Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 334830480
Report Date: 10/04/2019
Date Signed: 10/04/2019 10:25:18 AM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 3737 MAIN STREET, STE 700
RIVERSIDE, CA 92501
FACILITY NAME:CERVANTES FAMILY CHILD CAREFACILITY NUMBER:
334830480
ADMINISTRATOR:CERVANTES, ERIKAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(951) 488-7121
CITY:MORENO VALLEYSTATE: CAZIP CODE:
92557
CAPACITY:14CENSUS: 7DATE:
10/04/2019
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
08:57 AM
MET WITH:Erika CervantesTIME COMPLETED:
10:30 AM
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(3) On date and time listed, Licensing Program Analyst (LPA) La Kesha Edwards arrived at the facility to conduct an annual inspection. LPA toured the facility, inside and out, records were reviewed and the following was observed and/or discussed:

Normal days and hours of operation are: Monday through Friday, 6:00 AM to 6:00 PM

OFF-LIMIT AREAS INCLUDE: Upstairs, family room, living room and garage

· The licensee is present in the home and ensures that children in care are supervised at all times
· The licensee is operating within the licensed capacity and ratios
· Fire extinguishers, smoke detectors, and carbon monoxide detectors meet State Fire Marshall standards and were tested by the applicant during this inspection.
· Fireplaces is properly barricaded.
· Stairs are barricaded
· Storage areas for poisons, detergents, cleaning compounds, medications and other items which could pose a danger to children are stored where they are inaccessible to children
· All poisons are locked
· Storage areas for firearms and other dangerous weapons are inaccessible to children, and locked
· Ammunition is stored and locked separately from weapon(s) LICENSEE UNDERSTANDS ALL GUNS, WEAPONS AND AMMUNITION MUST BE KEY-LOCKED SEPARATELY AND MADE INACCESSIBLE PER TITLE 22 REGULATIONS.
· The home is kept clean and orderly, with heating and ventilation for safety and comfort (Cont 809-C
SUPERVISOR'S NAME: Dawn ParkerTELEPHONE: (951) 320-2101
LICENSING EVALUATOR NAME: Lakesha EdwardsTELEPHONE: (951) 970-4412
LICENSING EVALUATOR SIGNATURE:

DATE: 10/04/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/04/2019
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, 3737 MAIN STREET, STE 700
RIVERSIDE, CA 92501
FACILITY NAME: CERVANTES FAMILY CHILD CARE
FACILITY NUMBER: 334830480
VISIT DATE: 10/04/2019
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AB2231 (2016) – Increased Civil Penalties, effective July 1, 2017 – For failing to correct a violation the civil penalty is increased to $100 per day for EACH violation until corrected; For failing to correct a repeated violation the civil penalty is increased to $250 immediately assessed , and $100 per day afterwards for EACH repeated violation until corrected; For an Immediate Risk violation the civil penalty is increased to $500 immediately assess, and $100 per day for EACH violation after that until corrected; For any repeated Immediate Risk violations the civil penalty is increased to $1,000 immediately assess, and $100 per day afterwards for EACH repeated violation until corrected.
NOTE: Repeat violations are defined as a violation of a previously cited statutory or regulatory Section and/or subsection within 12 months prior.
- AB 1207 – Mandated Child Abuse Reporting: Child Day Care Personnel Training, beginning January 1, 2018 – In accordance with California Health and Safety Code Section 1596.8662 – requires all licensed providers, applicants, directors and employees to complete training as specified on their mandated reporter duties and to renew their training every two years. Applicants must meet requirements as a precondition to licensure. Existing licensees must meet requirements by March 30, 2018. New employees shall have 90 days to complete training as required. This training requirement may be directly met by using the Department’s Office of Child Abuse Prevention (OCAP) online training modules. The OCAP modules are free of cost and available at: http://www.mandatedreporterca.com/ and are provided in English and Spanish. If no training is made available in a required person’s primary language then those persons shall be exempt from this requirement
- AB2370 – Effective January 1, 2019 – Lead Poisoning – providers are required to provide a lead toxicity prevention handout to parents/guardians of newly enrolled and newly reenrolled children with information on risks and effects of lead poisoning; blood lead testing recommendations and requirements; and options for obtaining blood lead testing, including free and/or discounted testing. There will be a training component of this added to the Preventative Health Training beginning July 1, 2020.
- Effective January 1, 2017 – Children under 2 years of age shall ride in a rear-facing car seat unless the child weighs 40 or more pounds OR is 40 or more inches tall. For additional information regarding car seat laws see www.chp.ca.gov (Continued on 809-C)
SUPERVISOR'S NAME: Dawn ParkerTELEPHONE: (951) 320-2101
LICENSING EVALUATOR NAME: Lakesha EdwardsTELEPHONE: (951) 970-4412
LICENSING EVALUATOR SIGNATURE:

DATE: 10/04/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/04/2019
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, 3737 MAIN STREET, STE 700
RIVERSIDE, CA 92501
FACILITY NAME: CERVANTES FAMILY CHILD CARE
FACILITY NUMBER: 334830480
VISIT DATE: 10/04/2019
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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
· For more information on SIDS and Safe Sleep Environments, please visit:
California Department of Public Health – California SIDS Program: http://www.cdph.ca.gov/programs/SIDS/pages/default.aspx
AAP – Safe Sleep Campaign: http://www.healthychildcare.org/sids/html
AAP-Free Training: Reducing the Risk of SIDS in Early Education and Child Care: http://shop.aap.org/Reducing-the-Risk-of-SIDS-in-Early-Education-and-Child-Care
And Caring for our Children, Safe Sleep Practices and SIDS/Suffocation Risk Reduction: http://cfoc/nrckids/org/standardview/spccol/safe_sleep

The following was reviewed with the licensee(s):
- SB 277 – Immunizations, Personal Beliefs Exemption, effective January 1, 2016 - it eliminates the exemption from existing specified immunization requirements based upon personal beliefs, and only allows an exemption from future immunization requirements deemed appropriate by the State Department of Public Health or a medical professional for medical reasons.
- AB290 – Child Nutrition, effective January 1, 2016 - – In accordance with California Health and Safety Code Section 1596.866 - each family day care home licensee who provides care, shall have at least one hour of childhood nutrition training as part of the preventive health practices course or courses.
- SB792 – Immunization requirements for staff, volunteers, effective September 1, 2016 – In accordance with California Health and Safety Code Section 1597.622 (a)(1)- a person shall not be employed or volunteer at a family day care home if he or she has not been immunized against influenza, pertussis, and measles. Each employee and volunteer shall receive an influenza vaccination or they may provide a statement declining the vaccination. If employees/volunteers are receiving the influenza vaccination they must do so between August 1 and December 1 of each year. (Continued on 809-C)
SUPERVISOR'S NAME: Dawn ParkerTELEPHONE: (951) 320-2101
LICENSING EVALUATOR NAME: Lakesha EdwardsTELEPHONE: (951) 970-4412
LICENSING EVALUATOR SIGNATURE:

DATE: 10/04/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/04/2019
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, 3737 MAIN STREET, STE 700
RIVERSIDE, CA 92501
FACILITY NAME: CERVANTES FAMILY CHILD CARE
FACILITY NUMBER: 334830480
VISIT DATE: 10/04/2019
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Access to forms & Regulations for Family Child Care Homes online at www.ccld.ca.gov
- Responsibility to know the regulations for anyone providing care
- Inaccessibility of hazards must be constantly reassessed depending on the children in care
- Current facility’s phone numbers must be on file at all times.
- Failure to meet the posting requirements shall result in an immediate $100 civil penalty.
- Documentation of fire & earthquake drills to be conducted every six months
- Responsibilities of being a mandated reporter
- Baby walkers, bouncy seats, exersaucers and other similar items are prohibited
- The applicant is urged to visit the U.S. Consumer Product Safety Commission webpage at www.cpsc.gov to ensure that equipment purchased for the day care has not been recalled
- Once licensed, the Notice of Site Visit must be posted at the entrance of the facility for a period of 30 days.
- Access to forms & Regulations for Family Child Care online at www.ccld.ca.gov.
- Please email: childcareadvocatesprogram@dss.ca.gov to receive Department updates. They will be sent directly to your e-mail account once you have set up an account. This website can also be accessed through www.ccld.ca.gov
- The Duty Officer is available to answer questions Monday – Friday at 1-844-LET-US-NO (1-844-538-8766).

SUPERVISOR'S NAME: Dawn ParkerTELEPHONE: (951) 320-2101
LICENSING EVALUATOR NAME: Lakesha EdwardsTELEPHONE: (951) 970-4412
LICENSING EVALUATOR SIGNATURE:

DATE: 10/04/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/04/2019
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, 3737 MAIN STREET, STE 700
RIVERSIDE, CA 92501
FACILITY NAME: CERVANTES FAMILY CHILD CARE
FACILITY NUMBER: 334830480
VISIT DATE: 10/04/2019
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During the exit interview, the LICENSEE, Erika Cervantes, confirmed that there are no Registered Sex Offenders living in the facility and/or using the facility address for their mailing address.

As a REMINDER: when your child(ren) turn 18 years of age, you MUST SUBMIT an updated LIC279, LIC508 and TB Screen and have your child submit for LIVESCAN background clearance. This also applies to any adult PRIOR to them moving into the home or who currently lives in the home. Also, PRIOR to employment of any adult, you must submit the LIC508, TB screening and obtain a background clearance through LIVESCAN.

A NOTICE OF SITE VISIT WAS ISSUED AND LPA VERIFIED THAT IT WAS POSTED IN A PROMINENT LOCATION AT THE FACILITY BEFORE LEAVING.

A Confidential Names List was completed and provided to the LICENSEE. A copy of this report was provided to the licensee on this date and must be made available to the public upon request for the next 3 years.
SUPERVISOR'S NAME: Dawn ParkerTELEPHONE: (951) 320-2101
LICENSING EVALUATOR NAME: Lakesha EdwardsTELEPHONE: (951) 970-4412
LICENSING EVALUATOR SIGNATURE:

DATE: 10/04/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/04/2019
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, 3737 MAIN STREET, STE 700
RIVERSIDE, CA 92501
FACILITY NAME: CERVANTES FAMILY CHILD CARE
FACILITY NUMBER: 334830480
VISIT DATE: 10/04/2019
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· Each child has safe, healthful, and comfortable accommodations, furnishings, and equipment
· The home provides safe toys, play equipment, and materials
· There is an in-ground pool that has mesh, removable fence and gate. The fence is 5 feet tall and the gate opens away from the pool and is self-closing/self-latching Per Title 22 Regulations
· The home has a current roster of children
· The home conducts fire and disaster drills at least once every six months, last drill conducted on 9/27/19
· Licensee documents immunizations and maintains and updates records for children in care
· Licensee provides the child's parent or representative with a copy of the Family Child Care Home Notification of Parents' Rights
· The licensee and other personnel, as specified, have completed training on preventive health practices which was completed on 12/02/07; including pediatric CPR and First Aid which expires 11/20/19.
· Criminal record clearances are required prior to all adults living or working in a Family Child Care Home. A civil penalty of $100.00 per day the person has been present, may be assessed. Resident and/or staff records reviewed on 10/04/19 indicate that all adults who require caregiver background checks have received all required clearances or exemptions.
· The licensee understands that upon notice of the Department to remove an individual from the home, pursuant to H&S Code 1596.871(c)(2), or to exclude an individual from the home, pursuant to H&S Code 1596.8897, the licensee immediately removes the individual and prevents them from returning to the home or having contact with children in care
· Children are not left in parked vehicles and the licensee understands that this is prohibited
· The licensee understands that any authorized employee of the Department may enter and inspect any place providing personal care and services at any time, with or without advance notice
· 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: (Continued on 809-C)
SUPERVISOR'S NAME: Dawn ParkerTELEPHONE: (951) 320-2101
LICENSING EVALUATOR NAME: Lakesha EdwardsTELEPHONE: (951) 970-4412
LICENSING EVALUATOR SIGNATURE:

DATE: 10/04/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/04/2019
LIC809 (FAS) - (06/04)
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