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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197415541
Report Date: 07/13/2022
Date Signed: 07/14/2022 08:28:13 AM

Document Has Been Signed on 07/14/2022 08:28 AM - 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, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME:RIVAS FAMILY CHILD CAREFACILITY NUMBER:
197415541
ADMINISTRATOR:RIVAS, ROSA M.FACILITY TYPE:
810
ADDRESS:TELEPHONE:
(818) 408-0416
CITY:SAN FERNANDOSTATE: CAZIP CODE:
91340
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 10DATE:
07/13/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:43 AM
MET WITH:Rosa Rivas, Licensee TIME COMPLETED:
01:15 PM
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On 07/13/22 Licensing Program Analyst (LPA) Justeene Tamayo met with Licensee, Rosa Rivas, who guided analyst on a tour of the facility for the One Year Required inspection.This is a single story family home with a detached room. There is a children's playroom, living room, kitchen, four bedrooms and two restrooms. There is no pool/spa or body of water on the premises. Upon arrival LPA observed 3 infants,7 children, assistant #1 and the licensee. Family members residing in the home include 2 adults (licensee and adult #1) and no children. Facility operation are Monday-Friday 6AM-6PM. Incidental Medical Services (IMS) policy was discussed.

Physical Plant: Main care is provided in the children's playroom. The children use the bathroom located in the hallway next to the living room. Children have access to the living room and family room. The off limits areas are all the four bedrooms, kitchen, the second bathroom, detached room, and backyard. The home was inspected inside and out for safety, clean and orderly, comfort, cleanliness, telephone service, heating and ventilation, inaccessibility to poisons, detergents/cleaning compounds (under kitchen sink with safety latch), medicines (upper kitchen cabinet) and hazardous items (sharp knives unreachable behind kitchen sink) that can pose a danger to children. LPA did not observe a fireplace in the home. Safe and age appropriate toys, play equipment and materials were observed. The smoke detector and carbon monoxide detector,Fire Extinguisher (2A10BC) are in operable condition. Per Licensee no one smokes in the home. Electrical outlets are inaccessible, no baby bouncers saucer chairs, or any recalled and or prohibited toys or sleep/ play equipment were observed on the premises. There is a designated area for ill children as necessary in family room. Per Licensee there are no weapon/firearms in the home. The facility sketch is complete and current, there is working telephone (cell and landline).
SUPERVISORS NAME: Mariela Ramon
LICENSING EVALUATOR NAME: Justeene Tamayo
LICENSING EVALUATOR SIGNATURE: DATE: 07/13/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/13/2022
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, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: RIVAS FAMILY CHILD CARE
FACILITY NUMBER: 197415541
VISIT DATE: 07/13/2022
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Fire/disaster drill is maintained current. Last fire/disaster drill was completed on 05/12/22. Roster complete and maintained current.

Bathroom: Shower/tub are free of hazards (child care bathroom). LPA did not observe any hazardous items in the children's bathroom. Toilet and faucet are clean and operable.

Kitchen: Sharp utensils, open bottles or alcohol are inaccessible. If food is brought from the children’s home, the container shall be labeled with the child’s name and properly stored or refrigerated. The home has a clean and fully stocked refrigerator/freezer. Cleaning supplies are in under the kitchen sink (with safety latch). Breakfast, lunch, snacks and dinner are provided. Per licensee she has a food program. Children nap on cots in the playroom area.

Outdoor: The front yard is safe for children. The front yard is completely fenced (with chain link fence and green privacy screen). There is no body of water. LPA observed age appropriate toys and play equipment. Per licensee, there are no pets on the premises.

Advisory/Other: First Aid kit was observed with supplies readily available. CPR/First Aid expired on 02/10/2020. Licensee and assistant #1 will retake their CPR and first aid class in person and send CPR card for proof of completion. Facility has been cited a Type B Citation. Please see LIC 809-D.

Mandated Reporter expired on 02/24/2020. Licensee and assistant #1 will retake their mandated reporter training and email LPA Tamayo for proof of completion. There are no window cords accessible to children.
SUPERVISORS NAME: Mariela Ramon
LICENSING EVALUATOR NAME: Justeene Tamayo
LICENSING EVALUATOR SIGNATURE:

DATE: 07/13/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/13/2022
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 07/14/2022 08:28 AM - It Cannot Be Edited


Created By: Justeene Tamayo On 07/13/2022 at 12:30 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
, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551

FACILITY NAME: RIVAS FAMILY CHILD CARE
FACILITY NUMBER: 197415541

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/13/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102416(c)
Personnel Requirements
(c) The licensee and other personnel as specified shall complete training on preventive health practices, including pediatric cardiopulmonary resuscitation and pediatric first aid, pursuant to Health and Safety Code Section 1596.866.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, interview, record review, the licensee did not comply with the section cited above. Licensee's CPR/First Aid expired on 02/10/2020, which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 08/20/2022
Plan of Correction
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Licensee and assistant #1 will retake their CPR/First Aid in person and email proof of completion to LPA Tamayo no later than 08/20/22.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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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:Mariela Ramon
LICENSING EVALUATOR NAME:Justeene Tamayo
LICENSING EVALUATOR SIGNATURE:
DATE: 07/13/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/13/2022


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, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: RIVAS FAMILY CHILD CARE
FACILITY NUMBER: 197415541
VISIT DATE: 07/13/2022
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Documents Provided and or Discussed: Fire Drill Log, Safe Sleep PIN 20-24-CCP and LIC9227 Individual Sleeping Plan. LPA Tamayo gave licensee a copy of the PIN 20-24-CCP, as well as a copy of the LIC 9227. Licensee stated currently has child care insurance.

Licensee Rivas 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 Rivas and discussed the Child Care Licensing Safe Sleep webpage at https://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.

A notice of site visit was given to licensee and must remain posted for 30 days.

Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

Exit interview conducted and report was reviewed with the licensee Rosa Rivas along with her appeal rights.

SUPERVISORS NAME: Mariela Ramon
LICENSING EVALUATOR NAME: Justeene Tamayo
LICENSING EVALUATOR SIGNATURE:

DATE: 07/13/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/13/2022
LIC809 (FAS) - (06/04)
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