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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 367700054
Report Date: 03/01/2024
Date Signed: 06/17/2024 03:20:59 PM

Document Has Been Signed on 06/17/2024 03:20 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:REYES FAMILY CHILD CAREFACILITY NUMBER:
367700054
ADMINISTRATOR:REYES, RASHONFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(909) 559-1592
CITY:APPLE VALLEYSTATE: CAZIP CODE:
92307
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 14DATE:
03/01/2024
TYPE OF VISIT:Required - 3 YearUNANNOUNCEDTIME BEGAN:
12:00 PM
MET WITH:Zaira Olvera, Staff TIME COMPLETED:
03:00 PM
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On 06/17/24, this report is being amended to reflect the correct ratio of day care children present on 03/01/2024. LPAs observed a total of 3 infants, 10 preschool children, and 1 school age child in care.

On 03/08/24, this report has been amended to reflect the dismissal of the Type B citation Immunizations 102418(g) cited on 03/01/24 for children's immunization records for child #7 and child #11 due to cited in error.

On 03/01/24, Licensing Program Analyst (LPA) Justeene Tamayo and Sherell Braddock met with Licensee's assistant Zaira Olivera, who guided analyst on a tour of the facility for the One Year Required inspection. This is a one story, 6 bedroom, 3 bathroom home with kitchen/dining, family room, living room, laundry room and garage. There is a pool/spa or body of water on the premises. Upon arrival LPA observed 2 infants, 1 school age, and 11 preschool children in care, along with assistant #1 and assistant #2. Licensee was not home at the time due to a personal matter. Family members residing in the home include 1 adult (licensee) and no minor children. Facility operation are Monday-Friday 5AM-12AM. Incidental Medical Services (IMS) policy was discussed.

Physical Plant: Per Licensee bedrooms #1-3, dining room, kitchen, bathroom #1, and side yard is utilized for the family childcare activity area. Per licensee off-limit areas of the home is bedrooms #3-6, bathroom #2-3, backyard, and garage(key lock). Children use the bathroom in hallway near bedroom #1. The home was inspected inside and out for safety, clean and orderly, comfort, cleanliness, telephone service, heating and ventilation, inaccessibility to poisons, detergents/cleaning compounds (under kitchen sink with safety latch), and hazardous items (sharp knives in upper kitchen pantry unreachable to day care children) that can pose a danger to children. Per assistant no medications are present in the home. LPA observed a fireplace in the the living room to be fully screened. Safe and age appropriate toys, play equipment and materials were observed.
SUPERVISORS NAME: Mariela Ramon
LICENSING EVALUATOR NAME: Justeene Tamayo
LICENSING EVALUATOR SIGNATURE: DATE: 03/01/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/01/2024
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
CCLD Regional Office, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: REYES FAMILY CHILD CARE
FACILITY NUMBER: 367700054
VISIT DATE: 03/01/2024
NARRATIVE
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The smoke detector and carbon monoxide detector, Fire Extinguisher (2A10BC) are in operable condition. Per Licensee no one smokes in the home. Electrical outlets are inaccessible. LPA reminded licensee, no baby bouncers saucer chairs, or any recalled and or prohibited toys or sleep/ play equipment are allowed. There is a designated area for ill children as necessary in family room. Per Licensee there is a firearm present in a locked safe in off limits area. Ammunition is stored in locked container separated from firearm. The facility sketch is complete and current, there is working telephone (cell).

Fire/Disaster Drill is complete and maintained current. Last Fire/Disaster Drill was completed on 02/09/2024.

Roster complete and maintained current.

Bathroom: Shower/tub are free of hazards (child care bathroom). LPA did not observe any hazardous items in the children's bathroom. Toilet and faucet are clean and operable.

Kitchen: Sharp utensils, open bottles or alcohol are inaccessible. If food is brought from the children’s home, the container shall be labeled with the child’s name and properly stored or refrigerated. The home has a clean and fully stocked refrigerator/freezer. Licensee currently has a food program. Breakfast, lunch, snacks and dinner are provided. Naps are provided on cots in bedrooms #1-3.

Outdoor: The backyard is currently off limits to day care children. The backyard is completely fenced (with block cement). LPAs observed an in ground swimming pool with mesh fencing that measures over 5ft high. The self-latching gate has a key lock and pushes away from the swimming pool following Title 22 Regulations. Per licensee, there are two dogs on the premises. LPAs observed a barbecue pit and heater. Licensee is aware she must notify CCLD if she plans to make the backyard accessible to day care children.
SUPERVISORS NAME: Mariela Ramon
LICENSING EVALUATOR NAME: Justeene Tamayo
LICENSING EVALUATOR SIGNATURE:

DATE: 03/01/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/01/2024
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
CCLD Regional Office, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: REYES FAMILY CHILD CARE
FACILITY NUMBER: 367700054
VISIT DATE: 03/01/2024
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Advisory/Other: First Aid kit was observed with supplies readily available. Assistant #1 CPR/First Aid expires 11/2025. Assistant #1 Mandated Reporter expired on 02/23/2024. Assistant #1 will retake her mandated reporter training and send proof of completion to LPA Tamayo. There are no window cords accessible to children.

During observation and walk through of facility, LPAs observed 1 school age child, 2 infants, and 11 preschool in care. Facility has been cited a Type A citation for out of ratio. Please see LIC809-D.

This report cites a Type A violation and shall be provided to the parents/guardians of children currently enrolled and to parents/guardians of children newly enrolled at the facility during the next 12 months. Parents/guardians must sign Form LIC9224 and must be kept in each child's file.

During file review, infant #1 safe sleep logs were not completed from 02-28-24 to 02-29-24, which poses a potential risk to children in care. Facility has been cited a Type B Citation. Please see LIC809-D for deficiency page.

Documents Provided and or Discussed: Fire Drill Log, Roster, Postings, Safe Sleep PIN 20-24-CCP, Individual Sleeping Plan (LIC9227), and Safe Sleep Log.

Assistant 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.
SUPERVISORS NAME: Mariela Ramon
LICENSING EVALUATOR NAME: Justeene Tamayo
LICENSING EVALUATOR SIGNATURE:

DATE: 03/01/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/01/2024
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 03/01/2024 02:30 PM - It Cannot Be Edited


Created By: Justeene Tamayo On 03/01/2024 at 01:53 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: REYES FAMILY CHILD CARE
FACILITY NUMBER: 367700054

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/01/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Request Denied
Type A
Section Cited
CCR
102416.5(d)(2)
Staffing Ratio and Capacity
(d) For a Large Family Child Care Home, the maximum number of children for whom care may be provided at any one time when there is an assistant provider in the home, including children under age 10 who reside at the licensee's home and the assistant provider's children under age 10, shall be either: (2) More than twelve and up to fourteen children only if the criteria in Section 1597.465 of the Health and Safety Code are met.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation and record review, the licensee did not comply with the section cited above. LPAs observed a total of 14 children (2 infants, 11 preschool, and 1 school age child). Assistant's did not follow ratio, which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 03/01/2024
Plan of Correction
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Assistants are aware there must be no more than 3 infants, 1 child in kindergarten, and 1 child at least age 6.
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:Mariela Ramon
LICENSING EVALUATOR NAME:Justeene Tamayo
LICENSING EVALUATOR SIGNATURE:
DATE: 03/01/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/01/2024


LIC809 (FAS) - (06/04)
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Document Has Been Signed on 03/08/2024 10:50 AM - It Cannot Be Edited

Document is an Amendment of Original Document on 03/08/2024 10:18 AM


Created By: Justeene Tamayo On 03/01/2024 at 01:53 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
CCLD Regional Office, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551

FACILITY NAME: REYES FAMILY CHILD CARE
FACILITY NUMBER: 367700054

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/01/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Request Denied
Type B
Section Cited
CCR
102425(j)(2)
Infant Safe Sleep
The provider shall supervise infants while they are sleeping and adhere to the following requirements: The provider shall check and document the following:

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on file review, the licensee did not comply with the section cited above. LPAs observed safe sleep logs for the infants present to be incomplete, which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 03/15/2024
Plan of Correction
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Licensee will send proof of safe sleep logs to LPA Tamayo via email no later than 03/15/24.
Deficiency Dismissed
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. Child#7 and Child #11 without proof of immunizations, which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 03/15/2024
Plan of Correction
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 On 03/08/24, this report has been amended to reflect the dismissal of the Type B citation for Immunizations 102418(g) cited on 03/01/24 for children's immunization records for child #7 and child #11 due to cited in error.
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:Mariela Ramon
LICENSING EVALUATOR NAME:Justeene Tamayo
LICENSING EVALUATOR SIGNATURE:
DATE: 03/01/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/01/2024


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
CCLD Regional Office, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: REYES FAMILY CHILD CARE
FACILITY NUMBER: 367700054
VISIT DATE: 03/01/2024
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LPA discussed the safe sleep regulations with staff 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 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.

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

Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

Exit interview conducted and report was reviewed with assistant Zaira Olvera, along with her appeal rights and Notice of Site Visit.

SUPERVISORS NAME: Mariela Ramon
LICENSING EVALUATOR NAME: Justeene Tamayo
LICENSING EVALUATOR SIGNATURE:

DATE: 03/01/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/01/2024
LIC809 (FAS) - (06/04)
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