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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 360905849
Report Date: 12/09/2021
Date Signed: 12/09/2021 03:11:54 PM

Document Has Been Signed on 12/09/2021 03:11 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, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME:BELTRAN FAMILY DAY CAREFACILITY NUMBER:
360905849
ADMINISTRATOR:BELTRAN, YOLANDAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(909) 855-5914
CITY:SAN BERNARDINOSTATE: CAZIP CODE:
92407
CAPACITY: 12TOTAL ENROLLED CHILDREN: 12CENSUS: 6DATE:
12/09/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
02:48 PM
MET WITH:YOLANDA BELTRANTIME COMPLETED:
03:35 PM
NARRATIVE
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Licensing Program Analysts (LPA) Maddox and Ibitoye met with licensee, Yolanda Beltran today for the purpose of conducting an unannounced 1 year required inspection. Present today were licensee and son Adrian, and 6 day care children. The licensee guided Analysts on a tour of the facility inside and outside. The home is a single story family home with 4 bedrooms and 2 bathrooms. All adults in the home, 3 adults in the home with have fingerprint clearances and exams for T.B. Areas of the home for child care include the living room; dining area: 1 bathroom, 1 bedroom, backyard.

Home has central heating and air conditioning. The kitchen and bathroom were toured and inspected for proper storage of chemicals, detergents, cleaning compounds, medications and sharp pointed objects, all items were made inaccessible to children. The outside play area was clear of chemicals and debris, the entire yard is fenced. There is a swing set located in the backyard that was anchored during this inspection. All unused electrical outlets are plugged and play equipment and toys are available. Licensee is aware that baby walkers, bouncer, or any similar equipment are prohibited in any licensed facility. Per licensee, there are no weapons or firearms of any kind on the premises. The required fire extinguisher (2A 10BC), smoke detector, and carbon monoxide devise are in operable condition. Licensee has current CPR and First Aid training (exp 9/13/22). Licensee has a current Roster and Disaster drills log. Due to time restraints, this Required visit will be continued. Safe Sleep Regs were printed out during this inspection. Upon arrival, LPS's witnessed an infant sleeping in a bouncer/rocking chair with a blanket over his face. Type A citation issued today.
SUPERVISORS NAME: Claretta Yates
LICENSING EVALUATOR NAME: Babatunde Ibitoye
LICENSING EVALUATOR SIGNATURE: DATE: 12/09/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/09/2021
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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Document Has Been Signed on 12/09/2021 03:11 PM - It Cannot Be Edited


Created By: Babatunde Ibitoye On 12/09/2021 at 02:55 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
, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551

FACILITY NAME: BELTRAN FAMILY DAY CARE
FACILITY NUMBER: 360905849

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/09/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
12/10/2021
Section Cited
CCR
102425(g)(i)

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(g) An infant’s head shall not be covered while sleeping.

(i) If an infant falls asleep before being placed in a crib or play yard, the provider shall move the infant to a crib or play yard as soon as possible.
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Infants must sleep in a play pin or crib and heads cannot be covered.

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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:Claretta Yates
LICENSING EVALUATOR NAME:Babatunde Ibitoye
LICENSING EVALUATOR SIGNATURE:
DATE: 12/09/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/09/2021


LIC809 (FAS) - (06/04)
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