364846426-9-28-2023-09-CC-SBRR-CW4PXU-20230928114254

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 364846426
Report Date: 09/28/2023
Date Signed: 09/28/2023 11:43:01 AM

Document Has Been Signed on 09/28/2023 11:43 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
INLAND EMPIRE CHILD, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501

FACILITY NAME:	MAEZ FAMILY CHILD CARE		FACILITY NUMBER:	364846426
ADMINISTRATOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY: 8	TOTAL ENROLLED CHILDREN: 2	CENSUS: 0	DATE:	09/28/2023
TYPE OF VISIT:	Prelicensing	ANNOUNCED	TIME BEGAN:	08:45 AM
MET WITH:	Applicants Aaron Maez and Sandra Maez		TIME COMPLETED:	11:50 AM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	On 09/28/2023 at 8:45 AM, Licensing Program Analyst (LPA) Susan Brewer, arrived at the facility to conduct a Pre-licensing inspection. Present during this inspection were: Sandra Maez and Aaron Maez, Applicants. LPA was granted entry to tour the facility, inside and out and the following was observed and/or discussed: The applicant has 2 children enrolled in care. No children were present during the inspection. Normal days and hours of operation are Monday-Friday, 5:30 AM to 5:30 PM OFF-LIMIT AREAS INCLUDE: Master Bedroom 1 & Bath 1, Bedroom 2, Laundry Room & Garage. · Appropriate fire extinguisher (2A:10BC) tagged by fire department on 09/19/2023, smoke detector and carbon monoxide detector are present, are in working order and were tested by the applicant during this inspection on 09/28/2023. · The home has a working telephone. The licensees have working cell phones. · All hazardous items are NOT inaccessible on 09/28/2023. During the inspection, LPA observed cleaning supplies, vehicle oils and solutions in the garage and miscellaneous items that pose a potential hazard to children, where the door knob and latch to the door entering the garage is low enough for a small child to turn and unlatch. · No guns or weapons present as of this date. Applicants Aaron and Sandra Maez, understand all guns, weapons and ammunition must be key locked separately and made inaccessible per Title 22 Regulations. · This is a single-story home without stairs. · There is no fireplace on the property. · Storage of poisons is inaccessible to children and locked on 09/28/2023. · Verification of control of property on file by mortgage statement. · Facility Sketch and Emergency Disaster Plan are posted on a board and placed at the front entrance. · Pediatric CPR and First Aid Card - expire on 08/14/2024. · Health & Safety Certificate - completed on 11/18/2022 for both Aaron and Sandra Maez.

SUPERVISORS NAME: Kimberly Williams
LICENSING EVALUATOR NAME: Susan Brewer
LICENSING EVALUATOR SIGNATURE:	DATE: 09/28/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/28/2023

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: MAEZ FAMILY CHILD CARE	FACILITY NUMBER: 364846426
	VISIT DATE: 09/28/2023

NARRATIVE

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· Mandated reporter General:07/07/2023; AB1207 Child Care expires: 07/2025
· Fire clearance: Not required for a Small Family Child Care Home.
· Applicants understand 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.
· Clean, Safe and age-appropriate toys and equipment are present for both indoor and outdoor activities.
· There are no toxic plants observed at this time and outdoor perimeter is secured with a fence and gates/unsecured.
· The Applicants were informed of their reporting requirements and is provided with the Regional Office’s Unusual Incident Reporting email mailbox: UnusualIncidentReportsDO09@dss.ca.gov
· Issued applicant the following: SIDS information and Shaken Baby Syndrome pamphlet

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)/ (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 Susan Brewer, discussed the safe sleep regulations with Applicants Sandra and Aaron Maez, 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 Applicants 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.

SUPERVISORS NAME: Kimberly Williams
LICENSING EVALUATOR NAME: Susan Brewer
LICENSING EVALUATOR SIGNATURE:	DATE: 09/28/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/28/2023

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: MAEZ FAMILY CHILD CARE	FACILITY NUMBER: 364846426
	VISIT DATE: 09/28/2023

NARRATIVE

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Applicants Sandra Maez and Aaron Maez, were reminded that 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, 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.

As a REMINDER: when your child(ren) turn 18 years of age, you MUST SUBMIT an updated LIC279 and TB Screen and have your child submit for LIVESCAN background clearance.

LPA Susan Brewer, reviewed with Applicants Sandra Maez and Aaron Maez, 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. LIC126 Entrance Checklist was provided to the applicants.

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.

Additionally, The following was discussed with the applicant(s):
- AB 1207 – Mandated Child Abuse Reporting: Child Day Care Personnel Training, beginning January 1, 2018 – Requires all licensed providers, applicants, directors and employees to complete training as specified on their mandated reporter duties and to renew their training every two years.
- Effective January 1, 2017 – Children under 2 years of age shall ride in a rear-facing car seat unless the child weighs 40 or more pounds OR is 40 or more inches tall. For additional information regarding car seat laws see www.chp.ca.gov

SUPERVISORS NAME: Kimberly Williams
LICENSING EVALUATOR NAME: Susan Brewer
LICENSING EVALUATOR SIGNATURE:	DATE: 09/28/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/28/2023

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: MAEZ FAMILY CHILD CARE	FACILITY NUMBER: 364846426
	VISIT DATE: 09/28/2023

NARRATIVE

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Pre-Licensing Visit Packet provided:

- 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
- 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.

The Duty Officer is available to answer questions Mon. – Fri. at 1-844-LET-US-NO (1-844-538-8766).

Before licensure, the following needs to be corrected/completed on or before 10/28/2023:
1. Lock on the Garage door.
2. Proof of postings.

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.

An exit interview was conducted, and a copy of this report was provided to the applicants on this date.

During the exit interview, the Applicants Aaron Maez and Sandra Maez, confirmed that there are no Registered Sex Offenders living in the facility and/or using the facility address for their mailing address.

Exit interview conducted and report was reviewed with the Applicants Aaron Maez and Sandra Maez.

SUPERVISORS NAME: Kimberly Williams
LICENSING EVALUATOR NAME: Susan Brewer
LICENSING EVALUATOR SIGNATURE:	DATE: 09/28/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/28/2023

LIC809 (FAS) - (06/04)

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