was inventoried for necessary supplies. Licensee provided proof of immunization against influenza, pertussis, and measles during today’s inspection. Licensee has current mandated reporter training with an expiration date of January 2026.
Licensee's CPR certification is valid till 7/29/26. Children records and required licensing forms were discussed as well as mandated child abuse reporting and criminal record clearance requirement, all documents for licensee and assistant are current.
Per Licensee, there are no weapons, firearms in the home and there are no bodies of water around the premises. LPAs observation did not see any bodies of water around the premises. Per licensee, they provide food for children in care. Food preparation area was toured and found in compliance for safety, cleanliness, and proper storage.

LPAs reviewed with licensee 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.

The following were discussed:


Criminal Record Clearance: Licensee Lorraine Robles was reminded that all adults 18 and over living or working in the home, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, 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 for a maximum of 5 days or, if the penalty is for a repeat violation, for a maximum of 30 days per person will be assessed if this regulation is violated.

On this date, 04/10/2024, the California Attorney General - Megan’s Law website was searched for information on sex offenders required to register with local law enforcement under California's Megan's Law. No registered sex offenders were found at the facility addresses. Under state law, some registered sex offenders are not subject to public disclosure; therefore, they may not have been included in this search. However, the Department conducts a monthly cross reference of each address on record for all registered sex offenders against all CCLD facility addresses pursuant to information shared by California DOJ.

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SUPERVISORS NAME: Denise Gibbs
LICENSING EVALUATOR NAME: Claudia Kam
LICENSING EVALUATOR SIGNATURE:

DATE: 04/10/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/10/2024
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 SW RO, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME: ROBLES FAMILY CHILD CARE
FACILITY NUMBER: 198400667
VISIT DATE: 04/10/2024
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Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02-CCP. When any IMS is provided, an updated Plan of Operation that includes 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) or (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA are available at: https://www.ada.gov/resources/child-care-centers/.

Licensee Lorraine Robles was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain childcare by connecting them to childcare providers and Resource and Referral Agencies (R&Rs) throughout California.

Based on Title 22, observations, record review, and interviews there are no deficiencies cited today.

A notice of site visit was given and must remain posted for 30 days.

Exit interview conducted and report was reviewed with the licensee Lorraine Robles. A copy of the report and Appeal rights were given.

To improve the quality and value of the new inspection process, a survey may 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 CARE tools, please send email inquiries 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/inspection-process.

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 platforms.


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.

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SUPERVISORS NAME: Denise Gibbs
LICENSING EVALUATOR NAME: Claudia Kam
LICENSING EVALUATOR SIGNATURE:

DATE: 04/10/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/10/2024
LIC809 (FAS) - (06/04)
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