Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 191501110
Report Date: 03/05/2019
Date Signed 03/05/2019 05:10:27 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME:RIOS & GUTIERREZ FAMILY DAY CAREFACILITY NUMBER:
191501110
ADMINISTRATOR:RIOS,S & GUTIERREZ, EFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(909) 593-0308
CITY:LA VERNESTATE: CAZIP CODE:
91750
CAPACITY:14CENSUS: 10DATE:
03/05/2019
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
02:15 PM
MET WITH:Administrator Rios Stella TIME COMPLETED:
05:25 PM
NARRATIVE
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Licensing Program Analyst, (LPA) Ketki Desai conducted an unannounced Random/ Annual inspection to ensure the health & safety standards as required by regulations governing a Large Family Child Care home. Upon arrival, LPA met with Licensee Stella Rios along with her assistant/ daughter (Rachel Ibarra) providing additional care and supervision to children while the Licensee Stella Rios gave a tour of the home. There were 10 children present ( 7 school age and 3 toddlers). Individuals residing in the home are Licensee and three adult all are live scanned/ cleared but do not provide any additional care and supervision to children. Licensee needs the Emergency Disaster form posted. Pediatric First Aid/CPR certificate is valid through March 14th 2019 and Licensee has been registered for a new class also. Children’s records reviewed and meets the requirements. Fire/emergency drills not conducted with day-care children. Roster needs to be updated. Licensee has a working telephone. This is a single story home with a living room, kitchen, family dining room, 3 bedrooms, 2 bathrooms, front yard and backyard. Outdoor activities are held in the back yard with adult supervision, it is gated on one side and has the two sides fenced with concrete flooring , part of the backyard is shaded where additional activities are held. Areas accessible to children: Bathroom located in the back, family dining room, living room, and backyard. Children walk through the kitchen and laundry area to access the back yard. Off Limits: Three bedrooms/ Master bath/ laundry area and front yard. The Licensee does carry the Liability Insurance.

Home was inspected for safety, comfort, cleanliness, telephone service, ventilation and heating, inaccessibility to poisons, detergents, cleaning compounds, medicine, and hazardous items that can pose a danger to children. There are age-appropriate toys on the premises. There is age appropriate napping equipment on the premises also. Per licensee, there are No Firearms or Bodies of Water on premises. There is a combination smoke detectors/carbon monoxide detector on the ceiling at the entrance of the front door tested and is operable. Licensee has a fire extinguisher, 2A 10BC and has been serviced annually . It is kept in the kitchen. Page 1- continued

SUPERVISOR'S NAME: Adriana HernandezTELEPHONE: (323) 981-3362
LICENSING EVALUATOR NAME: Ketki DesaiTELEPHONE: (323) 981-3351
LICENSING EVALUATOR SIGNATURE:

DATE: 03/05/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/05/2019
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC809 (FAS) - (06/04)
Page: 1 of 5
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME: RIOS & GUTIERREZ FAMILY DAY CARE
FACILITY NUMBER: 191501110
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/05/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
03/19/2019
Section Cited
CCR
102417(g9A1)
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Operations of Family Chid care home: This requirement is not met by evidence as Licensee has not conducted the required Fire/ Disaster drills with the enrolled children and no log maintained. This poses a potential risk to Health and Safety to children in care.
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Licensee to document and run a fire/ earthquake drill by the POC due date and send a copy of the drill documented. .
Type B
04/05/2019
Section Cited
HSC
1596.866:(b)(1)
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Mandated Reporting Training: This requirement is not met as evidenced by the file review conducted by LPA for Licenee and the Assistant. LPA did not observe the certificate showing proof of completion of the training. This poses a potential risk to the health and safety of children in care.
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Licensee and Assistant shall complete the required training and submit the certificate by the due date.
Type B
03/08/2019
Section Cited
CCR
102417(g)(8)
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Operations of a Family Child Care home: This requirement is not met by evidence of record review. Licensee doesnot have a current roster on file. This poses a potential risk to Health and Safety to children in care.
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Licensee states will submit A CURRENT UPDATED copy of the children's roster to the LPA by the POC date.
Type B
03/11/2019
Section Cited
CCR
102421(a)
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Child Records: This requirement is not met by evidence of reviewing Children's files, which are missing the required departmental forms in the childrens file> This poses a potential risk to Health and Safety of the children in care
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Licensee to update all the children's file by the due date.
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: Adriana HernandezTELEPHONE: (323) 981-3362
LICENSING EVALUATOR NAME: Ketki DesaiTELEPHONE: (323) 981-3351
LICENSING EVALUATOR SIGNATURE:

DATE: 03/05/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/05/2019
LIC809 (FAS) - (06/04)
Page: 5 of 5
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME: RIOS & GUTIERREZ FAMILY DAY CARE
FACILITY NUMBER: 191501110
VISIT DATE: 03/05/2019
NARRATIVE
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Licensee was also made aware of the Child Advocacy program so she could receive the updated Quarterly reports and other information in a timely manner. ChildCareAdvocatesProgram@dss.ca.gov

LPA advised the Licensee to access forms and regulations on line at: www.ccld.ca.gov


Deficiencies cited during today's visit in accordance to the California Code of Regulations Title 22, Division 12, Chapter 1

Upon receipt of this report, the Licensee shall post the Notice of Site Visit and any Licensing report documenting a type “A” deficiency. The report and the Notice of Site Visit shall be posted for 30 consecutive days. Failure to maintain posting as required, will result in an immediate $100 civil penalty.

Exit interview was conducted with Licensee Rios Stella and appeal rights given
SUPERVISOR'S NAME: Adriana HernandezTELEPHONE: (323) 981-3362
LICENSING EVALUATOR NAME: Ketki DesaiTELEPHONE: (323) 981-3351
LICENSING EVALUATOR SIGNATURE:

DATE: 03/05/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/05/2019
LIC809 (FAS) - (06/04)
Page: 3 of 5
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME: RIOS & GUTIERREZ FAMILY DAY CARE
FACILITY NUMBER: 191501110
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/05/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
04/05/2019
Section Cited
HSC
1597.622(c)
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Immunization: This requirment is not met by record review of the Licensee/ Assitant who is not current on the required Immunizations. This poses a potential risk to Health and Safety to children in care.
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Licensee and the Assistant to obtain the required Immunizations by the due date and submit a copy to LPA.
MMR/ Tdap and Influenza or a Declining letter for Influenza shot.
Type B
03/11/2019
Section Cited
CCR
102417(9)
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Operations of a Family Child care home: This requirement is not met by evidence of missing the Emergency Disaster plan not being posted in the FCCH. This poses a potential risk to Health and Safety to children in care
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Licensee to post the required forms and send a picture by the due date.
Type B
03/06/2019
Section Cited
CCR
102417(a)
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Operations of a Family Child Care Home: This requirement is not met by evidence of sharp tools and a gallon of cleaning liquid left in the backyard table accessible to children. This poses a potential risk to Health and Safety to children in care
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Licensee states will have all corrections done by the POC date and will submit proof to LPA.
Type B
04/05/2019
Section Cited
CCR
102417(g)(4)
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Operations of Family Child care home: This requirement is not met by evidence of unlocked bathroom cabinets where hygiene products are stored easily accessible to children. This poses a potential risk to Health and Safety to children in care
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Licensee will place child proof locks on the cabinets making them inaccessible to children. Will submit proof by the due date.
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: Adriana HernandezTELEPHONE: (323) 981-3362
LICENSING EVALUATOR NAME: Ketki DesaiTELEPHONE: (323) 981-3351
LICENSING EVALUATOR SIGNATURE:

DATE: 03/05/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/05/2019
LIC809 (FAS) - (06/04)
Page: 4 of 5
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME: RIOS & GUTIERREZ FAMILY DAY CARE
FACILITY NUMBER: 191501110
VISIT DATE: 03/05/2019
NARRATIVE
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There is a First Aid Kit kept in the hall, it was inspected for quantity and expired medications. Bathroom was observed to be free of cleaning solutions, detergents and hazardous items. ( Bathroom cabinets need the child safety locks) Bedroom doors were observed to be closed. and remains inaccessible to children. Licensee remains current on the required annual fees.

Licensee's hours of operation are 6.00 A.M.--6.30 P.M. Monday through Friday. During hours of child care the Licensee is present in the home and ensures children in care are supervised at all times. When temporarily absent from the home, an assistant who has been cleared and current on the required First Aid and CPR training , shall provides day care services to the children. Currently an assistant who is cleared live scanned current on Pediatric CPR / First Aid is providing additional services.

Licensee's file was inspected for the required forms, as listed on LIC 311D. As Licensee stated that she does provide transportation to day care children. There are no pets in the home. Licensee does provide three meals and 2 snacks to children enrolled and is associated with Options program.

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



The following were discussed: Individuals who are 18 years of age or older living in the home must be finger print cleared prior to being in the presence of the children in care. Individuals within one month of their 18th birthday must be fingerprinted immediately. No smoking, No infant walkers, No Johnny jumpers, No exersaucers and any other item that falls into that category be on the premises. Discussed disaster drills, posting requirements, children records requirements, mandated child abuse training and injury/ death reporting, criminal records clearance, child abuse clearance, and criminal records transfer requirements.

Licensee & the assistant / Daughter needs to complete the required Mandated Reporting training, at www.mandatedreporterca.com .
SUPERVISOR'S NAME: Adriana HernandezTELEPHONE: (323) 981-3362
LICENSING EVALUATOR NAME: Ketki DesaiTELEPHONE: (323) 981-3351
LICENSING EVALUATOR SIGNATURE:

DATE: 03/05/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/05/2019
LIC809 (FAS) - (06/04)
Page: 2 of 5