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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198014085
Report Date: 06/27/2024
Date Signed: 06/27/2024 05:03:06 PM

Document Has Been Signed on 06/27/2024 05:03 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
MONTEREY PARK SW RO, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME:CAZARES FAMILY CHILD CAREFACILITY NUMBER:
198014085
ADMINISTRATOR/
DIRECTOR:		CAZARES, KAREYFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(562) 303-3301
CITY:LAKEWOODSTATE: CAZIP CODE:
90712
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 10DATE:
06/27/2024
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
02:40 PM
MET WITH:Licensee Karey CazaresTIME VISIT/
INSPECTION COMPLETED:
05:10 PM
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On June 27,2024 at 02:40PM, Licensing Program Analysts (LPAs) Jonnisha Culbert and Jeanette Estrada conducted an unannounced inspection at the facility noted above and met with Licensee, Karey Cazares. The purpose of the visit was to conduct an Annual/Required inspection. The operating hours of the facility is Monday through Friday from 7:00 AM to 6:00 PM. Entrance Checklist (LIC 126) was provided to the Licensee upon arrival. Individuals residing in the home were discussed and noted. At the time of the inspection, the Licensee, Licensee's Husband/Assistant, and ten (10) children were present.

All areas on limits to children was inspected. This facility is a two-story home that consists of four (4) bedrooms, two (2) bathrooms, living room, dining area, kitchen, detached rumpus room (day care room), detached garage, and fenced backyard.

Areas that are accessible to children include: Two (2) bedrooms, 2 bathrooms, living room, dining area, kitchen, detached rumpus room (day care room), and fenced backyard. Per Licensee, the children utilize the fenced backyard for outdoor activity.

Areas off-limits to children include: Two (2) bedroom and detached garage. LPAs observed the door to the stairs and upstairs area were closed and locked, making the stairs and off-limit bedroom inaccessible to children in care. Licensee was advised that off-limit areas must be made inaccessible during operating hours or while children in care are present.

The following documents were posted in a prominent, publicly accessible area: Facility License, Notification of Parents' Rights (PUB 394), and Earthquake Preparedness (LIC 9148). Licensee has an Emergency Disaster Plan (LIC 610A) and Facility Roster (LIC 9040) available for review. Licensee has verification of Disaster and Fire Drills available for review. The last drill was conducted on June 24, 2024.
SUPERVISORS NAME: Valarie Cook
LICENSING EVALUATOR NAME: Jonnisha Culbert
LICENSING EVALUATOR SIGNATURE: DATE: 06/27/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/27/2024
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 5
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MONTEREY PARK SW RO, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME: CAZARES FAMILY CHILD CARE
FACILITY NUMBER: 198014085
VISIT DATE: 06/27/2024
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Areas used by children were inspected for safety, comfort, heating, cleanliness and telephone service. The home has floor heaters and a screened fireplace located in the living room. Detergents, cleaning compounds and medicines were made inaccessible to children. Per Licensee, there are no poisons kept in the home. Licensee was advised that if any poisons are purchased, it is required to be locked with a key or combination lock. The home has 2 cats and 1 dog. Per Licensee, there are no bodies of water, firearms and/or weapons on the premises. LPAs observed age appropriate toys and napping equipment for children. LPAs also observed electrical outlet covers installed in the child care areas.

LPAs observed the required fire extinguisher (3-A:40-B:C) that is fully charged and was purchased on 09/16/2023. Licensee was reminded to have the fire extinguisher serviced yearly. Smoke detector and carbon monoxide detector were tested and are operable. Per Licensee, breakfast, lunch, and PM snack is provided. Licensee was reminded that food that is brought from the child's home shall be labeled with the child’s name and properly stored or refrigerated.

LPAs conducted a record review of three (3) children's records, Licensee's record, and the Licensee's Husband/Assistant's record. Based on the record reviews, children's records have all of the required documents per licensing regulations.

Based on Licensee and Licensee's husband/Assistant record review, the Licensee and Assistant has proof of immunization against measles, pertussis, influenza, and a TB clearance. Licensee and Assistant has a current Pediatric First Aid and CPR certification (expires 09/18/2024), but it was not issued by Red Cross or American Heart Association, or Emergency Medical Services Authority (EMSA) approved. LPAs advised Licensee to provided completion certificate from one of the qualified departments. Licensee and Licensee's Assistant completed Mandated Reporter Training (AB 1207) and it expires 09/20/2025. Licensee was advised that the Mandated Reporter training (AB 1207) must be completed every 2 years and is available at www.mandatedreporterca.com.

SUPERVISORS NAME: Valarie Cook
LICENSING EVALUATOR NAME: Jonnisha Culbert
LICENSING EVALUATOR SIGNATURE:

DATE: 06/27/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/27/2024
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
MONTEREY PARK SW RO, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME: CAZARES FAMILY CHILD CARE
FACILITY NUMBER: 198014085
VISIT DATE: 06/27/2024
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To improve the quality and value of the new inspection process, a survey may 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 CARE tools, please send email inquiries 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/inspection-process.

Licensee was reminded that all adults 18 and over living or working in the home, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, 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 for a maximum of 5 days or, if the penalty is for a repeat violation, for a maximum of 30 days per person will be assessed if this regulation is violated.
LPAs discussed the safe sleep regulations with licensee and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-andresources/safe-sleep as an additional resource. LPAs 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.

Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02- CCP. 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: https://www.ada.gov/resources/child-care-centers/.

Licensee was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain child care by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.
SUPERVISORS NAME: Valarie Cook
LICENSING EVALUATOR NAME: Jonnisha Culbert
LICENSING EVALUATOR SIGNATURE:

DATE: 06/27/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/27/2024
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
MONTEREY PARK SW RO, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME: CAZARES FAMILY CHILD CARE
FACILITY NUMBER: 198014085
VISIT DATE: 06/27/2024
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During the exit interview, Karey Cazares, confirmed that there are no Registered Sex Offenders living in the facility and LPAs completed the RSO profile in FAS.

No deficiencies were cited during today's inspection.

A Notice of Site Visit (LIC 9213) was given and must remain posted for 30 days.

Exit interview conducted and report was reviewed with Licensee, Karey Cazares.
SUPERVISORS NAME: Valarie Cook
LICENSING EVALUATOR NAME: Jonnisha Culbert
LICENSING EVALUATOR SIGNATURE:

DATE: 06/27/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/27/2024
LIC809 (FAS) - (06/04)
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