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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 364846123
Report Date: 01/26/2022
Date Signed: 01/27/2022 10:04:05 AM

Document Has Been Signed on 01/27/2022 10:04 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
CCLD Regional Office, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501
FACILITY NAME:GOVEA-CASTILLO FAMILY CHILD CAREFACILITY NUMBER:
364846123
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 0DATE:
01/26/2022
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
08:55 AM
MET WITH:Areli Castillo and Ramiro GoveaTIME COMPLETED:
11:20 AM
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On 01/26/2022 at 8:55am, Licensing Program Analyst (LPA) Laura Mejorado arrived at the facility to conduct a pre-licensing inspection. Present during this inspection were Applicants Areli Castillo and Ramiro Govea. LPA toured the facility, inside and out and the following was observed and discussed:

Normal days and hours of operation are: Monday – Sunday, 5:00am-8:00pm
OFF-LIMIT AREAS INCLUDE: Master bathroom, front yard, part of the backyard (fence will be placed to make area off limits)

· Appropriate fire extinguisher, smoke detector and carbon monoxide detector are present and were tested by the Applicant during this inspection. Fire extinguisher, smoke detector and carbon monoxide detector are in working order.
· All hazardous items are made inaccessible
· No guns or weapons present as of this date. Applicant understands all guns, weapons and ammunition must be key-locked separately and made inaccessible per Title 22 Regulations.
· Single story home
· Verification of control of property on file
· Facility Sketch and Emergency Disaster Plan are posted
· Pediatric CPR and First Aid Card expires on 12/23
· Health & Safety Preventative Practices training completed on 12/19/21
· AB1207 Mandated Child Abuse Reporter training certificate completed on 12/7/21

· There are no bodies of water as of 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 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 when not in use.

SUPERVISORS NAME: Kimberly Williams
LICENSING EVALUATOR NAME: Laura Mejorado
LICENSING EVALUATOR SIGNATURE: DATE: 01/26/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/26/2022
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 4
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501
FACILITY NAME: GOVEA-CASTILLO FAMILY CHILD CARE
FACILITY NUMBER: 364846123
VISIT DATE: 01/26/2022
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· Clean, safe and age appropriate toys
· There are no toxic plants observed at this time
· Issued Applicant the following: SIDS information and Shaken Baby Syndrome pamphlet – For more information on SIDS and Safe Sleep Environments, please visit:
· California Department of Public Health – California SIDS Program: http://www.cdph.ca.gov/programs/SIDS/pages/default.aspx
· AAP – Safe Sleep Campaign: http://www.healthychildcare.org/sids/html
· AAP-Free Training: Reducing the Risk of SIDS in Early Education and Child Care: http://shop.aap.org/Reducing-the-Risk-of-SIDS-in-Early-Education-and-Child-Care
· And Caring for our Children, Safe Sleep Practices and SIDS/Suffocation Risk Reduction: http://cfoc/nrckids/org/standardview/spccol/safe_sleep
· There shall be one crib or play yard for each infant who is unable to climb out of the crib or play yard.
· Cribs or play yards shall be free from all loose articles and objects.
· An infant shall not be swaddled while in care.
· The provider shall physically check on sleeping infants every 15 minutes and document findings.
· The provider shall place infants up to 12 months of age on their backs for sleeping.
· Infants up to 12 months of age who are sleeping in a position other than on their back require an Individual Infant Sleeping Plan [LIC 9227 (3/20)]
· When a child shows signs of illness they shall be separated from other children and the nature of the illness determined. If it is a communicable disease, he/she shall be separated from other children until the infectious stage is over.
· Incidental Medical Services (IMS) policy was discussed. 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
· Criminal record clearances are required prior to all adults living or working in a Family Child Care Home. A civil penalty of $100.00 per day the person has been present, may be assessed. Resident and/or staff records reviewed on 1/26/22 indicate that all adults who require caregiver background checks have received all required clearances or exemptions.
SUPERVISORS NAME: Kimberly Williams
LICENSING EVALUATOR NAME: Laura Mejorado
LICENSING EVALUATOR SIGNATURE:

DATE: 01/26/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/26/2022
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, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501
FACILITY NAME: GOVEA-CASTILLO FAMILY CHILD CARE
FACILITY NUMBER: 364846123
VISIT DATE: 01/26/2022
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· Applicant understands that when children turn 18 years of age, they are responsible for SUBMITTING an updated LIC279, LIC508, TB Screen and LIVESCAN background clearance. This also applies to any adult PRIOR to them moving into the home or who currently lives in the home. Also, PRIOR to employment of any adult, you must submit the LIC508, TB screening and obtain a background clearance through LIVESCAN.

- Pre-Licensing Visit Packet provided (children’s/staff records & posting requirements included)


- 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
- Access to forms & Regulations for Family Child Care online at www.ccld.ca.gov
- Responsibility to know the regulations for anyone providing care
- Inaccessibility of hazards must be constantly reassessed depending on the children in care
- Current facility’s phone numbers must be on file with the licensing office at all times
- Baby walkers, bouncy seats, exer-saucers and other similar items are prohibited
- The Applicant is urged to visit the U.S. Consumer Product Safety Commission webpage at www.cpsc.gov to ensure that equipment purchased for the day care has not been recalled
- 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.

- The Applicant can submit transfer forms to associate new individuals or to disassociate someone from your facility at: Associations_Disassociations862@dss.ca.gov
- The Applicant was informed of their reporting requirements and is provided with the Regional Office’s Unusual Incident Reporting email mailbox: UnusualIncidentReportsDO09@dss.ca.gov
- The Duty Officer is available to answer questions Monday – Friday from 8:00am to 5:00pm at (951)782-4200

Before licensure, the following needs to be corrected/completed:


- Ensure the barbecue grill is covered making it inaccessible and the propane tank is detached
- Ensure nightstands in bedroom have child proof locks and all hazardous items are made inaccessible
- Ensure sides of the house are fenced off making the area inaccessible
- Ensure the off-limit area of the backyard is fenced off making it inaccessible
SUPERVISORS NAME: Kimberly Williams
LICENSING EVALUATOR NAME: Laura Mejorado
LICENSING EVALUATOR SIGNATURE:

DATE: 01/26/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/26/2022
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, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501
FACILITY NAME: GOVEA-CASTILLO FAMILY CHILD CARE
FACILITY NUMBER: 364846123
VISIT DATE: 01/26/2022
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Once all corrections have been verified, the application for a Small Family Child Care Home will be submitted for approval with a maximum capacity of 6, or 8 with parent notification. Applicant advised that all corrections are due within 30 days or the application may be withdrawn.

During the exit interview, Applicants Areli Castillo and Ramiro Govea confirmed that there are no Registered Sex Offenders living in the facility and/or using the facility address for their mailing address.

A copy of this report was left with the Applicants and a copy must be made available upon request, to the public, for three years.
SUPERVISORS NAME: Kimberly Williams
LICENSING EVALUATOR NAME: Laura Mejorado
LICENSING EVALUATOR SIGNATURE:

DATE: 01/26/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/26/2022
LIC809 (FAS) - (06/04)
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