304313883-7-9-2021-06-CC-KDEI-C4RVYG-20210709165106

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 304313883
Report Date: 07/09/2021
Date Signed: 07/09/2021 04:51:25 PM

Document Has Been Signed on 07/09/2021 04:51 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:	CHAVEZ, PAOLA & JESUS & MAGANA, VERONICA		FACILITY NUMBER:	304313883
ADMINISTRATOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY: 8	TOTAL ENROLLED CHILDREN: 0	CENSUS: 0	DATE:	07/09/2021
TYPE OF VISIT:	Prelicensing	UNANNOUNCED	TIME BEGAN:	02:15 PM
MET WITH:	Applicants : Chavez Paola, Jesus & Magana Veronica		TIME COMPLETED:	05:15 PM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	Licensing Program Analyst’s (LPA) Ketki Desai, conducted an announced in-person Pre-Licensing inspection for a new Small Family Child Care home. LPA met with applicants Ms. Chavez Paola, Jesus & Magana Veronica who provided a tour of the new home. LPA observed Applicant wearing face mask, and following CDC and Dept of Public Health Guidelines. A review of the Facility Personnel Report Summary indicates adult resident, who require caregiver background check clearances exemptions is received and is cleared. Licensee stated, she is not currently registered with any Resource Foster Care agency or holds a Resource foster parent license. Applicant was reminded if changes to notify the licensing office. Per Applicant, operation hours will be Monday to Sunday , 6.00 AM to 8.00 PM and care and supervision shall be provided to children ages 4 months to 12 years of age (Infants to School age) All areas identified on the facility sketch were inspected, including but not limited to, off limit areas. This is a single story home with Four bedrooms/ Living room / Family room / Kitchen / Two full bathrooms / Front yard/ Side driveway / Laundry room/ Garage (remolded to a Phot shop)/ Backyard with extended side yard with three small sheds for storage and one Large wooden shed turned into an office area. Currently there are no children receiving care and supervision. Areas that will be used by children were inspected for safety, comfort, cleanliness, telephone service (cell phone), ventilation and heating. The home has central air and heating system. Detergents, cleaning compounds, medicines, sharp objects and hazardous items that can pose a danger to children are inaccessible in areas designated for children. Applicant states (that there are no poisons on the premises). Applicant was advised that any poisons must be locked with a key or combination lock. (1)

SUPERVISORS NAME: Thuy Ho
LICENSING EVALUATOR NAME: Ketki Desai
LICENSING EVALUATOR SIGNATURE:	DATE: 07/09/2021

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/09/2021

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, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868

FACILITY NAME: CHAVEZ, PAOLA & JESUS & MAGANA, VERONICA	FACILITY NUMBER: 304313883
	VISIT DATE: 07/09/2021

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Based on the Facility Sketch submitted, areas off limits to children and parents are: Three bedrooms, (3 bedrooms on the right side of the living area) Living area / Kitchen/ One bathroom/ Garage /Laundry room and the extended side yard with small wooden storage sheds and one large Wooden shed remolded into an office area. Applicant has placed a safety gate across the Kitchen making the front side inaccessible to children. Part of the extended side yard / Garage / Laundry room are also made inaccessible to children. Applicant has installed a self lock on the laundry room door/ Garage door (remolded into a Photo shop ) has two bolted locks, while the extended side yard besides the garage door also has a fenced locked door. The side yard where large garbage bins are placed also has a wooden gate making the side yard area inaccessible to children. End of the kitchen has a child safety gate making the home completely inaccessible to children and parents.

Applicant understands that licensing staff may have access to off-limit areas during inspection visit if necessary.

Areas Designated for Day care activities: Children shall enter the home through the front sliding metal gate into the side drive way leading into the designated Day care area. Applicant has a set up for temperature check and hand sanitizing station upon entrance into the Designated Day Care area ( Family room). The day care area is spacious with toys and educational items for the children. The designated bathroom is on the right end of the kitchen in front of the child safety gate. Designated children’s bathroom was observed to be safe and free of hazardous items. There is a cabinet under the sink, with child lock stoppers, no hazardous items were observed, and bathroom was clean.

Applicant has also designated one bedroom adjoining the Family room as a Day Care napping area for young infants. There are cribs/ Play pen and a changing station for Infant care, while older children shall nap on the cots. All the bedding linens/ blankets shall be provided by the Applicant . All Infant needs shall be provided by the parents.

Day care area was observed to have safe and age appropriate furniture/ toys and educational items. Napping room was observed to be spacious and clean.

OUTDOOR PLAY AREA: Per Applicant , children shall use the back yard area, shaded side drive way during outdoor activities. The back yard and side drive way is accessed through two sliding doors in the designated day care room. The back yard is completely fenced with grass flooring. Applicant has age appropriate outdoor toys and It is shaded and safe for outdoor play. (Page-2)

SUPERVISORS NAME: Thuy Ho
LICENSING EVALUATOR NAME: Ketki Desai
LICENSING EVALUATOR SIGNATURE:	DATE: 07/09/2021

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/09/2021

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: CHAVEZ, PAOLA & JESUS & MAGANA, VERONICA	FACILITY NUMBER: 304313883
	VISIT DATE: 07/09/2021

NARRATIVE

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The value on the 2A10BC fire extinguisher indicates fully charged, as indicated on service tag observed. Smoke and carbon monoxide detectors were tested and are operable.

Applicant plans to provide the snacks/ Lunch and Dinner to the enrolled children and is also in process of enrolling in the Food Program.

Applicants have completed the required Health and Safety with Nutrition and Lead Poisoning component Training and Pediatric First Aid and CPR which expires on 5/9/2022.

There are first aid supplies available.

There are two birds, one cat and one dog as pets in the home . Per applicant there are no weapons or bodies of water in the home. The home was clean, orderly, and at a comfortable temperature.

The following was discussed with the applicant:
Individuals who are 18 years of age or older living in the home must obtain a criminal record clearance. Individuals within one month of their 18th birthday must be fingerprinted immediately. Civil Penalties will be assessed if not in compliance.
·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 Pediatric First Aid and CPR certification and a valid criminal record clearance associated to the facility license

·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.

Licensee was also made aware of the Child Advocacy program so she could receive the updated Quarterly reports and other information in a timely manner. ChildCareAdvocatesProgram@dss.ca.gov

Reporting Requirements: Changes should be reported to the Department as soon as they occur such as construction, remodeling, telephone number changes and/or if you move from your home. (Page-3)

SUPERVISORS NAME: Thuy Ho
LICENSING EVALUATOR NAME: Ketki Desai
LICENSING EVALUATOR SIGNATURE:	DATE: 07/09/2021

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/09/2021

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: CHAVEZ, PAOLA & JESUS & MAGANA, VERONICA	FACILITY NUMBER: 304313883
	VISIT DATE: 07/09/2021

NARRATIVE

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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.
Children and Staff records must be maintained and updated as needed and must be available for review by the Department.

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.

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.

UPDATE: 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, pertussis, and measles.
The licensee has submitted proof of immunization's.

UPDATE: 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

Infant Care: Applicant states that she will care for infants. LPA advised the Applicant to sleep infants where they can always be directly supervised and advised against sleeping infants in a separate room. The Applicant states the following as a supervision plan for infants: The infants will sleep where she will be providing supervision and they shall not be left unattended. LPA provided a copy of the Child Care Provider’s Guide to Safe Sleep, by American Academy of Pediatrics. Online copy can be downloaded at: https://www.cdph.ca.gov/programs/SIDS/Documents/SIDSchildcaresafesleep.pdf (Page-4)

SUPERVISORS NAME: Thuy Ho
LICENSING EVALUATOR NAME: Ketki Desai
LICENSING EVALUATOR SIGNATURE:	DATE: 07/09/2021

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/09/2021

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: CHAVEZ, PAOLA & JESUS & MAGANA, VERONICA	FACILITY NUMBER: 304313883
	VISIT DATE: 07/09/2021

NARRATIVE

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Safe to Sleep Campaign: https://safetosleep.nichd.nih.gov/materials
LPA reviewed with applicant 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 as long as 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

LPA advised the applicant how to access forms, regulations and quarterly updates on the Child Care Licensing website at: www.ccld.ca.gov. LPA reviewed and issued the Forms/Records to Keep in Your Family Child Care Home (LIC 311D) and provided the following forms: All the forms were provided to the Applicant during the Pre-Licensing inspection today.

A Packet with following forms were provided and discussed with the applicant during the Pre-Inspection today.

CHILDREN FORMS/RECORDS - Children’s files must contain the following documents/information:
Identification and Emergency Information (LIC 700), Consent for Emergency Medical Treatment (LIC 627), Notification of Parent’s Rights (LIC 995A), Caregiver Background Check Process (LIC 995E), Family Child Care Consumer Awareness Information (LIC 9212), Consent/Verification for Nebulizer Care (LIC 9166), California School Immunization Record, Parent Notification for Additional Children in Care (LIC 9150), Affidavit Regarding Liability Insurance (LIC 282), Acknowledgment of Receipt of Licensing Reports (LIC 9224).

FACILITY FORMS/RECORDS - Facility files must contain the following documents/information:
Personnel Records: As required in Title 22 Regulations 102416.1, Unusual incident/Injury Report (LIC 624B): Child Care Facility Roster (LIC 9040), Notice of Employee Rights (LIC 9052), Statement Acknowledging Requirement to Report Suspected Child Abuse (LIC 9108), Property Owner/Landlord Consent (LIC 9149), Property Owner/Landlord Notification Form (LIC 9149). (Page-5)

SUPERVISORS NAME: Thuy Ho
LICENSING EVALUATOR NAME: Ketki Desai
LICENSING EVALUATOR SIGNATURE:	DATE: 07/09/2021

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/09/2021

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: CHAVEZ, PAOLA & JESUS & MAGANA, VERONICA	FACILITY NUMBER: 304313883
	VISIT DATE: 07/09/2021

NARRATIVE

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INFORMATION TO BE POSTED IN YOU FAMILY CHILD CARE HOME – You are required by Law to post the following: Facility License (LIC 203), Emergency Disaster Plan (LIC 610A), Earthquake Preparedness Checklist (LIC 9148), Notification of Parent’s Rights (PUB 394). A Notice of Site Visit (LIC 9213): Must be posted for 30 days after each site inspection by a Licensing Representative. Any Licensing Report documenting a Type “A” deficiency must be posted for 30 days during the hours that children are in care. Any Licensing Report or other document verifying compliance or non-compliance with the Department’s order to correct a Type “A” deficiency must be posted for 30 days during the hours that children are in care.

OTHER INFORMATION AND FORMS PROVIDED: Capacity Handout for a Small Family Child Care Home / Sleep safe guidelines were provided to the Applicant and PIN 20-24 (Infant sleep)

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.

COVID 19 Self Assessment guide was reviewed and received from the applicant.

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. Once licensed, the applicant is required to adhere to the terms and limitations stated on the license. A copy of this report and all other Licensing reports must be made available to the public for 3 years.

The facility at the time of Pre-licensing is in compliance for a (Small Family Child Care Home) with Title 22 Regulations. License shall be issued after management approval.

Appeal rights were presented and Exit interview was conducted with the applicants Ms. Chavez Paola, Jesus & Magana Veronica.

SUPERVISORS NAME: Thuy Ho
LICENSING EVALUATOR NAME: Ketki Desai
LICENSING EVALUATOR SIGNATURE:	DATE: 07/09/2021

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/09/2021

LIC809 (FAS) - (06/04)

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