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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 304314081
Report Date: 10/06/2022
Date Signed: 10/06/2022 12:17:09 PM

Document Has Been Signed on 10/06/2022 12:17 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:COTA, YOLANDAFACILITY NUMBER:
304314081
ADMINISTRATOR:COTA, YOLANDAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(714) 341-1648
CITY:BUENA PARKSTATE: CAZIP CODE:
90621
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 0DATE:
10/06/2022
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:LicenseeTIME COMPLETED:
12:45 PM
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Licensing Program Analyst (LPA) Mahnaz (Nancy) Malek conducted an announced in-person Pre-Licensing inspection for the purpose of change of location from License # 304313602 for a Large Family Child Care home at this new location. LPA met with Applicant Yolanda Cota, applicant's spouse, Jose Piceno and applicant's daughter, Yolanda Piceno who provided a tour of the new home.

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


The applicant stated she is currently registered with Foster Care agency and holds a foster parent license with County of Orange Social Services Agency Children & Family Services Division. Applicant was reminded to send a new certificate for this address to licensing office when received.

Applicant is requesting for a Large Family Childcare Home license. Operation hours will be Monday to Saturday from 5:00 am to 4:00 am (Less than 24 hours) to children ages 2 weeks old to 12 years old. Facility has submitted a sleeping plan for less than 24 hours operation.

All areas identified on the facility sketch were inspected, including but not limited to, off limit areas. This is a one story family home with 4 bedrooms, 2 full bathrooms, Family room, living room, kitchen, and patio and back yard with side yards.
Areas that will be used by children were inspected for safety, comfort, cleanliness. Telephone service (cell
Continued on page 2
SUPERVISORS NAME: Rina Lopez
LICENSING EVALUATOR NAME: Mahnaz Malek
LICENSING EVALUATOR SIGNATURE: DATE: 10/06/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/06/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 6
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: COTA, YOLANDA
FACILITY NUMBER: 304314081
VISIT DATE: 10/06/2022
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phone is the primary contact phone.



Based on the Facility Sketch submitted, areas off limits to children and parents are: Applicant has designated the four bedrooms, garage, one bathroom, and side yards of the home as off limit areas.

There is a child safety gate installed between the hallway of 3 bedrooms and children's area. The fourth bedroom is located on the patio which has a child proof door knob on it. Kitchen is open and has baby locks on all the drawers and cabinets making them inaccessible to children.

Garage door is next to the children's play room it has bolted locks on it making it inaccessible to children.

During the Pre-licensing inspection, LPA observed the designated off limits areas were closed and locked.

Licensee will use the Cell phone for Day care activities and applicant was informed if a cell phone is used for child care, it must remain on the premises at all times during hours of operation.



Licensee was informed and understands the home is to be free from smoking during hours of operation.
Applicant understands that licensing staff may have access to off-limit areas during inspection visit if necessary.

Areas Designated for Day care activities: Parents and children shall enter the home, through the main door opening into the play room # 2 area of the home, the designated day care area for napping & reading , while living area has been set up for additional day care activities, which has appropriate children's materials. Both the room were observed to have age appropriate activities and educational item. Learning, napping, and dinning will be held in both play room # 1 and play room # 2.

All children will nap in the designated rooms of play room # 2 and #2 . Infants will nap in the cribs and older children will nap on blue cots. Sheets and blankets will be provided by the applicant. Applicant shall provide ongoing supervision during nap time.

Control of property verification was reviewed and is on file.

Continued on page 3

SUPERVISORS NAME: Rina Lopez
LICENSING EVALUATOR NAME: Mahnaz Malek
LICENSING EVALUATOR SIGNATURE:

DATE: 10/06/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/06/2022
LIC809 (FAS) - (06/04)
Page: 2 of 6
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: COTA, YOLANDA
FACILITY NUMBER: 304314081
VISIT DATE: 10/06/2022
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The bathroom is located in the passage area between the bedrooms and family room (Play room # 1). There is a cabinet under the sink with safety latch installed. The children's bathroom was observed to be safe and free of hazardous items.

Applicant will provide AM/PM snacks and lunch will be provided to the children by parents. If food is brought from home and these containers shall be labelled with their names by the parents and stored accordingly.

Upon entrance through the designated main door of the home, applicant shall receive the children here, due to pandemic parents are encouraged to follow CDC guidelines,

OUTDOOR PLAY AREA: Applicant will use the open patio connected to the back yard for outdoor activities. It is fenced with concrete flooring. The patio has age appropriate activity items for children in care. It is safe for outdoor activities. The applicant has separated the patio from the main yard and side yard by a baby gate. The applicant was reminded if in the future she uses any climbing play structure equipment including slides, she needs to make sure to arrange soft padded mats or other cushioning items underneath and around the falling zones.

There are no pets, firearms, weapons, bodies of water in the home.

The value on the 2A10 BC fire extinguisher indicates fully charged, as indicated on service tag observed. Smoke and carbon monoxide detectors were tested and are operable. Applicant has mounted the Fire extinguisher on the side wall of the family room (play room # 2). Smoke detector/ Carbon Monoxide is mounted on the ceiling and they are operable.



Applicant haw completed the required Mandated Reporter Child Abuse training, Health and Safety training with Nutrition and Lead Poisoning component and Pediatric First Aid and CPR which is current.

The following was discussed with the applicant: 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, TB clearance along with a valid criminal record clearance associated to the facility license.
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SUPERVISORS NAME: Rina Lopez
LICENSING EVALUATOR NAME: Mahnaz Malek
LICENSING EVALUATOR SIGNATURE:

DATE: 10/06/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/06/2022
LIC809 (FAS) - (06/04)
Page: 3 of 6
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: COTA, YOLANDA
FACILITY NUMBER: 304314081
VISIT DATE: 10/06/2022
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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-10 BC must be serviced annually or as often as necessary. Smoke and carbon monoxide detectors should be checked, and batteries replaced as needed. The first aid kit was reviewed.

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.

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 Johnny jumpers, No Baby walkers, No saucer chairs, No trampolines and any other item that falls into that category are not permitted in the facility.

Applicant shall reveal each facility license number in all advertisements, publications or announcements with the intent to attract clients.

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



LPA discussed the following items with the Applicant Yolanda Cota during the Exit interview:

Criminal Record statement: Applicant, Yolanda Cota was 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.
Continued on page 5 (4)
SUPERVISORS NAME: Rina Lopez
LICENSING EVALUATOR NAME: Mahnaz Malek
LICENSING EVALUATOR SIGNATURE:

DATE: 10/06/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/06/2022
LIC809 (FAS) - (06/04)
Page: 4 of 6
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: COTA, YOLANDA
FACILITY NUMBER: 304314081
VISIT DATE: 10/06/2022
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Safe Sleep : LPA discussed the safe sleep regulations with applicant, Yolanda Cota & 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 of the applicant, Yolanda Cota 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.

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.

Review of records to be maintained : LPA reviewed with Applicant, Yolanda Cota 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. (LPA gave the LIC 311D with all the required forms and Fire logs to be maintained in the home)

Subscribe to CCLD important 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. To receive important license- 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 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

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SUPERVISORS NAME: Rina Lopez
LICENSING EVALUATOR NAME: Mahnaz Malek
LICENSING EVALUATOR SIGNATURE:

DATE: 10/06/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/06/2022
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: COTA, YOLANDA
FACILITY NUMBER: 304314081
VISIT DATE: 10/06/2022
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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/community-care-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 8 children, at least one child is enrolled in Kindergarten or 6 years old, to be in compliance with Title 22 requirements and additional forms were given to the applicant.

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

The facility at the time of Pre-licensing inspection is in compliance for a (Large Family Child Care Home) with Title 22 Regulations

Orange County Fire authority has granted the fire clearance with specific instructions as below:


Play area # 1 for 6 occupants play area # 2 approve for 4 occupants, all permits accounted for rear construction permits still open . Total occupancy approved 10.

A license for a total capacity of 10 children for Large Family Childcare Home will be issued after the final review and management's approval.

Exit interview was held and appeal rights were presented.
SUPERVISORS NAME: Rina Lopez
LICENSING EVALUATOR NAME: Mahnaz Malek
LICENSING EVALUATOR SIGNATURE:

DATE: 10/06/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/06/2022
LIC809 (FAS) - (06/04)
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