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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 334815272
Report Date: 11/02/2023
Date Signed: 11/02/2023 03:12:30 PM

Document Has Been Signed on 11/02/2023 03:12 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
INLAND EMPIRE CHILD, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501
FACILITY NAME:VAZQUEZ FAMILY CHILD CAREFACILITY NUMBER:
334815272
ADMINISTRATOR:VAZQUEZ, GLORIAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(951) 534-0231
CITY:RIVERSIDESTATE: CAZIP CODE:
92501
CAPACITY: 14TOTAL ENROLLED CHILDREN: 9CENSUS: 1DATE:
11/02/2023
TYPE OF VISIT:Required - 3 YearUNANNOUNCEDTIME BEGAN:
10:19 AM
MET WITH:Gloria Vazquez, LicenseeTIME COMPLETED:
03:25 PM
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On 11/02/2023 at 10:34 AM Licensing Program Analysts (LPAs) Susan Brewer and Laura Mejorado arrived at the facility to conduct an annual inspection. LPAs were greeted by Licensee and granted entry to tour the facility inside and out. LPA reviewed records and observed and/or discussed the following:

The licensee’s preferred language is Spanish. Updated during the inspection were the LIC279 Application form, LIC610A Emergency Disaster Plan, LIC999A Home and Yard Facility Sketches. The Outdoor Play area in the backyard is now off-limits to daycare children. The licensee stated, they are currently operating at a small capacity with no more than 4 children in care at any given time.

Normal days/hours of operation: Monday- Sunday 4:30 AM to 9:00 PM
OFF-LIMIT AREAS INCLUDE: Master Bedroom 1 & Master Bath, Bedrooms 2, 3, the Garage and Backyard.

The inspection consisted of reviews of the following domain: Physical Plant, Care and Supervision, Records, Facility Administration, Staffing Ratio and Capacity, Personal Rights. The inspection found the facility to be in compliance in these domains, except as noted on the LIC809D.

· The facility is operating within the licensed capacity and appropriate ratios with 1 child in care.
· The Licensee is present in the home and has ensured that children in care are supervised.
· When temporarily absent from the home, the Licensee shall arrange for a substitute adult to care for and supervise children.
· A working telephone is present.
· Appropriate fire extinguisher (2A:10BC) in the green, smoke detector and carbon monoxide detector are present, were tested by the Licensee during this inspection and were not operating. The licensee placed new batteries in the smoke/carbon monoxide device and re-tested in during the inspection. LPAs verified the device to be operating.
SUPERVISORS NAME: Kimberly Williams
LICENSING EVALUATOR NAME: Susan Brewer
LICENSING EVALUATOR SIGNATURE: DATE: 11/02/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/02/2023
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
INLAND EMPIRE CHILD, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501
FACILITY NAME: VAZQUEZ FAMILY CHILD CARE
FACILITY NUMBER: 334815272
VISIT DATE: 11/02/2023
NARRATIVE
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· LPAs observed hazardous items to be accessible, this includes detergents, cleaning compounds, medications and other items which could pose a danger to children. At 10:40 AM, observed accessible aerosol air fresheners underneath the restroom sink; shampoos, hygiene products in the shower, the hall closet, 1 air freshener spray can 5 bottles of essential oils and in the living room tv stand; 1 can of air fresher, 1 Clorox and 2 generic all-purpose cleaning spray bottle and 1 spray can of glass cleaner under the kitchen sink; some of which can be considered poisonous if a child were to ingest the cleaning products.
· Storage of poisons are accessible to children are NOT locked. At 11:12 AM LPAs observed several kitchen knives, lighters and kitchen scissors in a lower kitchen cabinet accessible to smaller and older children. A set of kitchen knives in a block are located in a top cabinet, which is not locked and accessible to older children in care. The licensee removed the items in the presence of the LPAs relocated to the garage. The knife block was placed in a top cabinet over the refrigerator to make inaccessible to daycare children in the presence of the LPAs.
· There is a properly barricaded fireplace on 11/02/2023.
· No guns or weapons present as stated by the Licensee. Licensee Gloria Vazquez, understands all guns, weapons and ammunition must be key locked separately and made inaccessible per Title 22 regulations.
· No stairs, this is a 1 story home.
· Home is clean and orderly, with heating and ventilation for safety and comfort.
· Clean, Safe and age-appropriate toys and equipment are present for both indoor and outdoor activities.
· Outdoor play areas are fenced and/ or appropriate supervision is present.
· Verification of control of property on file by mortgage statement.
· Pediatric CPR and First Aid Card expired on 05/03/2023, and the licensee failed to renew their training as required.
· Health & Safety Certificate - completed on 01/17/2017
· Mandated reporter General: NOT ON FILE; AB 1207 Child Care Expires: 12/16/2023
· Fire clearance: 09/09/2008
· Documentation of fire & earthquake drills to be conducted every six months: Last drill on 02/19/2023.
· There are no bodies of water, at this time. Licensee Gloria Vazquez, understands all bodies of water including ponds, above ground pools & spas, in-ground pools & spas, and some fountains must be properly covered or fenced per Title 22 regulations. The Department must be notified before and after installation of the above types of bodies of water. In addition, all wading pools or similar product must be emptied immediately after use and stored in an upright position.
SUPERVISORS NAME: Kimberly Williams
LICENSING EVALUATOR NAME: Susan Brewer
LICENSING EVALUATOR SIGNATURE:

DATE: 11/02/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/02/2023
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
INLAND EMPIRE CHILD, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501
FACILITY NAME: VAZQUEZ FAMILY CHILD CARE
FACILITY NUMBER: 334815272
VISIT DATE: 11/02/2023
NARRATIVE
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· Children’s files are NOT complete: 1 infant child present and in care was missing the Infant safe sleep log, immunization records, receipts the LIC995A Notification of Parents Rights and LIC9150 Parent Notification of Additional Children in the home.
· Staff’s files are complete (If licensee has a hired assistant): No assistants at this time.
· A review of staff records on 10/11/2023 indicates that all facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions.

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 to receive email communication.

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

Licensee Gloria Vazquez, 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. The Licensee can submit transfer forms to associate new individuals or to disassociate someone from your facility at: Associations_Disassociations862@dss.ca.gov for Riverside Regional Office.

LPAs Laura Mejorado and Susan Brewer, discussed the safe sleep regulations with licensee Gloria Vazquez 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.
SUPERVISORS NAME: Kimberly Williams
LICENSING EVALUATOR NAME: Susan Brewer
LICENSING EVALUATOR SIGNATURE:

DATE: 11/02/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/02/2023
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
INLAND EMPIRE CHILD, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501
FACILITY NAME: VAZQUEZ FAMILY CHILD CARE
FACILITY NUMBER: 334815272
VISIT DATE: 11/02/2023
NARRATIVE
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 LPAs 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.

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/community-care-licensing/process.

LPAs Laura Mejorado and Susan Brewer, informed licensee Gloria Vazquez that this report dated 11/02/2023 documents 1 Type A citation for violation of Title 22 Regulation 102417(g)(4)(A) Physical Plan. Type A citation(s) which shall be posted for 30 consecutive days as there is/are immediate risk(s) to the health, safety, or personal rights of children in care.

Also, LPAs Laura Mejorado and Susan Brewer, informed the licensee Gloria Vazquez to provide a copy of this licensing report dated 11/02/2023 that documents any Type A citation(s) to parents/guardians of all children currently enrolled by the next business day or the next day the children are in care, and to any newly enrolled parents/guardians for 12 months from the date of this report. A signed Acknowledgement of Receipt of Licensing Report (LIC 9224), or other written statement, must be placed in the child's file for verification.

Deficiencies cited this visit for Type A and Type B violations.

Civil Penalties not issued this visit.

A notice of site visit was given and must remain posted for 30 days.

Exit interview conducted and report was reviewed with the licensee Gloria Vazquez.
SUPERVISORS NAME: Kimberly Williams
LICENSING EVALUATOR NAME: Susan Brewer
LICENSING EVALUATOR SIGNATURE:

DATE: 11/02/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/02/2023
LIC809 (FAS) - (06/04)
Page: 4 of 13
Document Has Been Signed on 11/02/2023 03:12 PM - It Cannot Be Edited


Created By: Susan Brewer On 11/02/2023 at 01:42 PM
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
, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501

FACILITY NAME: VAZQUEZ FAMILY CHILD CARE
FACILITY NUMBER: 334815272

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/02/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
102417(g)(4)(A)
Operation of A Family Child Care Home
(g) The home shall be free from defects or conditions which might endanger a child. Safety precautions shall include but not limited to: (4) Poisons, detergents, cleaning compounds, medicines, firearms and other items which could pose a danger if readily available to children shall be stored where they are inaccessible to children. (A) Storage areas for poisons, firearms and other dangerous weapons shall be locked.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, the licensee did not comply with the section cited above in LPAs observed several kitchen knives, lighters with lighter fluid, kitchen scissors in a lower kitchen cabinet, 1 set of kitchen knives in a block are located in kitchen accessible to older children in care, aerosol air fresheners underneath the restroom sink; shampoos, hygiene products in the shower, the hall closet, 1 air freshener spray can 5 bottles of essential oils and in the living room TV stand; 1 can of air fresher, 1 Clorox and 2 generic all purpose cleaning spay bottle and 1 spray can of glass cleaner under the kitchen sink, which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 11/03/2023
Plan of Correction
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The licensee agrees to ensure the home shall be free from defects or conditions which might endanger a child and to include, poisons, detergents, cleaning compounds, medicines, firearms and other items which could pose a danger if readily available to children and will place a lock on cabinets to make poisons, toxins, cleaning supplies, medicines, household products and other dangerous knives and/or weapons inaccessible to children. The licensee also agrees to submit proof of locks or latches placed on storage cabinets to make inaccessible to children and submit the proof by photo, to the department on or before 11/03/2023.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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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:Kimberly Williams
LICENSING EVALUATOR NAME:Susan Brewer
LICENSING EVALUATOR SIGNATURE:
DATE: 11/02/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/02/2023


LIC809 (FAS) - (06/04)
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Document Has Been Signed on 11/02/2023 03:12 PM - It Cannot Be Edited


Created By: Susan Brewer On 11/02/2023 at 01:42 PM
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
, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501

FACILITY NAME: VAZQUEZ FAMILY CHILD CARE
FACILITY NUMBER: 334815272

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/02/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102417(g)(9)(A)
Operation of A Family Child Care Home
(g) The home shall be free from defects or conditions which might endanger a child. Safety precautions shall include but not limited to: (9) Each family child care home shall have a written disaster plan of action prepared on a form approved by the Department. All children, age and ability permitting, and the provider, the assistant provider, and other members of the household, shall be instructed in their duties under the disaster plan. As their age and ability permit, newly enrolled children shall be informed promptly of their duties as required in the plan. (A) Each family child care home shall conduct fire drills and disaster drills at least once every six months.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, the licensee did not comply with the section cited above in the licensee failed to conduct a fire drill with daycare chidlren after 02/2023, as required which poses potential health, safety or personal rights risk to persons in care.
POC Due Date: 11/08/2023
Plan of Correction
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The licensee agrees to conduct fire drills and disaster drills at least once every six months beginning the week of 11/06/2023 and submit proof of the fire drill to the department on or before 11/08/2023.
Type B
Section Cited
CCR
102425(b)
Infant Safe Sleep
(b) Cribs or play yards shall be free from all loose articles and objects.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based observation, the licensee did not comply with the section cited above in at 10:47 AM LPAs observed a subject child sleeping in a play yard, with a milk bottle propped in their mouth by a blanket, a stuffed animal pillow and a large folded mattress pad laid on top of the mattress, which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 11/02/2023
Plan of Correction
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The licensee agrees to ensure cribs or play yards shall be free from all loose articles and objects for all infant chidlren enrolled and cared for at the facility.
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:Kimberly Williams
LICENSING EVALUATOR NAME:Susan Brewer
LICENSING EVALUATOR SIGNATURE:
DATE: 11/02/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/02/2023


LIC809 (FAS) - (06/04)
Page: 6 of 13
Document Has Been Signed on 11/02/2023 03:12 PM - It Cannot Be Edited


Created By: Susan Brewer On 11/02/2023 at 01:42 PM
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
, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501

FACILITY NAME: VAZQUEZ FAMILY CHILD CARE
FACILITY NUMBER: 334815272

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/02/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102416(c)
Personnel Requirements
(c) The licensee and other personnel as specified shall complete training on preventive health practices, including pediatric cardiopulmonary resuscitation and pediatric first aid, pursuant to Health and Safety Code Section 1596.866.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, the licensee did not comply with the section cited above in the licensee failed to renew their training on preventive health practices, including pediatric cardiopulmonary resuscitation and pediatric first aid, pursuant to Health and Safety Code Section 1596.866. which poses/posed a potential health, safety or personal rights risk to persons in care, which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 12/01/2023
Plan of Correction
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The licensee agrees to submit proof of registration to renew their training on preventive health practices, including pediatric cardiopulmonary resuscitation and pediatric first aid, pursuant to Health and Safety Code Section 1596.866.in through an EMSA approved vendor on or before 12/01/2023 and submit proof of the training certification upon completion, to the department by fax, mail or e-mail.
Type B
Section Cited
CCR
102418(g)
Immunizations
(g) The licensee shall document each child's immunizations as required by the California Code of Regulations, Title 17, Section 6070, and shall maintain such documentation for as long as the child is enrolled.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, the licensee did not comply with the section cited above in the licensee failed to ensure documention of a subject child's immunizations as required by the California Code of Regulations, Title 17, Section 6070, and maintain such documentation for a subject child enrolled and present during the inspection which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 11/08/2023
Plan of Correction
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The licensee agrees to document each child's immunizations as required by the California Code of Regulations, Title 17, Section 6070, and shall maintain such documentation for as long as the child is enrolled and submit proof of immunizations records for a subject child on or before 11/08/2023 by fax, mail or e-mail.
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:Kimberly Williams
LICENSING EVALUATOR NAME:Susan Brewer
LICENSING EVALUATOR SIGNATURE:
DATE: 11/02/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/02/2023


LIC809 (FAS) - (06/04)
Page: 7 of 13
Document Has Been Signed on 11/02/2023 03:12 PM - It Cannot Be Edited


Created By: Susan Brewer On 11/02/2023 at 01:42 PM
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
, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501

FACILITY NAME: VAZQUEZ FAMILY CHILD CARE
FACILITY NUMBER: 334815272

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/02/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102425(j)(2)(D)(c)
Infant Safe Sleep
Documentation shall be maintained in the infant’s file and be available to the Department for review. Documentation shall include the following: Time of each 15-minute check

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based onr ecord review, the licensee did not comply with the section cited above in the licensee failed to document 15 minutes for a subject child present and in care as required for infant safe sleep standards for which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 11/08/2023
Plan of Correction
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The licensee agrees to documentation and maintain the time of each 15-minute infant safe sleep checks in the each infant’s file, ensuring the documentation is available to the department for review and submit proof of documentation for a subject infant child enrolled and attending on or before 11/08/2023 by fax, mail or e-mail.
Section Cited
Deficient Practice Statement
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2
3
4
POC Due Date:
Plan of Correction
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2
3
4
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:Kimberly Williams
LICENSING EVALUATOR NAME:Susan Brewer
LICENSING EVALUATOR SIGNATURE:
DATE: 11/02/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/02/2023


LIC809 (FAS) - (06/04)
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