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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 566215797
Report Date: 05/23/2023
Date Signed: 05/23/2023 04:40:32 PM

Document Has Been Signed on 05/23/2023 04:40 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:PEREZ FCC AKA RIVERPARK CHILD CARE HOMEFACILITY NUMBER:
566215797
ADMINISTRATOR:YULIANA PEREZFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(805) 698-1656
CITY:OXNARDSTATE: CAZIP CODE:
93036
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 10DATE:
05/23/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:YULIANA PEREZTIME COMPLETED:
02:30 PM
NARRATIVE
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On May 23, 2023, Licensing Program Analyst's (LPA's) Susana Martinez and Giovani Gonzalez conducted an unannounced Annual/Random inspection. LPA's met with licensee Yuliana Perez and advised her of the purpose for the inspection. Licensee provided LPA's a tour of the home inside and out. At the time of inspection there were 8 children napping and two awake supervised my the licensee. Licensee states that her assistant (S1) was currently picking up children from school. Licensee states she has a new assistant (S2) that started on 5/22/23. During the inspection, LPA's observed S2 arrive with a child.

LPA's observed required licensing documents mounted in the main child-care room. Fire and earthquake drills are being documented every six months. Last drill was conducted on 5/09/2023. Fire extinguisher mounted on the wall inside the school room was last purchased 6/6/2022. Fire and carbon monoxide detector was observed to be mounted in the kitchen wall. LPA's did not test the detectors as children were napping. Licensee states they were just tested recently.

Children in care have access to one room, one restroom, kitchen, living room, and back yard. Kitchen was observed to be under construction. LPA's observed children to have access to the construction area. One child who was barefoot was observed to be walking around the kitchen where flooring was removed. Children have access to toys that are age-appropriate inside and outside of the home. Back yard play area is enclosed. At 1:26 PM LPA's observed the play structure to be broken. Licensee states this just happened over the weekend. LPA's asked why it hasn't been removed. Licensee states she will remove it today. There were no bodies of water present at the time of inspection.

LPA reviewed five out of five children files. All children files were current. Licensee CPR/first aid is valid through 6/2024. Licensee was reminded a licensed child day care provider, administrator, or employee of a licensed child day care facility shall complete the mandated reporter certification AB1207 every two years at www.mandatedreporterca.com. Licensee's Mandated Reported Training certificate is valid until 05/27/2024. Employees files were reviewed, S2 was not associated to the facility at the time of inspection. S2 was missing Employee Rights.
Continued on 809-C
SUPERVISORS NAME: George Mingle
LICENSING EVALUATOR NAME: Susana Martinez
LICENSING EVALUATOR SIGNATURE: DATE: 05/23/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/23/2023
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
CCLD Regional Office, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117
FACILITY NAME: PEREZ FCC AKA RIVERPARK CHILD CARE HOME
FACILITY NUMBER: 566215797
VISIT DATE: 05/23/2023
NARRATIVE
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To improve the quality and value of the new inspection process, a survey will be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or tools, please send them by email to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/process.

Licensee 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.

LPA discussed the safe sleep regulations with licensee 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. LPA observed a safe sleep log not being documented for infants in care every 15 minutes.

This facility provides Incidental Medical Services – IMS. LPA reviewed storage of medication and equipment/supplies, and reviewed children’s, personnel, and administrative records. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Family Child Care Homes Section 102417. 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

Two Type A deficiencies, three Type B deficiencies and one Technical Violation were cited during today's inspection. Deficiencies can be found on the attached 809-D's.

The ACKNOWLEDGEMENT OF RECEIPT OF LICENSING REPORTS (LIC 9224) shall be signed and kept in each of the children’s records. Web site address to obtain forms, review quarterly updates, review Title 22 & Health & Safety Codes is: https://www.cdss.ca.gov/inforesources/child-care-licensing

Continued on 809-C

SUPERVISORS NAME: George Mingle
LICENSING EVALUATOR NAME: Susana Martinez
LICENSING EVALUATOR SIGNATURE:

DATE: 05/23/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/23/2023
LIC809 (FAS) - (06/04)
Page: 2 of 7
Document Has Been Signed on 05/23/2023 04:40 PM - It Cannot Be Edited


Created By: Susana Martinez On 05/23/2023 at 02:53 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
, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117

FACILITY NAME: PEREZ FCC AKA RIVERPARK CHILD CARE HOME
FACILITY NUMBER: 566215797

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/23/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
102370(d)(2)
Criminal Record Clearance
(d) All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1596.871 shall prior to working, residing or volunteering in a licensed facility: (2) Request a transfer of a criminal record clearance as specified in Section 102370(j) or

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, interview, record review, the licensee did not comply with the section cited above in 1 out of 1 staff members which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 05/23/2023
Plan of Correction
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LPA's observed staff member leaving the home. Licensee is requested to attend an informal in office meeting which will be scheduled at a later time.
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:George Mingle
LICENSING EVALUATOR NAME:Susana Martinez
LICENSING EVALUATOR SIGNATURE:
DATE: 05/23/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/23/2023


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Document Has Been Signed on 05/23/2023 04:40 PM - It Cannot Be Edited


Created By: Susana Martinez On 05/23/2023 at 02:53 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
, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117

FACILITY NAME: PEREZ FCC AKA RIVERPARK CHILD CARE HOME
FACILITY NUMBER: 566215797

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/23/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102417(d)
Operation of A Family Child Care Home
(d) The home shall provide safe toys, play equipment and materials.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, interview, record review, the licensee did not comply with the section cited above in 1 out of 1 play structures which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 05/30/2023
Plan of Correction
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LPA's observed play structure to be removed to the side. Licensee is to submit a written plan on how she plans on preventing this from reocurring. Licensee is requested to attend an informal in office meeting which will be scheduled at a later time.
Type B
Section Cited
CCR
102417(g)(4)
Operation of A Family Child Care Home
(g) The home shall be free from defects or conditions which might endanger a child. Safety precautions shall include but not limited to: (4) Poisons, detergents, cleaning compounds, medicines, firearms and other items which could pose a danger if readily available to children shall be stored where they are inaccessible to children.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, interview and record review, the licensee did not comply with the section cited above in 1 out of 1 accessible rooms which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 05/30/2023
Plan of Correction
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Licensee is to submit a written plan on how she plans on preventing this from reocurring. Licensee is requested to attend an informal in office meeting which will be scheduled at a later time.
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:George Mingle
LICENSING EVALUATOR NAME:Susana Martinez
LICENSING EVALUATOR SIGNATURE:
DATE: 05/23/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/23/2023


LIC809 (FAS) - (06/04)
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Document Has Been Signed on 05/23/2023 04:40 PM - It Cannot Be Edited


Created By: Susana Martinez On 05/23/2023 at 02:53 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
, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117

FACILITY NAME: PEREZ FCC AKA RIVERPARK CHILD CARE HOME
FACILITY NUMBER: 566215797

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/23/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102425(j)(2)(D)
Infant Safe Sleep
Documentation shall be maintained in the infant’s file and be available to the Department for review. Documentation shall include the following:

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, interview, record review, the licensee did not comply with the section cited above in 1 out of 1 infants which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 05/30/2023
Plan of Correction
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Licensee is to submit an updated sleep chart for the infant by the POC due date. Licensee is to submit a written plan on how she plans on preventing this from reocurring. Licensee is requested to attend an informal in office meeting which will be scheduled at a later time.
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:George Mingle
LICENSING EVALUATOR NAME:Susana Martinez
LICENSING EVALUATOR SIGNATURE:
DATE: 05/23/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/23/2023


LIC809 (FAS) - (06/04)
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Document Has Been Signed on 05/23/2023 04:40 PM - It Cannot Be Edited


Created By: Susana Martinez On 05/23/2023 at 03:00 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
, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117

FACILITY NAME: PEREZ FCC AKA RIVERPARK CHILD CARE HOME
FACILITY NUMBER: 566215797

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/23/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
102417(g)
Operation of A Family Child Care Home
(g) The home shall be free from defects or conditions which might endanger a child. Safety precautions shall include but not limited to:

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, interview and record review, the licensee did not comply with the section cited above in 1 out of 1 hazourdous items which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 05/23/2023
Plan of Correction
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Licensee is to submit a written plan on how she plans on preventing this from reocurring. Licensee is requested to attend an informal in office meeting which will be scheduled at a later time.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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4
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:George Mingle
LICENSING EVALUATOR NAME:Susana Martinez
LICENSING EVALUATOR SIGNATURE:
DATE: 05/23/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/23/2023


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
CCLD Regional Office, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117
FACILITY NAME: PEREZ FCC AKA RIVERPARK CHILD CARE HOME
FACILITY NUMBER: 566215797
VISIT DATE: 05/23/2023
NARRATIVE
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Copies of this report must be posted for 30 days in a visible location for the authorized representatives of children. Notice of Site Visit has been posted (LIC9213). The notice shall be posted for 30 consecutive days. Failure to maintain posting as required will result in a $100.00 civil penalty.

A notice of site visit was given and must remain posted on, or immediately adjacent to, the interior side of the main door for 30 days.

Licensee has also been invited for an in-office informal conference which will be scheduled at a later time.

Exit interview conducted with Licensee Yuliana Perez. A copy of the Appeal Rights (LIC 9058 FAS 01/16) were given and explained. Licensee’s signature on this form acknowledges receipt of these rights.

SUPERVISORS NAME: George Mingle
LICENSING EVALUATOR NAME: Susana Martinez
LICENSING EVALUATOR SIGNATURE:

DATE: 05/23/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/23/2023
LIC809 (FAS) - (06/04)
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