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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198400914
Report Date: 03/05/2024
Date Signed: 03/06/2024 06:45:13 AM

Document Has Been Signed on 03/06/2024 06:45 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:SIERRA FAMILY CHILD CAREFACILITY NUMBER:
198400914
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 0DATE:
03/05/2024
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
09:15 AM
MET WITH:Priscilla Sierra, ApplicantTIME COMPLETED:
12:15 PM
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Licensing Program Analyst (LPA) Dayna Chambers conducted a pre-licensing inspection on March 5, 2024 at 9:15am. Entrance Checklist was provided to the applicant. LPA met with Priscilla Sierra, Applicant, who guided analyst on a tour of the facility. During the inspection individuals residing in the home were discussed and noted. The applicant is requesting a Small Family Home license. Per applicant, operation hours will be Monday through Friday 6:00am to 5:00pm, closed Saturday and Sunday. Applicant states they will care for children 0 months to 13 years of age. All areas identified on the facility sketch were inspected, including but not limited to, off- limit areas. This is a one -story home that consists of 2 bedrooms, 1 restroom, Living Room, Dining Room/Kitchen, and Detached garage. The kitchen also has a door that leads to the front patio yard which is off-limits to children. The children will enter from the gate and be accompanied by the licensee and parents to the door. There is no backyard. The applicant’s neighborhood has a park that children will use with authorization by parents. The children will not use the front yard for play. Per applicant, the children will use the restroom located through the kitchen near bedroom #1. Children will use the living room for activities and napping. Infants will sleep in bedroom #2. Children will eat in the dining room. Areas used by children were inspected for safety, comfort, and cleanliness. Telephone service is a cell phone and will remain in the home during daycare hours. Ventilation and heating are installed via electric heater and installed air conditioner when needed. LPA obtained a photo and a declaration LIC855 for the inoperable wall heater.
Detergents, cleaning compounds, medicines, sharp objects, and hazardous items that can pose a danger to children were not observed in the restroom, kitchen, or family room or in the off-limit areas of the home.
LPA advised applicant that all poisons must be locked with a key or combination lock. LPA observed the cleaning items were placed in a bin in the off-limit area in the front yard. Based on the Facility Sketch submitted, areas off limits to children and parents are: Detached Garage, Bedroom #1, and Kitchen.
The off-limits rooms have doorknob locks. The kitchen is off-limits and has a gate to prevent entry into the kitchen. The applicant understands that licensing staff may have access to off-limit areas during inspection visit if necessary.There is no backyard at the home. The applicant states they will use the neighborhood park and that children will always be physically and visually supervised.
SUPERVISORS NAME: Valarie Cook
LICENSING EVALUATOR NAME: Dayna Chambers
LICENSING EVALUATOR SIGNATURE: DATE: 03/05/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/05/2024
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
CCLD Regional Office, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME: SIERRA FAMILY CHILD CARE
FACILITY NUMBER: 198400914
VISIT DATE: 03/05/2024
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Per applicant, there are no firearms or weapons on the premises. LPA observed five small dogs and the dogs will not be accessible to children in care during operation hours. The valve on the new 2A10BC fire extinguisher indicates fully charged, the receipt is dated 01/06/2024.Smoke and carbon monoxide detectors were tested to ensure that they are operable. There are toys available for children. LPA observed 6 napping cots for children. LPA observed a play yard for infants.The applicant states that they will provide food for children in care. If food is not provided and food is brought from the children’s homes; container shall be labeled with child’s name and properly stored or refrigerated.The applicant has completed the required Health and Safety Training, Nutrition & Lead Training. Applicant’s Pediatric First Aid and CPR expires on 07/14/2025. There are first aid supplies available in the living room.In the absence of the licensee, a qualified adult must be present supervising the children. A qualified adult is an individual who has: CURRENT MANDATED REPORTER – EXPIRES EVERY TWO YEARS: WWW.MANDATEDREPORTERCA.COM
PEDIATRIC FIRST AID AND CPR CERTIFICATE – EMSA APPROVED ONLY – RENEW EVERY TWO YEARS. LIC 9108 – STATEMENT ACKNOWLEDGING REQUIREMENT TO REPORT CHILD ABUSE. IMMUNIZATIONS: MMR, TDAP, CURRENT INFLUENZA OR DECLINATION STATEMENT, AND TB CLEARANCES. FINGERPRINT CLEARANCES – CACI, DOJ, FBI – ASSOCIATED TO FACILITY.
Annual fees must be paid promptly and by the due date or a late fee shall be assessed and/or the License may be terminated.The fire extinguisher type -2A-10BC -must be serviced annually or as often as necessary. Smoke and carbon monoxide detectors should be checked, and batteries replaced as needed. LPA provided applicant with a “capacity chart” for enrolling children. Reporting Requirements: Unusual Incidents/Changes should be reported to the Department within 24 hours /as soon as they occur such as construction, remodeling, telephone number changes and/or if you move from your home. Reporting Requirements: Any unusual incidents or injuries must be reported to the Department within 24 hours via telephone and within seven (7) days in writing. Fire and safety drills must be performed every six months and documented for review by the Department. Example Fire Drill Log was provided to applicant. Smoking is prohibited in a family childcare home. Children and Staff records must be maintained and updated as needed and must be available for review by the Department. LIC 311D was provided to applicant. No smoking, no infant walkers, No Johnny jumpers, no saucer chairs, no trampolines, and any other item that falls into that category are not permitted in the facility. Smoking on the premises is prohibited. All adults living and working in the home shall be made of aware of the Departments right to inspection authority, which includes but not limited to the right to enter the home when children are being cared for, interview children and adults and review documentation. Licensees shall reveal each facility license number in all advertisements, publications, or announcements with the intent to attract clients. Liability Insurance was discussed.
SUPERVISORS NAME: Valarie Cook
LICENSING EVALUATOR NAME: Dayna Chambers
LICENSING EVALUATOR SIGNATURE:

DATE: 03/05/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/05/2024
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
CCLD Regional Office, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME: SIERRA FAMILY CHILD CARE
FACILITY NUMBER: 198400914
VISIT DATE: 03/05/2024
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LPA advised applicant to review Title 22 Regulation 102417(m)(1) for additional information. · 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 or declination, MMR, TDAP, and TB Clearance (current). The licensee and all adults working with children have proof of immunization.
Health and Safety Code 1596.7995: Beginning January 1, 2018, all licensed providers, applicants, directors, and employees to complete training as specified on mandated reporter duties. Training is available at: www.mandatedreporterca.com Mandated reporter expires every two years. Licensee is responsible for renewing.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.
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. LPA signed applicant up for quarterly updates.
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.
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
LPA discussed the safe sleep regulations with applicant about infant safe sleep regulations and procedures. LPA 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 provided applicant with Title 22 regulations for safe sleep, PIN 20-24CCP, Example Infant Sleep Chart, Infant Safe Sleep FAQs, copy of LIC9227.
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.
A notice of site visit was given and must remain posted for 30 days.
Exit interview conducted and report was reviewed with the applicant, Priscilla Sierra.
SUPERVISORS NAME: Valarie Cook
LICENSING EVALUATOR NAME: Dayna Chambers
LICENSING EVALUATOR SIGNATURE:

DATE: 03/05/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/05/2024
LIC809 (FAS) - (06/04)
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