336301200-10-9-2024-10-CC-GHEZ-D9VNY8-20241009105218

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 336301200
Report Date: 10/09/2024
Date Signed: 10/09/2024 10:52:29 AM

Document Has Been Signed on 10/09/2024 10:52 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVERSIDE SE CC RO, 3737 MAIN STREET, STE 700
RIVERSIDE, CA 92501

FACILITY NAME:	DOMINGUEZ FAMILY CHILD CARE		FACILITY NUMBER:	336301200
ADMINISTRATOR/ DIRECTOR:	DOMINGUEZ, ALEXISS		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(760) 404-8511
CITY:	INDIO	STATE: CA	ZIP CODE:	92203
CAPACITY: 14	TOTAL ENROLLED CHILDREN: 14	CENSUS: 0	DATE:	10/09/2024
TYPE OF VISIT:	Prelicensing	ANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	08:45 AM
MET WITH:	Alexiss Dominguez		TIME VISIT/ INSPECTION COMPLETED:	11:00 AM

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On October 9, 2024 at 8:45 AM, Licensing Program Analyst (LPA) Gabriela Hernandez arrived at the facility to conduct a pre-licensing inspection. The licensee was previously licensed as #334846031 and has applied to relocate the childcare facility to this address. Present during this inspection were: Licensee Alexiss Dominguez and her husband.The home has 4 bedrooms, 3 bathrooms, Den, Laundry Room and attached garage. LPA toured the facility, inside and out with Licensee and the following was observed and/or discussed:
· Per Licensee, off-limit areas include: Room #4, Laundry Room, Den, Side Yards and Garage. Room #4, and Laundry room all have safety knob as well as lock on the door requiring a key for entry. Den has a lock that requires a code for entry. Garage has lock and magnetic safety lock on the door.
· Normal hours of operation will be: Sunday thru Saturday from 5:00 am to 8:00 pm.
· Smoke detectors and Carbon Monoxide detectors were tested by the applicant during this inspection and were in working order.
· There is central heating and air conditioning.
· The fire extinguisher is fully charged and meets standards established by the State Fire Marshal.
· All hazardous items were observed to be inaccessible. Storage of poisons and toxins are inaccessible to children and locked in the laundry room. Cleaning supplies are stored in the upper shelf of the closet located by the laundry room. The closet has safety knob and magnetic lock in place. Sharp items including kitchen knives, are inaccessible and stored in the pantry. Medicines are locked and stored in bedroom #4.
· First Aid Kit is located in closet and contains all required items.
· Weapons are present/stored according to Title 22. Licensee understands all guns, weapons and ammunition must be key locked separately and made inaccessible per Title 22 Regulations

· Single Story home; there are no stairs present.

· The fireplace is properly screened.

· Clean, safe and age-appropriate toys were observed.

SUPERVISORS NAME: Pauline Beschorner
LICENSING EVALUATOR NAME: Gabriela Hernandez
LICENSING EVALUATOR SIGNATURE:	DATE: 10/09/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/09/2024

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
RIVERSIDE SE CC RO, 3737 MAIN STREET, STE 700
RIVERSIDE, CA 92501

FACILITY NAME: DOMINGUEZ FAMILY CHILD CARE	FACILITY NUMBER: 336301200
	VISIT DATE: 10/09/2024

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·LPA confirmed working telephone is present.
· There were no toxic plants inside or outside the facility observed at this time.
· The outside activity area consists of backyard; side yards are off-limits.
· There are no bodies of water observed on this date. Applicant understands all bodies of water including ponds, above ground pools and spas, in-ground pools and 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 bodies of water described. In addition, all wading pools or similar product must be emptied immediately after use and stored in an upright position when not in use.
· Applicant will be transporting children. Applicant will be using Blue Silverado Truck and Silver Impala to pick-up and drop-off children. The vehicle is in safe operating condition. LPA verified Licensee has Valid Drivers License, registrations and insurance.
· Verification of control of property is maintained by applicant.
· Facility Sketch and Emergency Disaster Plan are posted.
· Pediatric CPR and First Aid Card has not been completed; Licensee will complete and submit proof to LPA.
· Mandated Reporter certificate expires 05/2025.
· Preventive Health and Safety training, including nutrition and lead components were completed on 11/22/2020.
Licensee Alexiss was reminded all adults 18 and over living in the home, persons who provide care and supervision to children, and staff who have contact with children, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, 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 for a maximum of 5-days or, if the penalty is for a repeat violation, for a maximum of 30-days per person will be assessed if this regulation is violated.

The applicant provided proof of control of property.

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) or (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

LPA reviewed with applicant 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. Entrance Checklist was provided to the applicant.

SUPERVISORS NAME: Pauline Beschorner
LICENSING EVALUATOR NAME: Gabriela Hernandez
LICENSING EVALUATOR SIGNATURE:	DATE: 10/09/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/09/2024

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
RIVERSIDE SE CC RO, 3737 MAIN STREET, STE 700
RIVERSIDE, CA 92501

FACILITY NAME: DOMINGUEZ FAMILY CHILD CARE	FACILITY NUMBER: 336301200
	VISIT DATE: 10/09/2024

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LPA discussed the safe sleep regulations with Licensee Alexis 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 applicant 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.

On this date, 10/07/2024, The California Attorney General – Megan’s Law website was searched for information on sex offenders required to register with local law enforcement under California’s Megan’s Law. No registered sex offenders were found at the facility address. Under state law, some registered sex offenders are not subject to public disclosure; therefore, they may not have been included in this search. However, the Department conducts a monthly cross reference of each address on record for all registered sex offenders against all CCLD facility addresses pursuant to information shared by California DOJ.

Applicant was informed of the MyChildCarePlan.org site, 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.

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 to receive email communication.

The following items were also reviewed with the applicant during inspection:
- Failure to meet the posting requirements shall result in an immediate $100 civil penalty.
- Documentation of fire & earthquake drills to be conducted every six months
- Responsibilities of being a mandated reporter and updating training every 2 years
- Personal rights of children in care, including no corporal punishment

SUPERVISORS NAME: Pauline Beschorner
LICENSING EVALUATOR NAME: Gabriela Hernandez
LICENSING EVALUATOR SIGNATURE:	DATE: 10/09/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/09/2024

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
RIVERSIDE SE CC RO, 3737 MAIN STREET, STE 700
RIVERSIDE, CA 92501

FACILITY NAME: DOMINGUEZ FAMILY CHILD CARE	FACILITY NUMBER: 336301200
	VISIT DATE: 10/09/2024

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- Responsibility to know the Title 22 Regulations for anyone providing care and supervision
- Capacity and Supervision requirements
- Inaccessibility of hazards must be constantly reassessed depending on the children in care
- Current facility phone numbers must always be on file with the licensing office
- Baby walkers, bouncy seats, exer-saucers, and other similar items are prohibited
- Car seat law
- Smoking is prohibited in the facility while providing child care or transporting children
- Once licensed, the Notice of Site Visit must be posted at the entrance of the facility for a period of 30 days. If a serious violation is cited, a copy of the licensing report (LIC809/LIC9099) must also be posted for 30 days. A civil penalty of $100 per violation will be assessed for noncompliance.
- Applicant was informed of their reporting requirements and is provided with the Regional Office’s Unusual Incident Reporting email mailbox: UnusualIncidentReportsDO10@dss.ca.gov
-The Applicant can submit fingerprint transfer forms to associate new individuals or to disassociate someone from the facility at: Associations_Disassociations858@dss.ca.gov
- Access to forms & Title 22 Regulations for Family Child Care Homes online at www.ccld.ca.gov
- The Duty Officer is available to answer questions Monday – Friday 8:00am to 5:00pm at: 951-782-4200.

Before licensure, the following needs to be corrected/completed:
1.Complete approved CPR course and provide Certificate to LPA.

Once all corrections have been verified, the application for a Large Family Child Care Home will be submitted for approval with a maximum capacity 12 or 14 with parent notification. Applicant advised that all corrections are due within 30 days, or the application may be withdrawn.

Exit interview conducted and report was reviewed with the Licensee Alexiss Dominguez.

SUPERVISORS NAME: Pauline Beschorner
LICENSING EVALUATOR NAME: Gabriela Hernandez
LICENSING EVALUATOR SIGNATURE:	DATE: 10/09/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/09/2024

LIC809 (FAS) - (06/04)

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