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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376630053
Report Date: 08/28/2024
Date Signed: 08/28/2024 12:33:15 PM

Document Has Been Signed on 08/28/2024 12:33 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, 7575 METROPOLITAN DR., STE 110
SAN DIEGO, CA 92108
FACILITY NAME:PEREZ DOMINGUEZ, ALAM FAMILY CHILD CAREFACILITY NUMBER:
376630053
ADMINISTRATOR/
DIRECTOR:		FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 0DATE:
08/28/2024
TYPE OF VISIT:PrelicensingANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:30 AM
MET WITH:Alam Perez DominguezTIME VISIT/
INSPECTION COMPLETED:
12:30 PM
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On 08/28/24 at 9:30AM, Licensing Program Analyst (LPA) Luigi Gargaro conducted an announced prelicensing inspection with the applicant. The purpose of the visit is to ensure the home is in compliance with standards established in CCR, Title 22, Division 12, Chapter 3, for Family Child Care Homes. The one floor, three bedroom, two bathroom stand alone home was toured and inspected to ensure an environment safe for the care and supervision of children. The fire extinguisher and combination smoke and carbon monoxide detector meet requirements and are operational. All hazardous items were latched/locked and secured out of reach of children. Analyst inquired if there are any bodies of water or weapons in the home and the applicant replied no. A review of records on this date indicates that all adults or other individuals who require caregiver background checks have received criminal record and child abuse clearances or exemptions.

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 person will be assessed if this regulation is violated. Applicant rents the home and provided proof of control of property in the form of a home lease agreement that he submitted with his original application. First Aid and CPR expire on 06/27/26 for the applicant.

Applicant will be using the following rooms for childcare: the kitchen, the dining room/living room area and the second and third home bedrooms with day care bathroom located in the third bedroom. The following areas will be off limits: the first (master) bedroom, the main bathroom and the garage. The master bedroom, the main bathroom and the garage are all made off limits with doorknob covers that are installed on their respective entry door handles.

The applicant has sufficient day care equipment available. The home has a fenced backyard available for outdoor activities that is accessed from a sliding glass exit door located in the third day care bathroom.
SUPERVISORS NAME: Jason Garay
LICENSING EVALUATOR NAME: Luigi Gargaro
LICENSING EVALUATOR SIGNATURE: DATE: 08/28/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/28/2024
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, 7575 METROPOLITAN DR., STE 110
SAN DIEGO, CA 92108
FACILITY NAME: PEREZ DOMINGUEZ, ALAM FAMILY CHILD CARE
FACILITY NUMBER: 376630053
VISIT DATE: 08/28/2024
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LPA discussed the safe sleep regulations with 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. Unusual Incident Reports may be e-mailed to: SDIncidentReports@dss.ca.gov.

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 and applicant discussed California Megan's Law and he provided applicant with the website address: www.meganslaw.ca.gov for him to review information regarding his facility on a regular basis.

LPA reviewed with applicant 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. The new provider packet was also reviewed with the applicant including information on child abuse reporting, shaken baby syndrome, SIDS, Lead Poisoning Facts and the YMCA Resource Center. Applicant was reminded that corporal punishment, smoking, walkers, exersaucers, jumpers and bouncy seats are not allowed in day care.

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.

Exit interview conducted and report was reviewed with the applicant, Alam Perez Dominguez. No corrections are needed, a license for 8 will be issued effective today. Community Care Licensing web site: http://ccld.ca.gov.
SUPERVISORS NAME: Jason Garay
LICENSING EVALUATOR NAME: Luigi Gargaro
LICENSING EVALUATOR SIGNATURE:

DATE: 08/28/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/28/2024
LIC809 (FAS) - (06/04)
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