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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 304204556
Report Date: 08/13/2021
Date Signed: 08/13/2021 12:31:59 PM

Document Has Been Signed on 08/13/2021 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, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME:GUDINO, ALICIAFACILITY NUMBER:
304204556
ADMINISTRATOR:GUDINO, ALICIAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(714) 873-6569
CITY:ANAHEIMSTATE: CAZIP CODE:
92806
CAPACITY: 14TOTAL ENROLLED CHILDREN: 0CENSUS: 2DATE:
08/13/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Alicia Gudino - LicenseeTIME COMPLETED:
12:45 PM
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An Annual Random inspection was conducted at the facility by Licensing Program Analyst (LPA) Carmen Odom. LPA observed licensee and assistant Esther Gudino, caring for 2 infant children napping and playing. Licensee was operating within the licensed capacity as specified on license. Due to State of Emergency COVID-19, LPA observed staff and children wearing face mask, social distancing and following CDC and Dept of Public Health Guidelines.

A review of the Facility Personnel Report Summary on this date indicates all facility residents, staff, or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions. Currently there are 2 adults including the licensee living in the facility. Facility Day care hours are 7:30 am-5:30 pm, Monday through Friday.

During today’s inspection, LPA and licensee toured the inside and outside areas identified in the facility sketch as accessible to childcare children. Off limits areas are made inaccessible by means of baby gates and baby locks. The childcare area consists of the living room, enclosed patio and bathroom located in the dining room. Licensee stated the children's primary area is the childcare room. There are working carbon monoxide, smoke detector, and fire extinguishers in the home that meet statutory and State Fire Marshall standards. Detergents, cleaning compounds, medicines, and other items which could pose a danger if readily available to children were stored inaccessible to children. Licensee stated there are no firearms and/or other dangerous weapons in the facility, and none were observed during today's inspections. There is a fireplace in the living room screened by a metal screen and inaccessible to children in care. The home has age appropriate toys for the ages served. LPA verified there is a working telephone service cellular service. LPA inspected the outdoor play area located in the back yard, play area was clean with a brick wall fence around the back. There are no bodies of water on the premises.
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SUPERVISORS NAME: Judy Hanson
LICENSING EVALUATOR NAME: Carmen Odom
LICENSING EVALUATOR SIGNATURE: DATE: 08/13/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/13/2021
This report must be available at Child Care and Group Home facilities for public review for 3 years.

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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, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME: GUDINO, ALICIA
FACILITY NUMBER: 304204556
VISIT DATE: 08/13/2021
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The licensee does have a current roster of children in care. Children’s records for children present during LPA’s inspection were reviewed for a copy of the emergency information card that contains all the information specified by regulation (LIC 700) and found to be in compliance. LPA observed 2 infants present, 1 of the 2 children were from 0-12 months. On 8/13/21 at 10:00am during children file reviews, LPA did not find LIC 9227 Individual Infant Sleeping Plan in children’s file and documentation of every 15-minute check log during napping hours, 1 infant child was out of compliance.

The licensee and assistant’s Pediatric CPR/First Aid certification expired 9/7/21. Beginning September 1, 2016, Health and Safety (H&S) 1597.622 states, a person shall not be employed or volunteer at a family childcare home if he or she has not been immunized against influenza, pertussis, and measles. Proof of immunization against pertussis, measles for licensee and assistant were reviewed and within compliance. Licensee and assistant had flu declination letters in file. Beginning March 31, 2018, H&S Code 1596.8662 requires all licensed providers and employees to complete mandated reporting training, and to renew the training every two years. On 8/13/21 at 10:20am during staff file reviews, Licensee and assistant did not have mandated reporter training certificate available for review.

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

The licensee understands she must be present in the facility and must ensure children in care are always supervised. Children are not to be left alone in parked vehicles. When the licensee is temporarily absent from the facility, arrangements must be made for a qualified substitute adult to care and supervise children while absent. The substitute adult must have the required criminal record, child abuse index clearances, immunization, Pediatric CPR/First Aid, and mandated reporter training. LPA provided Guardian Information and website info:


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SUPERVISORS NAME: Judy Hanson
LICENSING EVALUATOR NAME: Carmen Odom
LICENSING EVALUATOR SIGNATURE:

DATE: 08/13/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/13/2021
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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, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME: GUDINO, ALICIA
FACILITY NUMBER: 304204556
VISIT DATE: 08/13/2021
NARRATIVE
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https://www.cdss.ca.gov/inforesources/cdss-programs/community-care-licensing/caregiver-background-check/guardian

CCLD website www.ccld.ca.gov was provided to licensee to access regulations, updates, and licensing forms. Licensee was advised to register through childcareadvocatesprogram@dss.ca.gov in order to receive quarterly updates. Licensee was advised of their responsibility to review the Provider Information Notices (PIN) found on the CCLD website. A copy of the California Department of Social Services Lead Information Brochure was explained and provided to the licensee. A copy of the 2016 “A Child Care Providers Guide to Safe Sleep” was provided to the licensee. The following electronic links were also provided:
English: https//www.cdph.ca.gov/programs/SIDS/Documents/SIDSchildcaresafesleep.pdf
Spanish: https//www.cdph.ca.gov/programs/SIDS/Documents/ChildCareProvSleepSPAN2011.pdf AAP:https://www.healthychildren.org/English/ages-stages/baby/sleep/Pages/A-Parents-Guide-to-Safe-Sleep.aspx
NIH: https://safetosleep.nichd.nih.gov/safesleepbasics/environment/room/text_alternative
Safe to Sleep Campaign: https://safetosleep.nichd.nih.gov/materials
LPA reviewed with licensee the following safe sleep best practices:
· Always place infants on their backs for sleeping
· Use only a tight-fitting sheet on the crib or play yard mattress
· Do not hang any items from the crib or above the crib
· Keep all items, including blankets, out of the crib or play yard
· Pacifiers may be used if they do not have items attached to them
· Infants should not be swaddled or have any items covering them while sleeping
· The temperature of the room should be comfortable enough for an adult to wear a t-shirt and not be too hot or too cold.

Updated face covering guidance was provided and licensee was to continue to message the “Three W’s”: Wash your hands. Watch your physical distance. Wear a mask. This face covering guidance is for all individuals 2 years and older, except for the exceptions (child’s development, medical exemptions, etc.) that are outlined by CDPH.

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SUPERVISORS NAME: Judy Hanson
LICENSING EVALUATOR NAME: Carmen Odom
LICENSING EVALUATOR SIGNATURE:

DATE: 08/13/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/13/2021
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, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME: GUDINO, ALICIA
FACILITY NUMBER: 304204556
VISIT DATE: 08/13/2021
NARRATIVE
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Important COVID-19 resources and links were provided:
· CDC Student become sick diagnosis flowchart
· CDC Example of Routine Childcare disinfecting
· CCLD PIN 20-18-CCP
· COVID-19 General Guidance Cleaning/Disinfecting in Childcare facilities:
· COVID-19 Update Guidance Childcare Programs/Providers link:
https://files.covid19.ca.gov/pdf/guidance-childcare.pdf
· CCLD COVID-19 Licensed childcare and facilities and provider FAQs link: https://www.cdss.ca.gov/inforesources/cdss-programs/community-care-licensing/child-care-licensing/covid-19-child-care-resources/faqs-for-licensed-child-care-facilities-and-providers

Safe, free, and effective COVID-19 vaccines are now available to everyone age 16 and up. Every Californian can sign up at myturn.ca.gov or call (833) 422-4255 to get their COVID-19 vaccine appointment.

The facility was not in compliance and violations of the California Code of Regulations, Title 22, Division 12 were observed, discussed and cited at the time of the visit. The following violations of the California Code of Regulations, Title 22; Division 12, were observed and cited today: Infant Safe Sleep 102425(c ), Infant Safe Sleep 102425(j), Infant Safe Sleep(j)(2)(D), and Health and Safety Code 1596.8662(4)(b)(1) (see LIC 809D).

An exit interview was conducted with licensee, Alicia Gudino in Spanish. Appeal Rights were explained. The Licensee was provided a copy of appeal rights (LIC 9058 01/16) and their signature on this form acknowledges receipt of these rights. All appeals must be in writing and received by the Regional Office within 15 business days. First level appeals should be sent to the regional manager to the address listed above. The Notice of Site Visit was posted and discussed as required by H&S Code Sec. 1596.817. Notice of Site Visit must be posted for 30 consecutive days. Failure to post will result in civil penalties of $100.00. The Notice of Site Visit must be posted on or adjacent to the door.
SUPERVISORS NAME: Judy Hanson
LICENSING EVALUATOR NAME: Carmen Odom
LICENSING EVALUATOR SIGNATURE:

DATE: 08/13/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/13/2021
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Document Has Been Signed on 08/13/2021 12:32 PM - It Cannot Be Edited


Created By: Carmen Odom On 08/13/2021 at 11:26 AM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868

FACILITY NAME: GUDINO, ALICIA
FACILITY NUMBER: 304204556

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/13/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
08/13/2021
Section Cited
CCR
102425(c)

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Infant Safe Sleep 102425(c) An Individual Infant Sleeping Plan [LIC 9227 (3/20)] shall be completed for each infant up to 12 month of age the provider has in care and maintained at the facility in the infant’s file. This requirement is not met as evidence by:
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LPA Odom provided a copy of LIC9227 form and explained each section. Licensee will have C1 parent's complete the form and place in child's file. Licensee will take a picture and send to LPA Odom for proof of completion by 8/18/21.
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Based on children file reviews at 10:00am C1 did not have the Safe sleep plan LIC9227 in the file. Licensee stated, I am not familiar with the Safe Sleep Plan form for infant 0-12 months. This poses a potential health and safety to the children in care.
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Type B
08/13/2021
Section Cited
CCR102425(j)

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Infant Safe Sleep 102425(j)The provider shall supervise infants while they are sleeping and adhere to the following requirements: (1)The provider shall physically check on the infant every 15 minutes. (2)The provider shall check and document the following: (A)Labored breathing... infant without moving the door. This requirement is not met as evidence by:
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LPA Odom explained how to create a napping log and what needs to be documented on the log daily. Licensee will create a napping log for each infant child and send a copy to the department by 8/18/21.
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Based on observation and file reviews at 10:00am, Licensee did not have a sleeping 15-minute log documenting for labor breathing, signs of distress, infant movement and visually observing 15 minutes. Licensee stated, I check the children every 10-15 mintues but I do not have a log. This poses a potential health and safety to the children in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Judy Hanson
LICENSING EVALUATOR NAME:Carmen Odom
LICENSING EVALUATOR SIGNATURE:
DATE: 08/13/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/13/2021


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Document Has Been Signed on 08/13/2021 12:32 PM - It Cannot Be Edited


Created By: Carmen Odom On 08/13/2021 at 11:50 AM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868

FACILITY NAME: GUDINO, ALICIA
FACILITY NUMBER: 304204556

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/13/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
08/13/2021
Section Cited
CCR
102425(j)(2)(D)

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Infant Safe Sleep 102425(j)(2)(D) Documentation shall be maintained in the infant’s file and be available to the Department for review. Documentation shall include the following:a.Date. b. Infant’s name. c.Time of each 15-minute check. This requirement is not met as evidence by:
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Licensee will create a 15-minute napping log with child's name, date and time to be filed in children's file. Licensee will send a picture of child's napping log as proof to LPA Odom by 8/18/21.
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Based on children's file reviews at 10:00am, C1 did not have documentation of sleeping plan log in file with date, infant's name, and time of each 15-minute check. Licensee stated, I did not know I had to create a sleeping log and file in child's file. This poses a potential health and safety to the children in care.
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Type B
08/13/2021
Section Cited
HSC1596.8662(4)(b)(1)

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On or before March 30, 2018, a person who, on January 1, 2018, is a licensed child day care employee...of a licensed childcare... and shall complete renewal mandated reporter training every two years following the date on which he or she completed the initial mandated reporter training. This requirement was not met as evidenced by:
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Licensee stated, staff including herself will renew and complete the mandated reporter training online in Spanish. Licensee will submit copies of certificates by 8/25/21 to licensing office. LPA Odom provided website www.mandatedreporterca.com
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Based on LPA reviewing staff’s files on 8/13/21 at 10:20am, Licensee and assistant did not have mandated reporter certificates available for review. Licensee failed to meet this requirement of Title 22 Regulations. This is a potential risk to the health and safety of children in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Judy Hanson
LICENSING EVALUATOR NAME:Carmen Odom
LICENSING EVALUATOR SIGNATURE:
DATE: 08/13/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/13/2021


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