Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197407897
Report Date: 02/07/2018
Date Signed: 02/07/2018 01:11:12 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1605 EAST PALMDALE BLV, STE A
PALMDALE, CA 93550
FACILITY NAME:RIVERA FAMILY CHILD CAREFACILITY NUMBER:
197407897
ADMINISTRATOR:EDITH RIVERAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(661) 287-1691
CITY:NEWHALLSTATE: CAZIP CODE:
91321
CAPACITY:14CENSUS: 4DATE:
02/07/2018
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Edith RiveraTIME COMPLETED:
03:45 PM
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Licensing Program Analyst (LPA) Joanne Alcala conducted an annual random inspection at the above facility. Upon arrival LPA was greeted by licensee, Edith Rivera. LPA observed 3 preschool children and 1 infant. Per Licensing Information System (LIS) all adults residing and working in the home have obtained background clearances. Per LIS, facility annual fees are current. The licensee is operating within proper capacity and ratios. LPA observed licensee to be present at the home and providing adequate care and supervision.

The home is clean, orderly, comfortable and well ventilated. LPA observed a working smoke detector and Carbon Monoxide, fully charged 2A10BC fire extinguisher and working telephone. There are several age appropriate toys and a first aid kit on the premises. Knives and medications are in accessible to children. Kitchen and bathroom areas were inspected for inaccessibility of toxins/cleaning compounds and other potentially dangerous objects/materials. Electrical outlets around the home were properly covered. The attached garage is off limits as well. The backyard is completely fenced in. There are no bodies of water in the FCCH. Per the licensee, there are no firearms on the premises.

Children are provided with cots and play pins for napping.

SUPERVISOR'S NAME: Adriana HernandezTELEPHONE: (661) 789-6944
LICENSING EVALUATOR NAME: Joanne AlcalaTELEPHONE: (661) 789-6944
LICENSING EVALUATOR SIGNATURE:

DATE: 02/07/2018
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/07/2018
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, 1605 EAST PALMDALE BLV, STE A
PALMDALE, CA 93550

FACILITY NAME: RIVERA FAMILY CHILD CARE
FACILITY NUMBER: 197407897
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/07/2018
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
03/07/2018
Section Cited
HSC
1596.866
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Additional health and safety training; condition of licensure: (2) Training in pediatric first aid and pediatric CPR by persons described in subdivisions (a) and (b) shall be current at all times. The licensee did not have a current CPR card it expired on 9/19/17. This is a potential health and safety
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The licensee agrees to take a hand on CPR course and submit a copy of her valid CPR card to LPA by plan of correction date.
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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: Adriana HernandezTELEPHONE: (661) 789-6944
LICENSING EVALUATOR NAME: Joanne AlcalaTELEPHONE: (661) 789-6944
LICENSING EVALUATOR SIGNATURE:

DATE: 02/07/2018
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/07/2018
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, 1605 EAST PALMDALE BLV, STE A
PALMDALE, CA 93550
FACILITY NAME: RIVERA FAMILY CHILD CARE
FACILITY NUMBER: 197407897
VISIT DATE: 02/07/2018
NARRATIVE
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Licensee has the required documents posted in the FCCH; Facility License (LIC 203), Emergency Disaster Plan (LIC610a), Notification of Parents' Rights Poster (PUB 394).

The following was discussed with the licensee;


No smoking, No infant walkers, Johnny jumpers, exersaucers and any other item that falls into that category, earthquake safety and necessity of drills (every 6 months), required forms for children’s files, facility files, posting requirements, penalty, fingerprint clearance, and the transfer process and penalty.
For additional information and forms visit our website at: www.ccld.ca.gov
A copy of this report must be made available to the public for 3 years.

For updates on Community Care Licensing please visit the following website at: Childcareadvocatesprogram@dss.ca.gov
https://ccld.childcarevideos.org/

The facility was not in compliance per Title 22 regulations, a Type B deficiency will be cited today 02/07/2018. An exit Interview was conducted, a copy of this Report and a Notice of Site visit was provided and appeal rights were discussed.

SUPERVISOR'S NAME: Adriana HernandezTELEPHONE: (661) 789-6944
LICENSING EVALUATOR NAME: Joanne AlcalaTELEPHONE: (661) 789-6944
LICENSING EVALUATOR SIGNATURE:

DATE: 02/07/2018
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/07/2018
LIC809 (FAS) - (06/04)
Page: 3 of 4
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1605 EAST PALMDALE BLV, STE A
PALMDALE, CA 93550
FACILITY NAME: RIVERA FAMILY CHILD CARE
FACILITY NUMBER: 197407897
VISIT DATE: 02/07/2018
NARRATIVE
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The licensee did not have a current CPR and first aid it expired on 9/19/17. This will be a Type B citation today.

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 licensee was informed about the mandated reporter training that needs to be taken between January-March 2018 for free at the following website www.mandatedreporterca.com please make sure to print your certificate and keep it for your records. This training must be renewed every 2 years.

LPA observed a current child roster. Per the licensee, fire and disaster drills are conducted monthly. Child files were found to be complete.

SUPERVISOR'S NAME: Adriana HernandezTELEPHONE: (661) 789-6944
LICENSING EVALUATOR NAME: Joanne AlcalaTELEPHONE: (661) 789-6944
LICENSING EVALUATOR SIGNATURE:

DATE: 02/07/2018
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/07/2018
LIC809 (FAS) - (06/04)
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