Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 304313090
Report Date: 10/20/2017
Date Signed: 10/20/2017 01:19:21 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:
(562) 314-5342
CITY:LA HABRASTATE: CAZIP CODE:
90631
CAPACITY:14CENSUS: 10DATE:
10/20/2017
TYPE OF VISIT:Annual/RequiredUNANNOUNCEDTIME BEGAN:
11:43 AM
MET WITH:Petra Castaneda and Gabriel CastanedaTIME COMPLETED:
01:50 PM
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3) Licensing Program Analyst (LPA), Jacqueline Moore was greeted and allowed entrance into the facility by licensee, Petra Castaneda. LPA observed 8 day care children, 4 children were in the day care/ living room preparing for nap and 4 children were in the dining room area finishing up lunch. Census was taken as followed: 3 infants and 5 preschool children. Two additional school age children were transported from school to the facility by licensee' adult son Manuel Castaneda Jr, and arrived to the facility at 12:22pm. Also present and assisting with the day care was licensee' s adult son's Gabriel Castaneda and Manuel Castaneda. A review of adult individuals living or working in this facility on this date who require caregiver background checks have received criminal record and child abuse index clearances or exemptions. There are 4 adults and 1 minor living in the facility
LPA toured the home inside and outside with the licensee. Off limit areas included: the three bedrooms in the hallway, bathroom inside of master bedroom, front yard, and the detached garage.
Areas designated for day care included: the living room/day care room, dining room, kitchen, hallway bathroom, and the enclosed backyard.
Furniture and equipment was inspected for age appropriateness and good repair. Telephone service, heating, lighting and ventilation were evaluated. The home was equipped with a 2A:10BC, Fire Extinguisher, smoke detector, and carbon monoxide detector which were in operable condition. EMSA Pediatric CPR & First Aid cards which will expire 1/5/19. Adult assistants also had current EMSA Pediatric CPR & First aid cards which will expire 9/19.
The bathroom area was inspected for proper storage of all cleaning compounds, medications, perfumes, shampoos, toothpaste, and sharp pointed objects.
The enclosed fenced backyard was used for outdoor play area. There are no wall heaters in the home. Fireplace was barricaded by a large shelf. Per licensee there are no weapons are firearms in the facility. LPA did not observe any bodies of water at the facility. LPA observed one pet dog in the backyard. .

Report Continued on page 2 ( LIC 809C)
SUPERVISOR'S NAME: Marian WallmeierTELEPHONE: (714) 703-2800
LICENSING EVALUATOR NAME: Jacqueline MooreTELEPHONE: (714) 703-2823
LICENSING EVALUATOR SIGNATURE:

DATE: 10/20/2017
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/20/2017
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 3
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: 10/20/2017
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Page 2
LPA reviewed children's files for immunization record and parent right's notification. Licensee posted all the required forms. LPA reviewed children's roster and fire drill/disaster drill log. LPA took a photos of the children's roster. Staff had the required immunization's on file for Pertussis, Measles, and Influenza.

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 presence in the facility. No smoking in the areas accessible to the day care children, disaster drills, posting requirements, children records, mandated child abuse and injury/death reporting. LPA 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), and criminal records clearances/exemption transfer requests (contact Licensing Office (714)703-2800 ask for Personnel ID#, fax Criminal Background Transfer Request form (LIC 9182) and (LIC 508) with copy of ID to fax# (714)703-2831 prior to hiring staff), All areas/ rooms that are off-limits need to be made inaccessible during operating hours, no infant walkers, Johnny jumpers, Exersaucers and any other item that falls into that category,SIDS and Never Shake a Baby (Copy given), Quarterly updates, Child Care Advocate Program childcareadvocatesprogram@dss.ca.gov. 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,
Also provided was information about the E-Learning Modules available at https://ccld.childcarevideos.org. A copy of the 2016 “A Child Care Providers Guild to Safe Sleep” was provided to the facility representative. English: https//www.cdph.ca.gov/programs/SIDS/Doucments/SIDSchildcaresafesleep.pdf., and SB 792 copy given. Centralized complaint and information bureau (copy given), Mandated reporter training, California child passenger safety law (PUB 269) copy was given.

Report continued on Page 3(LIC 809 C)

SUPERVISOR'S NAME: Marian WallmeierTELEPHONE: (714) 703-2800
LICENSING EVALUATOR NAME: Jacqueline MooreTELEPHONE: (714) 703-2823
LICENSING EVALUATOR SIGNATURE:

DATE: 10/20/2017
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/20/2017
LIC809 (FAS) - (06/04)
Page: 2 of 3
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: 10/20/2017
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Page 3/ LIC 809C

Licensee's Adult son translated today's inspection report to the licensee in the Spanish language.

In the areas evaluated, no deficiencies were observed. The facility was incompliance with CA Code of Regulations, Title 22, and Division 12 at the time of inspection.

An exit interview was conducted with licensee. Report was reviewed and discussed. The licensee was provided a copy of their appeal rights and their signature on this form acknowledges receipt of these rights. The Notice of Site Visit was posted. Facility representative was informed that the notice of site visit must be posted for 30 consecutive days. Failure to post will result in civil penalties of $100. LPA informed the licensee of how to access regulations and forms from CCLD websites: ccld.ca.gov This report is to be on file and accessible for public review at the facility for at least 3 years.

SUPERVISOR'S NAME: Marian WallmeierTELEPHONE: (714) 703-2800
LICENSING EVALUATOR NAME: Jacqueline MooreTELEPHONE: (714) 703-2823
LICENSING EVALUATOR SIGNATURE:

DATE: 10/20/2017
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/20/2017
LIC809 (FAS) - (06/04)
Page: 3 of 3