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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197493588
Report Date: 06/21/2022
Date Signed: 06/21/2022 10:56:17 AM

Document Has Been Signed on 06/21/2022 10:56 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, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME:RIOS & ROBLES MESA FAMILY CHILD CAREFACILITY NUMBER:
197493588
ADMINISTRATOR:RIOS, J.& ROBLES MESA,J.FACILITY TYPE:
810
ADDRESS:TELEPHONE:
(818) 893-8502
CITY:PANORAMA CITYSTATE: CAZIP CODE:
91402
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 3DATE:
06/21/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
08:55 AM
MET WITH:Jennifer Rios and Jose Robles, LicenseesTIME COMPLETED:
11:20 AM
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On 06/21/22 Licensing Program Analyst (LPA) Silva Garibyan, conducted an unannounced Required - 1 Year Inspection and was met by Licensees, Jennifer Rios and Jose Robles. Days and hours of operation are Monday - Sunday 24 hours.

LPA toured the home inside and outside and a census was taken. Licensees were present with three children (including their 11 month old son). Current facility sketch was reviewed. Licensees' home is a single story, 2 bedroom, 1 bathroom home with a living/dining room, kitchen, laundry room, car port. Family members residing at facility are: 3 adults ( both applicants, and brother ) LPA observed a separate structure/home on the same address. Licensee's brother lives in the structure adjacent to the main home. All adults are finger printed, cleared and associated to the facility. There is no swimming pool or other bodies of water on the premises. There are no firearms or ammunition on the premises. Firearms and ammunition are stored and locked separately. All poisons are kept in a locked storage area. No poisons were observed during the inspection. Detergents, cleaning compounds, medication and other hazardous items are made inaccessible. There are no fireplaces or open face heaters in the home. There is a working fire extinguisher (3A 40 BC), smoke detector, carbon monoxide detector and adequate heating and ventilation for safety and comfort. There are no stairs in this home. LPA observed the fire drill log by the entry door. The fire drills are done twice a year. Page 1 of 3

SUPERVISORS NAME: Karren Starks
LICENSING EVALUATOR NAME: Silva Garibyan
LICENSING EVALUATOR SIGNATURE: DATE: 06/21/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/21/2022
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, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME: RIOS & ROBLES MESA FAMILY CHILD CARE
FACILITY NUMBER: 197493588
VISIT DATE: 06/21/2022
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Safe toys and play equipment are observed. The home has working telephone service and LPA confirmed the phone number is (818) 893-8502.

There are currently five infants enrolled. LPA discussed Safe Sleep Regulations with licensee. There are three cribs for each infant in care, cribs are kept free from all loose articles and objects while infants are sleeping, and there are no objects hanging above or attached to the crib. Infants are not swaddled while in care. Provider physically checks on sleeping infants every fifteen minutes and documents any signs of distress which includes but is not limited to flushed skin color, increase in body temperature, restlessness and labored breathing. Infants can be visually observed through an open door if sleeping in a separate room. Individual Infant Sleeping Plan is completed and in file for each infant up to 12 months of age. Infants up to 12 months of age are placed on their backs for sleeping.

Licensee ensures that children in care are supervised at all times and is aware children shall not be left in parked vehicles. Car seats are used for transportation purposes only and are not used for sleeping children. The backyard is used by children in care. There is chain link fence surrounding the area that children in care use. The backyard has a covered area with concrete for children to play in. There is also a composite grass area and age appropriate toys for children in care. Capacity as specified on the license is being maintained.

All adults who reside or work in the home have a criminal record clearance or exemption. There are no excluded individuals present at this home.

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SUPERVISORS NAME: Karren Starks
LICENSING EVALUATOR NAME: Silva Garibyan
LICENSING EVALUATOR SIGNATURE:

DATE: 06/21/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/21/2022
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, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME: RIOS & ROBLES MESA FAMILY CHILD CARE
FACILITY NUMBER: 197493588
VISIT DATE: 06/21/2022
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LPA reviewed a sample of children’s files and observed files were complete with emergency information as required. Licensees' Mandated Reporter Training was completed on 03/30/2021. Licensees' pediatric CPR/First Aid expires on 06/17/23. A review of records indicates that licensees have immunization records on file for influenza, pertussis and measles.

Incidental Medical Services (IMS) are / are not currently being provided. Licensee is aware that an IMS plan is required to be submitted to the licensing office if they provide any of these services. Information regarding Americans with Disability Act (ADA) can be obtained by contacting US Department of Justice toll free ADA Information line at (800) 514-0301(voice), (800) 514-0383 (TDD) and website link https://www.ada.gov/childqanda.htm.



LPA and Licensee discussed the Community Care Licensing website www.ccld.ca.gov which will provide access to Provider Information Notices (PINs), Quarterly Updates, COVID-19 Information and Resources, Mandated Reporter Training, Safe Sleep in Child Care, Lead Poisoning Facts, Forms and Regulations.

Per Title 22, Division 12, Chapter 3, of the California Code of Regulations, no deficiencies are cited.

This report shall be made available to the public upon request. LIC 9213 Notice of Site Visit is provided and required to be posted for 30 days.

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SUPERVISORS NAME: Karren Starks
LICENSING EVALUATOR NAME: Silva Garibyan
LICENSING EVALUATOR SIGNATURE:

DATE: 06/21/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/21/2022
LIC809 (FAS) - (06/04)
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