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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198009364
Report Date: 08/19/2021
Date Signed: 08/19/2021 12:19:41 PM

Document Has Been Signed on 08/19/2021 12:19 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 CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME:ROBLES FAMILY CHILD CAREFACILITY NUMBER:
198009364
ADMINISTRATOR:ROBLES, M. & C.FACILITY TYPE:
810
ADDRESS:TELEPHONE:
(562) 222-1068
CITY:PICO RIVERASTATE: CAZIP CODE:
90660
CAPACITY: 14TOTAL ENROLLED CHILDREN: 0CENSUS: 10DATE:
08/19/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:40 AM
MET WITH:Maria Robles, Licensee TIME COMPLETED:
12:30 PM
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At 9:40 am Licensing Program Analysts (LPA) Roxana Lopez conducted an unannounced required 1 year inspection to the above facility. Prior to entry LPA conducted a risk assessment, appropriate PPE was used. LPA met with Maria Robles, Licensee who guided analysts on a tour of the facility. Also present during this inspection, was Marlyn Robles and Carlos Robles, Licensee’s Assistants. Per Licensee, there are 10 children that are currently enrolled. A current children’s roster was available for review. There were 10 children present two being infants upon arrival.

The licensee states that 4 adults and 1 child currently live in the home. Per Licensee, she currently has two assistants. All adults present in the home have obtained a criminal record clearance or exemption prior to working, residing or volunteering in the licensed child care home. Licensee states that there are no firearms stored in the home.

This is a two story home which consists of 5 bedrooms, 3 bathrooms, kitchen, living room, recreation room, garage front yard and backyard (fenced). The children have access to 1 bathroom, 1 bedroom, living room, kitchen area, recreation room and backyard for play. Per licensee, areas off limits to children and parents include: entire second floor, front yard and garage. Areas inaccessible were observed to be locked, Where children less than five years old are in care, stairs are fenced or barricaded. There is a child safety gate which keeps stairs inaccessible to children. LPA observed that there is a fireplace in the living room and is barricaded.
All areas identified on the facility sketch that are accessible for children to use were inspected for safety, comfort, and cleanliness. There is telephone service via a landline that is used during daycare hours. There is ventilation and heating (central). The following was observed and reviewed during this inspection.
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SUPERVISORS NAME: Brandi VanOosten
LICENSING EVALUATOR NAME: Roxana Lopez
LICENSING EVALUATOR SIGNATURE: DATE: 08/19/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/19/2021
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, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME: ROBLES FAMILY CHILD CARE
FACILITY NUMBER: 198009364
VISIT DATE: 08/19/2021
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Detergents, cleaning compounds, medications, and other items which could pose a danger to children were not observed to be inaccessible to children. Poisons are locked in the garage which was observed to be locked with a security know. The restroom that children use was observed to be safe and sanitary.

The valve on the required 2A 10BC fire extinguisher indicates fully charged and was serviced on 06/25/2021, as indicated on service tag. Smoke and carbon monoxide detectors were tested and are operable. All homes shall conduct fire and disaster drills at least once every six months, and document the date and time of each drill. Last drill documented was conducted on 07/15/2021.

Emergency Disaster Plan, Parent’s Rights Poster and the Facility License were observed to be posted in the day care room.

The home is observed to be clean and orderly. There are toys available for children. Appropriate sleeping arrangements in forms of cots, one crib and 1 playpen were observed.

Licensee states that she is currently caring for infants. LPA advised the licensee about the sleeping regulation and provided the LIC 9227 Individual sleeping plan. Licensee states that infants sleep in the dinning room and living room area.

LPA did not observe the following items during the inspection: Infant Walkers, Johnny Jumpers, Saucer Chairs, Trampolines and/or any other item that fall into these categories are not permitted in a family child care facility.

Smoking is prohibited in a licensed Family Child Care Home. Per Licensee, no one smokes in the home.

Currently, children are using the back yard for outdoor play time. The outdoor play area was observed to be fenced. LPA observed that the outdoor yard has toys and other materials for children to play with.

There is one cat in the premises, Per licensee the cat remains in the garage during operating hours.

The licensee is observed to be operating within the license capacity limitations.
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SUPERVISORS NAME: Brandi VanOosten
LICENSING EVALUATOR NAME: Roxana Lopez
LICENSING EVALUATOR SIGNATURE:

DATE: 08/19/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/19/2021
LIC809 (FAS) - (06/04)
Page: 2 of 5
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 CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME: ROBLES FAMILY CHILD CARE
FACILITY NUMBER: 198009364
VISIT DATE: 08/19/2021
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At 10:45 am children’s records were reviewed, including emergency information and were observed to be complete. LPA observed that Child # 6 and Child # 7 were missing proof of immunizations and Child # 9 and Child # 10 were missing complete files. LPA issued a Confidential Names List (LIC 811) to the licensee which documents staff and children’s files reviewed during this inspection.

The licensee and other personnel have completed training on preventive health practices including Pediatric First Aid and CPR. The licensee’s and assistants CPR expires on 6/2023. There are first aid supplies available.

The licensee and her assistant do have proof of immunization against influenza, pertussis, and measles.

Mandated Reporter AB 1207 compliant Child Care Training Certificate is on file for Licensee and Marlyn Robles assistant.

Incidental Medical Services (IMS):
The licensee states that she will provide IMS. Per licensee, there are no children enrolled that require IMS at this time. 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.

LPA advised the licensee to access forms, regulations and quarterly updates on line at: www.ccld.ca.gov.

The following was discussed with the Licensee: Individuals who are 18 years of age or older living in the home must obtain a criminal record clearance. Individuals within one month of their 18th birthday must be fingerprinted immediately. Failure to obtain criminal record background check clearances prior to initial presence in the home will result in an immediate $100.00 dollar or more per day Civil Penalty.

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SUPERVISORS NAME: Brandi VanOosten
LICENSING EVALUATOR NAME: Roxana Lopez
LICENSING EVALUATOR SIGNATURE:

DATE: 08/19/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/19/2021
LIC809 (FAS) - (06/04)
Page: 3 of 5
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 CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME: ROBLES FAMILY CHILD CARE
FACILITY NUMBER: 198009364
VISIT DATE: 08/19/2021
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In the absence of the Licensee, a qualified adult must be present supervising the children; a qualified adult is an individual who has a valid and current adult/infant CPR & Pediatric First Aid certification and a valid criminal record clearance associated to the facility license.

LPA consulted with Licensee regarding COVID-19 health and safety guidelines on this date, a RAST inspection was conducted on 8/10/2020. LPA observed COVID- 19 postings posted in the day care on this date.

During this inspection LPA discussed Social and Physical Distancing Guidance And Healthy Practices For Child Care Facilities In Response To The Global Coronavirus (COVID-19) Pandemic Written In Collaboration With The California Department Of Education.



Based on the LPA’s observations and records review, the following deficiencies listed on the attached LIC 809D (deficiency page) are being cited in accordance with California Code of Regulations Title 22. Deficiencies that are being cited need to be cleared to protect the children’s health & safety.

The Notice of Site Visit (LIC 9213) – must remain posted for 30 days during the hours of operation after each site visit made by a licensing representative. Failure to maintain posting as required will result in a civil penalty of $100.00.

Exit interview was conducted with Maria Robles, Licensee including, but not limited to Provider Rights, Appeal Procedures and Agencies Consultative Role and their signature on this form acknowledges receipt of these forms.

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SUPERVISORS NAME: Brandi VanOosten
LICENSING EVALUATOR NAME: Roxana Lopez
LICENSING EVALUATOR SIGNATURE:

DATE: 08/19/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/19/2021
LIC809 (FAS) - (06/04)
Page: 4 of 5
Document Has Been Signed on 08/19/2021 12:19 PM - It Cannot Be Edited


Created By: Roxana Lopez On 08/19/2021 at 11:32 AM
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 CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME: ROBLES FAMILY CHILD CARE
FACILITY NUMBER: 198009364

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/19/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
09/02/2021
Section Cited
CCR
102421(b)

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102421 Child's Records- (b) The licensee shall maintain, in each child's record, a copy of the emergency information card as required in Section 102417(g)(7). This requirement was not met as evidenced by:
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Per Licensee, She will have parents sign all required paper work andwill submit proof of completed file to LPA Lopez via email by POC due date.
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Based on LPA's documentation review and interviews Child #9 & Child #10 are missing emergency information. This poses a potential risk for the health and safety of children in care.
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Type B
09/02/2021
Section Cited
CCR1012418(a)

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102418 Immunizations (a) Prior to admission to a family day care home, children shall be immunized against diseases as required by the California Code of Regulations, Title 17, beginning with Section 6000. This requirement was not met as evidenced by:
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Per Licensee, She will ask parents for proof of immunization and will submit proof of immunizations to LPA Lopez via email by POC due date.
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Based on LPA's documentation review and interviews Child #6 & Child #7 do not have proof of immunizations. This poses a potential risk for the health and safety of children in care.
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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:Brandi VanOosten
LICENSING EVALUATOR NAME:Roxana Lopez
LICENSING EVALUATOR SIGNATURE:
DATE: 08/19/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/19/2021


LIC809 (FAS) - (06/04)
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