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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 191597930
Report Date: 08/30/2022
Date Signed: 08/30/2022 03:18:01 PM

Document Has Been Signed on 08/30/2022 03:18 PM - It Cannot Be Edited

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 CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME:CANO FAMILY DAY CAREFACILITY NUMBER:
191597930
ADMINISTRATOR:CANO, VICTORIAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(562) 863-7821
CITY:NORWALKSTATE: CAZIP CODE:
90650
CAPACITY: 12TOTAL ENROLLED CHILDREN: 11CENSUS: 4DATE:
08/30/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:25 PM
MET WITH:Licensee Victoria Cano TIME COMPLETED:
03:30 PM
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On 8/30/22 Licensing Program Analysts (LPA) Jeanette Estrada and Austin Estrada conducted an unannounced required 1 year inspection at the above facility. LPAs met with the Licensee Victoria Cano and informed her of the purpose for the visit. LPAs provided Licensee with a copy of the Facility Entrance Checklist. Assistant -Licensee's spouse guided LPAs on a tour of the facility. There were 4 children and one assistant present during the inspection. All residents were noted and verified. Facility provides care to children ages 0 to 5 years old. Facility is open Monday to Friday 7AM to 5:30 PM.
This is a one story, 3 bedroom, 2 bathroom home, with a living room/ dining room, den, kitchen/laundry room, fenced front yard, backyard and garage.
Per Licensee areas on limits to children are: Living room/dining room, bathroom in the hall way and the fenced front yard.
Per Licensee areas off limits to children are: 3 bedrooms, den, one bathroom in an off limit bedroom, backyard and garage. Access is prevented to off limit areas with safety gates placed at the kitchen entrance and the hallway.
All areas that are accessible to children were inspected for safety, comfort, and cleanliness. The following was observed and reviewed during this inspection: LPAs observed required posted documentation- Facility license, Publication (PUB) 394- Notification of Parent Rights and Licensing Form (LIC) 9148- Earthquake Preparedness form. LPAs observed and reviewed a current roster LIC 9040 and a current disaster drill log. Last disaster drill was performed in February 2022. There is an operable carbon monoxide detector and an operable smoke detector in the living room/day care room. LPAs observed a 2A10BC Fire Extinguisher in the facility which indicated full and was last serviced March 2022. The home maintains telephone service (cell phone). Food is provided by Licensee. Licensee was reminded if children bring food from home it must be labeled with the child’s name and properly stored or refrigerated.
There are toys and other age appropriate materials available for children to use in the day care room. Sharp objects, detergents and cleaning compounds were inaccessible to children in care. Knives, cleaning compounds and detergents are inaccessible to children in a kitchen cabinet.
SUPERVISORS NAME: Valarie Cook
LICENSING EVALUATOR NAME: Jeanette Estrada
LICENSING EVALUATOR SIGNATURE: DATE: 08/30/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/30/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.

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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, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME: CANO FAMILY DAY CARE
FACILITY NUMBER: 191597930
VISIT DATE: 08/30/2022
NARRATIVE
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Medication is stored in the off limits kitchen. Per Licensee, no children enrolled require medication. The facility has central air and heating. There is a fireplace in the off limit den. Children nap in the living room/day care room and they are provided appropriate napping equipment. Children use the restroom in the hallway. Cleaning products are kept in a high shelf. No accessible hazards were observed in the restroom.
Children use the front yard for outdoor play. LPAs observed the front yard is fully fenced. Per Licensee, children are supervised while playing outside. Poisons are kept in the off limits garage. Licensee understands that all poisons must be locked, not only inaccessible to children. Isolation area for sick children waiting to be picked up is in the living room or outside, separated from other children. Per Licensee, there are no firearms or weapons stored in the home. LPAs did not observe any pools or spas, or other bodies of water. There are 3 pet dogs in the home which are kept in the off limit area of the home.
Infant Care: Currently licensee has 3 infants enrolled. LPAs observed 1 play yard in the living room/day care room. Per Licensee two infants nap on cots. Napping equipment does not block entrances or exits. LPAs observed a blanket and a loose fitting sheet on the play yard mattress. Licensee was advised Infants shall not be swaddled in care. Car seats shall not be used for sleeping. 1 infant did not have LIC 9227 on file and 2 infants present did not have the 15 minute infant sleep log on file. LPAs discussed the new Safe sleep regulation, including LIC 9227 Infant Sleep Plan for infants under 12 months, 15-minute sleep check documentation for infants 0-24 months, LPAs provided a copy of PIN 20-24-CCP and the infant safe sleep regulation 102425.
Overnight Care: There is no overnight care provided at the moment. LPAs discussed the following: Licensee is aware that they must remain awake while children are awake. If children sleep in separate area from licensee, the door must remain open. If licensee cannot hear children when they wake up, video or audio device can be used.
Children's records were reviewed: Children's records contained (LIC) 282- Affidavit Regarding Liability Insurance, Immunization Records, LIC 700- Identification and Emergency Information, LIC 627- Consent for Medical Treatment, LIC 995A Notification of Parents’ Rights, 1 out of 4 children present did not have LIC 9227 Infant Sleeping Plan and 2 out of 4 children present did not have the 15 minute infant sleep logs.
Staff records were reviewed: Licensee's and assistant's Pediatric CPR/First Aid was completed on 5/15/21. Staff did not have proof of required immunizations (measles, pertussis, flu). Licensee had proof of TB clearance. Licensee's Mandated Reporter training was completed in 2018. Assistant did not have proof of a current Mandated Reporter training certificate. Licensee and Assistant did not have LIC 508 criminal record statement on file.
SUPERVISORS NAME: Valarie Cook
LICENSING EVALUATOR NAME: Jeanette Estrada
LICENSING EVALUATOR SIGNATURE:

DATE: 08/30/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/30/2022
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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, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME: CANO FAMILY DAY CARE
FACILITY NUMBER: 191597930
VISIT DATE: 08/30/2022
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During inspection the child present was observed to be treated with dignity and respect, and free from corporal and/or unusual punishment.
Incidental Medical Services (IMS): 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 Center and the ADA, available at: http://www.ada.gov/childqanda.htm
Licensee was reminded that all adults 18 and over living or working in the home, including employees and volunteers, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a licensed Family Child Care Home. A civil penalty of $100.00 minimum/day up to $500.00 maximum per day/per person will be assessed if this regulation is violated.
LPA discussed the safe sleep regulations with Licensee and discussed the Child Care Licensing Safe Sleep webpage athttps://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleephttps://www.cdss.ca.gov/inforesources/child-care-licensing/ public -information-and-resources/safe-sleep as an additional resource. LPA also informed licensee of the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at https://www.cpsc.gov/ and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment. To improve the quality and value of the new inspection process, a survey will be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or tools, please send them by email to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/process.

The deficiencies listed on the following pages were observed by the LPA and are being cited in accordance with California Code of Regulations Title 22. Please see attached LIC 809-Ds for Type B citations. Deficiencies that are being cited need to be cleared to protect the children’s health & safety.
Exit interview conducted and report was reviewed with the Licensee, Victoria Cano . A notice of site visit was given and must remain posted for 30 days.
SUPERVISORS NAME: Valarie Cook
LICENSING EVALUATOR NAME: Jeanette Estrada
LICENSING EVALUATOR SIGNATURE:

DATE: 08/30/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/30/2022
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 08/30/2022 03:18 PM - It Cannot Be Edited


Created By: Jeanette Estrada On 08/30/2022 at 01:56 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME: CANO FAMILY DAY CARE
FACILITY NUMBER: 191597930

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/30/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102425(b)
Infant Safe Sleep
(b) Cribs or play yards shall be free from all loose articles and objects.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, the licensee did not comply with the section cited above in one infant's play yard which contained a blanket and a loose fititng sheet which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 09/07/2022
Plan of Correction
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Licensee removed the blanket from the play yard. Licensee will obtain a tight fitting sheet for the matress. Licensee will submit photo of matress with tight fitting sheet to LPA.
Type B
Section Cited
CCR
102425(j)
Infant Safe Sleep
The provider shall supervise infants while they are sleeping and adhere to the following requirements:

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on interview and record review , the licensee did not comply with the section cited above in 2 out of 2 infants present who did not have a 15 minute infant sleep log on file which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 09/07/2022
Plan of Correction
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 Licensee was advised to review regulation 102425(j)(1) through 102425 (j)(2)(D) for information on what to document: labored breathing, signs of distress, infants up to 12months who are sleeping in a position other than their back. Documentation shall include the following: Date, Child's name, time of 15 minute check. Licensee will submit 15 minute infant sleep log for infants present during the inspection to LPA via photo.
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:Valarie Cook
LICENSING EVALUATOR NAME:Jeanette Estrada
LICENSING EVALUATOR SIGNATURE:
DATE: 08/30/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/30/2022


LIC809 (FAS) - (06/04)
Page: 4 of 6
Document Has Been Signed on 08/30/2022 03:18 PM - It Cannot Be Edited


Created By: Jeanette Estrada On 08/30/2022 at 01:56 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME: CANO FAMILY DAY CARE
FACILITY NUMBER: 191597930

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/30/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
HSC
1596.8662(b)(1)
Administration of Child Day Care Licensing
(1) On or before March 30, 2018, a person who, on January 1, 2018, is a licensed child day care provider, administrator, or employee of a licensed child day care facility shall complete the mandated reporter training provided pursuant to paragraphs (2) and (3) of subdivision (a), and shall complete renewal mandated reporter training every two years following the date on which he or she completed the initial mandated reporter training.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on interview and record review, the licensee did not comply with the section cited above in two staff files (Licensee and Assistant) which did not contain a current mandated reporter training certificate which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 09/30/2022
Plan of Correction
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Licensee and assistant will complete mandated reporter training -general training and child care provider training. Licensee will submit proof of certificates for herself and the assistant via photo. Licensee was advised training can be accessed on www.mandatedreporterca.com
Type B
Section Cited
HSC
1597.622(c)
Administration of Child Day Care Licensing
(c) The family day care home shall maintain documentation of the required immunizations or exemptions from immunization, as set forth in this section, in the person's personnel record that is maintained by the family day care home.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on interview, the licensee did not comply with the section cited above in two staff files (licensee and assistant) which did not contain proof of required immunizations which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 09/30/2022
Plan of Correction
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Licensee will obtain proof of required immunizations for herself and the assistant (Measles, pertussis and flu) and will submit proof to LPA via email.
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:Valarie Cook
LICENSING EVALUATOR NAME:Jeanette Estrada
LICENSING EVALUATOR SIGNATURE:
DATE: 08/30/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/30/2022


LIC809 (FAS) - (06/04)
Page: 5 of 6
Document Has Been Signed on 08/30/2022 03:18 PM - It Cannot Be Edited


Created By: Jeanette Estrada On 08/30/2022 at 01:56 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME: CANO FAMILY DAY CARE
FACILITY NUMBER: 191597930

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/30/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102416.1(a)(11)
Personnel Records
(a) Personnel records shall be maintained on each employee and shall contain the following information: (11) A signed statement regarding their criminal record history as required by Section 102370(c).

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, the licensee did not comply with the section cited above in two staff files which did not contain LIC 508 criminal record statement which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 09/07/2022
Plan of Correction
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Licensee will submit a copy of the completed LIC 508 criminal record statement for herself and assistant via email
Section Cited
Deficient Practice Statement
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2
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POC Due Date:
Plan of Correction
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2
3
4
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:Valarie Cook
LICENSING EVALUATOR NAME:Jeanette Estrada
LICENSING EVALUATOR SIGNATURE:
DATE: 08/30/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/30/2022


LIC809 (FAS) - (06/04)
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