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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 426215616
Report Date: 08/26/2021
Date Signed: 08/26/2021 01:40:06 PM

Document Has Been Signed on 08/26/2021 01:40 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, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117
FACILITY NAME:RIVERA FAMILY CHILD CAREFACILITY NUMBER:
426215616
ADMINISTRATOR:MARICRUZ RIVERAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(805) 294-2831
CITY:LOMPOCSTATE: CAZIP CODE:
93436
CAPACITY: 14TOTAL ENROLLED CHILDREN: 0CENSUS: 5DATE:
08/26/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:50 AM
MET WITH:Maricruz RiveraTIME COMPLETED:
01:45 PM
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On August 26, 2021, at 11:50 AM, Licensing Program Analyst (LPA) S. Mendoza-Ceja conducted an unannounced Required 1 year inspection. LPA met with Licensee Mariacruz Rivera prior to entry to the home, LPA conducted a risk assessment for COVID-19. Licensee escorted LPA through the home. The Licensee Mariacruz Rivera stated the child care is conducted in the primarily in the day care room, living room, and dinning area for homework. Licensee stated she is not using one of the bedrooms at this time (school age kids classroom), but may use it in the future. The entire home was inspected, including the off limit areas. The home was observed to be clean and orderly. The primary day care room was observed to be appropriately furnished for young children with toys. LPA observed the COVID-19 posters posted for review. Licensee stated she conducts temperature checks when the children arrive. The off-limit areas of the home are the bedrooms and garage which have plastic door covers making them inaccessible to day care children.

The required 2A10 BC fire extinguisher was purchased on 10/20/2020 (expires 10/20/2021). Licensee is reminded the 2 A10 BC fire extinguisher needs to be serviced or replaced yearly. There is carbon monoxide detector and smoke detector which were tested and operational. LPA discussed firearms and ammunition, Licensee Maricruz Rivera stated there are no guns and ammunition in the home or bodies of water on the premises. LPA did not observe any bodies of water on the premises. LPA also reviewed emergency contact information for children enrolled in the day care. Review of records and interview with Licensee Maricruz Rivera revealed she has a timer set for 15-minutes to check on child #1 every 15 minutes. Licensee stated she had not completed Individual Infant Sleeping Plan (LIC9227) with the parent or documented the 15 minute-check for the infant. LPA reviewed and provided handouts for Regulation 102425 and discussed infant care with Licensee, including Individual Infant Sleeping Plan (LIC9227) and Sleeping Chart

Licensee Maricruz Rivera's AB1207 Child Abuse Mandated Reporter Training is certification is current (09/14/2020 - 09/14/2022) and assistant Nicole Sanchez certification is current 02/25/2021 - 0/25/2023). Maricruz Rivera has current Child, Infant and Adult CPR and First Aid (expires 09/15/2022).
SUPERVISORS NAME: Ana Tolentino
LICENSING EVALUATOR NAME: Sylvia Mendoza-Ceja
LICENSING EVALUATOR SIGNATURE: DATE: 08/26/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/26/2021
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, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117
FACILITY NAME: RIVERA FAMILY CHILD CARE
FACILITY NUMBER: 426215616
VISIT DATE: 08/26/2021
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Licensee was advised a Technical Violation will be documented in regards to Infant Care Regulation 102425 (c) and (j)(2).

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.


An exit interview was conducted with Licensee.

Failure to post the "Notice of Site Visit" for 30 days may result in a $100.00 civil penalty,
SUPERVISORS NAME: Ana Tolentino
LICENSING EVALUATOR NAME: Sylvia Mendoza-Ceja
LICENSING EVALUATOR SIGNATURE:

DATE: 08/26/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/26/2021
LIC809 (FAS) - (06/04)
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