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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376629497
Report Date: 12/29/2022
Date Signed: 12/29/2022 11:14:53 AM

Document Has Been Signed on 12/29/2022 11:14 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, 7575 METROPOLITAN DR., STE 110
SAN DIEGO, CA 92108
FACILITY NAME:JUAREZ, ROSA FAMILY CHILD CAREFACILITY NUMBER:
376629497
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 1DATE:
12/29/2022
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
07:40 AM
MET WITH:Rosa JuarezTIME COMPLETED:
09:50 AM
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On December 29th, 2022 at 7:40 AM, Licensing Program Analyst (LPA) Jo Ann Legaspi conducted a pre-licensing inspection with Applicant Rosa Juarez. The inspection’s purpose is to ensure that the home follows standards established in CCR, Title 22, Division 12, Chapter 3, for Family Child Care Homes. Present in the home was the Applicant, her spouse, two relatives and two (2) related children, one child under age 10 years. Language Link Operators 14920 and 13878 provided Spanish translation services. This five (5) bedroom, three (3) bathroom, two (2) story house was toured and inspected. The daycare operational schedule will be weekdays 6 AM to 6 PM.

The Applicant shall submit an updated application to the Licensing Department should the daycare operational schedule change. The Applicant understands that they will need to notify the Department of any changes to the childcare areas and obtain departmental approval before use of any new childcare areas not previously licensed. The fireplace is screened. Applicant will use the following areas for childcare: the living room, family room, enclosed patio room, one (1) bathroom, fenced backyard and front yard. The off limits areas include the, kitchen, remaining bathrooms and bedrooms. Kitchen cabinets have sliding cabinet locks. The stairs to the bedrooms and remaining bathrooms are gated with a retractable child safety gate. Applicant states there are no bodies of water and none were observed during time of visit. The fire extinguishers are rated 2A 10B: C and are located in the kitchen and family room. The smoke/carbon monoxide detector meets requirements and is operational. Poisons, detergents, cleaning compounds and medications are secured inaccessible to children in care by placement in a high kitchen shelf, hallway closet with a cabinet sliding lock and in a locked bathroom cabinet. Children’s toys and play equipment are available. The Applicant has a working telephone/cell phone. The Applicant agreed to notify licensing should their telephone number or email address ever change. The Applicant indicated there are no firearms or other weapons in the home.

The Applicant intends to conduct outdoor activities in the neighborhood park, front and backyard The Applicant acknowledges continuous, visual supervision shall be given whenever children are engaged in
SUPERVISORS NAME: Tulam Vu
LICENSING EVALUATOR NAME: JoAnn R Legaspi
LICENSING EVALUATOR SIGNATURE: DATE: 12/29/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/29/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.

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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, 7575 METROPOLITAN DR., STE 110
SAN DIEGO, CA 92108
FACILITY NAME: JUAREZ, ROSA FAMILY CHILD CARE
FACILITY NUMBER: 376629497
VISIT DATE: 12/29/2022
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outdoor activities. The Applicant intends to occasionally transport the children in their own vehicle. The Applicant shall transport children in rear seats in appropriate child passenger restraint systems which meet applicable federal motor vehicle safety standards. The Applicant acknowledges that car seats shall only be used for transportation purposes and shall not be used for sleeping. The Applicant acknowledges children shall never be left unattended in the daycare vehicle. The Applicant further confirms maintenance of the daycare vehicle shall be upheld to ensure safety.

Applicant maintains documentation of proof of control of property for review by the Department. Applicant has completed the preventative health and lead poisoning prevention courses. The Mandated Reporter training was completed on 05/08/2022 (Applicant) and 08/18/2022 (assistant). The Applicant acknowledges that both they and the assistant will have to renew the Mandated Reporter Training and obtain its completion certificate once every two (2) years. Pediatric CPR and First Aid certifications expire for the Applicant in May 2024 and the helper in August 2024. The Applicant acknowledges that both they and any staff will have to update pediatric CPR and First Aide certifications prior to their expiration dates. The Applicant and adult residents in the home have criminal record clearances and/or exemptions on file. Applicant was 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 Applicant was advised that any new/additional adults must be cleared prior to working or residing in home. Any minor upon their 18th birthday must be fingerprinted within 30 days. Immunization records per SB792 were reviewed and comply. Applicant has an assistant.



LPA discussed the safe sleep regulations with the Applicant 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 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.
SUPERVISORS NAME: Tulam Vu
LICENSING EVALUATOR NAME: JoAnn R Legaspi
LICENSING EVALUATOR SIGNATURE:

DATE: 12/29/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/29/2022
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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, 7575 METROPOLITAN DR., STE 110
SAN DIEGO, CA 92108
FACILITY NAME: JUAREZ, ROSA FAMILY CHILD CARE
FACILITY NUMBER: 376629497
VISIT DATE: 12/29/2022
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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 provided Applicant with 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. LPA and Applicant discussed the facility disaster plan and safety of children and pets. Applicant has one (1) small dog.


The Applicant was also informed the following items are prohibited during day care operating hours: walkers, exersaucers, jumpers, inclined sleepers and bouncy seats. Corporal punishment and smoking are not allowed in the day care.


Applicant and LPA reviewed the Ratio/Capacity worksheet for a small family home. LPA reminded Applicant that the total amount of children allowed in the home daycare at any one given time includes children, aged 10 years and younger, who reside in the home. Applicant and LPA discussed the maximum capacity for a small family child care home: four infants only (infants mean any children under 24 months); or six children with no more than three infants; or, with landlord consent, eight children with no more than two infants, one child in kindergarten or elementary school and one child at least age six, including children under age 10 who live in the home. Landlord consent is on file.

The Applicant agrees to comply with all regulations and laws governing family childcare homes.

Applicant was advised that any agent of the Licensing Department upon presentation of proper identification, may enter and inspect any place providing personal care, supervision, and services at any time, with or without advance notice. The Applicant shall permit the Department to inspect the family childcare home, and to privately interview children or staff, to determine compliance with or to prevent violations of family childcare laws or regulations. Applicant was advised that the Department shall assess an immediate civil penalty of five

SUPERVISORS NAME: Tulam Vu
LICENSING EVALUATOR NAME: JoAnn R Legaspi
LICENSING EVALUATOR SIGNATURE:

DATE: 12/29/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/29/2022
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, 7575 METROPOLITAN DR., STE 110
SAN DIEGO, CA 92108
FACILITY NAME: JUAREZ, ROSA FAMILY CHILD CARE
FACILITY NUMBER: 376629497
VISIT DATE: 12/29/2022
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 hundred dollars ($500) per violation and one hundred dollars ($100) for each day the violation continues after citation, if the Applicant refuses any agent of the licensing Department entry into the daycare or any part of the daycare.

LPA informed Applicant that the failure of a Licensee to pay all applicable and accrued fees and/or civil penalties shall constitute grounds of forfeiture of the daycare license.

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. Applicant’s email address has been enrolled in the Department’s email notification system, but is awaiting final confirmation by the Applicant.


No corrections are needed. A small license is issued effective today 12/29/2022. The Applicant states they will retrieve the license from the licensing office when available. Exit interview conducted and report was reviewed with the Applicant Rosa Juarez.
SUPERVISORS NAME: Tulam Vu
LICENSING EVALUATOR NAME: JoAnn R Legaspi
LICENSING EVALUATOR SIGNATURE:

DATE: 12/29/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/29/2022
LIC809 (FAS) - (06/04)
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