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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 304314032
Report Date: 07/29/2022
Date Signed: 07/29/2022 01:28:59 PM

Document Has Been Signed on 07/29/2022 01:28 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:CASTILLO, LUZFACILITY NUMBER:
304314032
ADMINISTRATOR:CASTILLO, LUZFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(918) 330-1110
CITY:ANAHEIMSTATE: CAZIP CODE:
92806
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 0DATE:
07/29/2022
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Luz Castillo, ApplicantTIME COMPLETED:
01:45 PM
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Licensing Program Analyst (LPA) Stacy Torrence conducted an announced in-person Pre-Licensing inspection for a new Large Family Child Care home. The LPA toured the facility with the applicant, Luz Castillo. Currently there are two adult residents and no minor children living in the home. Applicant stated she is not currently registered with any Foster Care agency or holds a foster parent license. Applicant was reminded to notify the licensing office, if this changes. The applicant is requesting a Large Family childcare home license. Per applicant, operation hours will be Monday to Friday 6:00 AM to 6:00 PM and care and supervision shall be provided to children ages newborn infants to 12 years old (Infants to School age children).

A review of the Facility Personnel Report Summary indicates adult resident, who require caregiver background check clearances, transfers, exemptions have been obtained and they are cleared.

The facility is a single-story home with four bedrooms, two bathrooms, living room, family room, dining room, kitchen, attached garage(locked), front yard (not fenced), patio, and backyard that is fenced. Applicant have designated the one bedroom, one bathroom, family room, and covered patio as part of the day-care. Applicant have designated the three bedrooms, one bathroom, living room, dining room, kitchen, front yard, and backyard as part of the off-limit area. Applicant have placed a safety gates at the entrance of family and kitchen, ensuring the kitchen, dining room, and living is office limits to the children in care. Applicant has place child proof safety knobs on the off-limit bedroom doors, making these areas inaccessible to children in care. Applicant will escort the children to the bathroom. The applicant acknowledged the children may never enter the off-limit areas. Control of property was verified by LPA during today’s inspection. Applicant have cell phones that are used for childcare. Applicant was informed if cell phones are used for childcare, they must remain on the premises at all times during hours of operation. Applicant was informed and understands the home is to be free from smoking during hours of operation.

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SUPERVISORS NAME: Thuy Ho
LICENSING EVALUATOR NAME: Stacy Torrence
LICENSING EVALUATOR SIGNATURE: DATE: 07/29/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/29/2022
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: CASTILLO, LUZ
FACILITY NUMBER: 304314032
VISIT DATE: 07/29/2022
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The facility has a fireplace, located in the family room, which is barricaded by means of sealing off with nailed plywood and a shelf in front of it. Cleaning solutions/chemicals, utensils, and sharp knives, located in the kitchen, are locked in a cabinet located above the countertop which is designated as the off-limit area. LPA observed Poisons/Hazardous items are stored on site, in the locked garage. There are no bodies of water on the premises.

The toys are age appropriate and in good condition for the potential ages served. Baby walkers, bouncers, jumpers, and similar items will not be used for children in care. Applicant stated there are not weapons or firearms on the premises. LPA advised applicant that when there are firearms present, they must be locked and stored separately from the ammunition. During today's inspection, the smoke detector and carbon monoxide were operable, and the fire extinguisher was charged.

EMSA approved Pediatric CPR & Pediatric First Aid are current for the applicant and assistant both expires on 11/2023. Applicant completed the 8-hour Preventative Health Practices, Nutrition Course, and Lead Poisoning on 05/01/2022 with A-B-CPR.
The following was discussed with applicant:
Applicants were informed that individuals who are 18 years of age or older living or working in the home must be fingerprinted cleared prior to initial presence in a licensed Family Child Care Home. LPA provide applicants with website for Live-Scan locations oag.ca.gov/fingerprints/locations for all adult complete LIC 9163. If an adult is fingerprinted cleared and associated to another facility, licensee must submit a Criminal Record Transfer Request (LIC 9182) or Exemption Transfer Request form (LIC 9188). Contact Licensing Office (714)703-2800 ask for Personnel ID#, fax Criminal Background Transfer Request form (LIC 9182 or LIC 9188) with copy of a valid identification issued by State or Federal Government and Criminal Record Statement (LIC 508) to fax # (714)703-2831 prior to hiring adult. Failure to complete the clearance process or license association for any adult resident or assistant will result in a civil penalty assessment against the license.

LPA reviewed Unusual Incident Report (UIR) form (LIC 624B)-advised to contact Licensing Officer of the Day within 24 hours and complete the UIR within seven days by faxing LIC624B to (714)703-2831.

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SUPERVISORS NAME: Thuy Ho
LICENSING EVALUATOR NAME: Stacy Torrence
LICENSING EVALUATOR SIGNATURE:

DATE: 07/29/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/29/2022
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
CCLD Regional Office, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME: CASTILLO, LUZ
FACILITY NUMBER: 304314032
VISIT DATE: 07/29/2022
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LPA advised applicants to report to licensing any unusual incident or child absence that threatens the physical or emotional health or safety of any child or any changes to hours and days of operation and also for any changes to facility, including on/off limit areas and change in phone number.

LPA reviewed LPA reviewed with applicant the LIC 311D, Forms/Records to Keep In Your Family Child Care Home, children’s forms/records, facility forms/records, and information to be posted.

In the absence of the licensee a qualified adult must be present supervising the children; a qualified adult is an adult who has a valid and current Pediatric First Aid and CPR certification, TB clearance along with a valid criminal record clearance associated 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. Fire extinguisher type 2A-10 BC must be serviced annually or as often as necessary. Smoke and carbon monoxide detectors should be checked, and batteries replaced as needed.

Applicant were informed of Mandated Reporter Training for self and all assistants. Department website http:/www.ccld.ca.gov was given to download forms, Title 22 regulations, Providers Information Notices, and online trainings.

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 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.

LPA reviewed with applicant the following safe sleep best practices:
Safe to Sleep Campaign: https//safesleep.nichd.nih.gov/materials
· 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 too hot or too cold
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SUPERVISORS NAME: Thuy Ho
LICENSING EVALUATOR NAME: Stacy Torrence
LICENSING EVALUATOR SIGNATURE:

DATE: 07/29/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/29/2022
LIC809 (FAS) - (06/04)
Page: 3 of 5
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: CASTILLO, LUZ
FACILITY NUMBER: 304314032
VISIT DATE: 07/29/2022
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The applicant was given a pamphlet on Lead Exposure and was discussed with provider. Also provided was information about the E-Learning Modules available at https://ccld.childcarevideos.org. The Chaptered Legislation for AB 2084 (Nutritious Beverages) is available to view on the website at: http://ccld.ca.gov/res/pdf/12APX-11.pdf.

LPA provided Guardian Information and website info:
https://www.cdss.ca.gov/inforesources/cdssprograms/community-care-licensing/caregiver-background
check/guardian

Hard copy and link of Child Care Providers Guide to Safe Sleep provided to licensee:
https://www.cdph.ca.gov/programs/SIDS/Documents/SIDSchildcaresafesleep.pdf.

LPA discussed the following information with the Applicant, during the exit interview:
Criminal Record Statement: Applicants were reminded that all adults 18 and over living or working in the home, 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.

Safe Sleep : LPA discussed the safe sleep regulations with applicants and 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 also informed the applicants 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.


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SUPERVISORS NAME: Thuy Ho
LICENSING EVALUATOR NAME: Stacy Torrence
LICENSING EVALUATOR SIGNATURE:

DATE: 07/29/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/29/2022
LIC809 (FAS) - (06/04)
Page: 4 of 5
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: CASTILLO, LUZ
FACILITY NUMBER: 304314032
VISIT DATE: 07/29/2022
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APPLICANT WILL WAIT UNTIL FACILITY OPENS TO DETERMINE IMS NEEDS: Incidental Medical Services (IMS) policy was discussed. 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.

To improve the quality and value of the new inspection process, a survey will 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 tools, please send them by email 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/communitycare-licensing/process.

OTHER INFORMATION AND FORMS PROVIDED: Capacity Handout for a Large Family Child Care Home. LPA explained the age requirements for the enrolled children ensuring that when there are 12 children, no more than 4 infants and 8 older children over the age of 2, with qualified assistant or 14 children, no more than 3 infants and 11 older children, at least 2 school age children; one child at least age 6 and one child enrolled in Kindergarten to be in compliance with Title 22 requirements. Applicant shall maintain LIC 9227 form in the infant file.

LPA reviewed Title 22 Regulation Section 102423 Personal Rights including but not limited to: no intimidation, no humiliation, and no corporal punishment.

Fire clearance was granted on 07/07/2022.

The facility was in compliance for a Large Family Child Care Home with Title 22 Regulations at the time of inspection.
A license will be issued after final review, in the event additional requirements are needed, the applicant will be notified.

An exit interview conducted, and report was reviewed with Luz Castillo. Appeal Rights and the appeal rights process was discussed with the applicant. Applicant was informed all appeals must be in writing and received by the licensing office within 15 business days.
End of Report
SUPERVISORS NAME: Thuy Ho
LICENSING EVALUATOR NAME: Stacy Torrence
LICENSING EVALUATOR SIGNATURE:

DATE: 07/29/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/29/2022
LIC809 (FAS) - (06/04)
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