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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 304314151
Report Date: 09/30/2024
Date Signed: 10/01/2024 03:40:15 PM

Document Has Been Signed on 10/01/2024 03:40 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:PEREZ, GLADYSFACILITY NUMBER:
304314151
ADMINISTRATOR/
DIRECTOR:		FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 0DATE:
09/30/2024
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:30 AM
MET WITH:Licensee, Gladys Perez TIME VISIT/
INSPECTION COMPLETED:
11:45 AM
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Licensing Program Analyst (LPA) Dianna Valdez Santana conducted a case management inspection, in response to the licensee’s request for a capacity increase. LPA met with licensee, Gladys Perez who guided analyst on a tour of the facility. Licensee stated there is currently two adults and two minor children living in the home. Licensee stated she is not currently registered with any Foster Care agency or holds a foster parent license. Licensee was reminded if changes are made to notify the licensing office. Facility Day care hours are 6:00 AM - 6:00 PM, Monday through Saturday.

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.

All areas on the Facility Sketch (LIC 999) were inspected, including but not limited to, off-limits areas. The facility is a one-story home with 3 bedrooms, 2 bathrooms, a living room, a kitchen, a family room, a front yard (not fenced), a backyard (fenced), and a garage.

Garage will not be used for day-care. The licensee stated the garage will be off-limits.

The licensee acknowledged the children may never enter the off-limit areas during operation hours. Control of property was verified by LPA during today’s inspection. The licensee has a cell phone that is used for childcare. The licensee was informed if a cell phone is used for childcare, it must remain on the premises at all times during hours of operation. The licensee 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: Dianna ValdezSantana
LICENSING EVALUATOR SIGNATURE: DATE: 09/30/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/30/2024
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, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME: PEREZ, GLADYS
FACILITY NUMBER: 304314151
VISIT DATE: 09/30/2024
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Areas Designated for Day Care Activities: The licensee has designated the family room (main play room), kitchen, living room, one bathroom located one left of the main hallway and back yard as the day care areas.

There is a fireplace, located in the living room that has a glass cover and made inaccessible to children when in care. During today’s inspection, LPA observed the fireplace was made inaccessible to children in care. Detergents, cleaning compounds, medicines, and other items which could pose a danger if readily available to children were stored inaccessible to children. Poisons and Hazardous items were not observed. There are no bodies of water. The toys are age appropriate and in good condition for the ages served. Baby walkers, bouncers, jumpers, and similar items will not be used for children in care. Licensee stated there are weapons or firearms on the premises. When firearms are 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. Last fire/disaster drill was conducted 5/29/2024.

Outdoor play activities will be conducted in the backyard, which is appropriately fenced. LPA observed play equipment to be safe and free of hazards. There is one dog on the premises in a sectioned off area of the backyard.

Per the licensee, she provides food for the children. LPA reminded licensee, that if food is not provided and food is brought from the children’s homes; containers shall be labeled with child’s name and properly stored or refrigerated.



Per the licensee, children will nap in the designated main play room and living room. Children will nap on cots and infants in cribs/play yards. The licensee understands that there shall be one crib or play yard for each infant who is unable to climb out of the crib or play yard.

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SUPERVISORS NAME: Thuy Ho
LICENSING EVALUATOR NAME: Dianna ValdezSantana
LICENSING EVALUATOR SIGNATURE:

DATE: 09/30/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/30/2024
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, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME: PEREZ, GLADYS
FACILITY NUMBER: 304314151
VISIT DATE: 09/30/2024
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Licensee stated she will provide linens and blankets for napping. Licensee stated that parents will provide diapers, lotion, wipes, and formula for the infants. Per the licensee, a changing table will be used to change diapers. LPA observed a changing table inside the main play room. LPA advised the licensee to always supervise infants at all times when changing their diapers.

Licensee has a current (EMSA approved) Pediatric First Aid and Pediatric CPR certification that expires on 4/15/2025. A first aid kit is available at the facility located next to the fire extinguisher near the kitchen sink on the counter. The licensee has completed the required mandated reporter training. Recertification is required every two years. Licensee AB1207 mandated reporter certification expires 5/3/2026.

The licensee has a current roster of children in care. During this inspection, LPA reviewed 11 children’s records and they were in compliance.

LPA advised the licensee how to access forms, regulations and quarterly updates online at: www.ccld.ca.gov

LPA discussed the safe sleep regulations with licensee 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 licensee 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.

Incidental Medical Services (IMS) policy was discussed. Licensee stated she is not currently administering medication. 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: https://www.ada.gov/resources/child-care-centers/.
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SUPERVISORS NAME: Thuy Ho
LICENSING EVALUATOR NAME: Dianna ValdezSantana
LICENSING EVALUATOR SIGNATURE:

DATE: 09/30/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/30/2024
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, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME: PEREZ, GLADYS
FACILITY NUMBER: 304314151
VISIT DATE: 09/30/2024
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Licensee was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain child care by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.

Licensee was reminded that all adults 18 and over, 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 Child Care Family 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.


Fire clearance granted on 8/29/2024.

During todays’ inspection, there were no deficiencies cited and licensee was in compliance with California Code of Regulations Title 22 for operating a Family Child Care home.

A new license for operating a Large Family Child Care Home shall be issued upon final review and if additional information is needed, licensee shall be contacted.

Exit interview conducted and report was reviewed with the licensee, Gladys Perez. A notice of site visit was given and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

During the exit interview, the LICENSEE Gladys Perez, confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS.

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.
SUPERVISORS NAME: Thuy Ho
LICENSING EVALUATOR NAME: Dianna ValdezSantana
LICENSING EVALUATOR SIGNATURE:

DATE: 09/30/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/30/2024
LIC809 (FAS) - (06/04)
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