Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 304313090
Report Date: 12/08/2016
Date Signed: 12/08/2016 02:46:19 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME:CASTANEDA, PETRAFACILITY NUMBER:
304313090
ADMINISTRATOR:CASTANEDA, PETRAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(502) 314-5342
CITY:LA HABRASTATE: CAZIP CODE:
90631
CAPACITY:14CENSUS: 0DATE:
12/08/2016
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Petra Castaneda and
Manuel Castaneda
TIME COMPLETED:
03:10 PM
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A Pre-licensing visit was made by Licensing Program Analyst (LPA), Jacqueline Moore on this date due to a relocation change previous license number 304312573. Present was licensee, Petra Castaneda who allowed LPA entrance into the facility. Licensee's two adults sons, were also present during today's visit. One of licensee's son's translated today's visit to licensee in the Spanish language. No children were present during today's visit. LPA toured inside and outside of the home and paperwork was reviewed. Control of property was reviewed and a copy was given to LPA during visit.
A review of staff records on this date indicates that all facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances. There are 4 adults and 1 minor living in the home. Children's records and child care roster was reviewed. CPR and First Aid Card will expire 08/18/17.
Licensee had 7 hours health and safety class card, and was missing the 1 hour required nutrition class. The Parents' Rights poster and posting requirements are accessible for viewing in the day care room.
Department web site form was given to down load forms and Title 22 regulations on-line at http://www.ccld.ca.gov and http://www.dss.cahwnet.gov. LPA discussed and reviewed Unusual Incident Report form (advised to contact Licensing Officer of the Day within 24 hours and complete the Unusual Incident Report (LIC 624) within 7 days); SB 792, SB 277, Quarterly Updates, California Child Passenger Safety Law poster (copy was given), Complaint Bureau poster(copy was given) were discussed as well as fire and disaster drills form was discussed. LPA advised that it is recommended that fire/disaster drills are conducted and documented on a monthly basis.
This is a one story, 3 bedroom home with 2 bathrooms with detached garage. Licensee has designated the living room, dining room area, kitchen which had latches on all of the kitchen cabinets, hallway bathroom, and fenced backyard for the care and supervision of children. The off limit areas: have been designated as the 3 bedrooms, master bathroom which all had child safety locks on the door knobs during today's visit, and the garage. Toys and outside play equipment that appears age appropriate for ages served are located here. The smoke detector, fire extinguisher, and carbon monoxide detector were present and operational.
SUPERVISOR'S NAME: Marian WallmeierTELEPHONE: (714) 703-2800
LICENSING EVALUATOR NAME: Jacqueline MooreTELEPHONE: (714) 703-2821
LICENSING EVALUATOR SIGNATURE:

DATE: 12/08/2016
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/08/2016
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, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME: CASTANEDA, PETRA
FACILITY NUMBER: 304313090
VISIT DATE: 12/08/2016
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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

Required Immunization's of Influenza, Pertussis and Measles were reviewed and a copy was given to LPA during visit. Copy of Insurance was given to LPA.


Fire clearance from Whittier Fire Prevention Department has been received and approved for requested capacity.


Licensee denies the use of the garage for day care purposes. Licensee denies the presence of weapons and firearms on the premises. No bodies of water were observed, fireplace was barricaded with bookshelves, and there was 1 dog at the home.

Based on licensee had not completed 1 hour required nutrition class. Therefore, a provisional license will be issued for a large family child care home, effective 12/8/16 upon review and approval. Licensee will send copy of completed 1 hour nutrition class to LPA within 90 days of today's date, LPA will then issue a regular license.


The Chaptered Legislation for AB 2084 (Nutritious Beverages) is available to view on the website at: http://ccld.ca.gov/res/pdf/12APX-11.pdf

Exit interview conducted. Report was reviewed and discussed. Appeal rights discussed
SUPERVISOR'S NAME: Marian WallmeierTELEPHONE: (714) 703-2800
LICENSING EVALUATOR NAME: Jacqueline MooreTELEPHONE: (714) 703-2821
LICENSING EVALUATOR SIGNATURE:

DATE: 12/08/2016
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/08/2016
LIC809 (FAS) - (06/04)
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