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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198017895
Report Date: 05/04/2023
Date Signed: 05/04/2023 04:04:20 PM

Document Has Been Signed on 05/04/2023 04:04 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:ELIZARRARAZ FCCFACILITY NUMBER:
198017895
ADMINISTRATOR:MIROSLAVA & RIGOBERTO E.FACILITY TYPE:
810
ADDRESS:TELEPHONE:
(562) 929-7187
CITY:NORWALKSTATE: CAZIP CODE:
90650
CAPACITY: 14TOTAL ENROLLED CHILDREN: 9CENSUS: 4DATE:
05/04/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Licensees Miroslava and Rigoberto Elizarraraz TIME COMPLETED:
12:10 PM
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On 5/4/23 Licensing Program Analyst (LPA) Jeanette Estrada conducted an unannounced required 1 year inspection at the above facility. LPA met with the Licensees Miroslava Elizarraraz and Rigoberto Elizarraraz. LPA informed Licensees of the purpose for the visit and provided Licensees with a copy of the facility entrance checklist (LIC 126) All residents living in the home were discussed and noted. Facility provides care to children ages 3 months 13 years old. The facility is open Monday to Sunday 6AM to 6PM. During this inspection there were 4 children and the two Licensees present.
This is a one story, 4 bedroom, 2 bathroom home with a living room, kitchen, dining area, enclosed backyard, attached garage.
Per Licensee areas on limits to children are: Living room in passing, children's dining/activity area, one bedroom used as an activity room, one bathroom near the activity room, one bedroom used as a napping room and the enclosed backyard.
Per Licensee areas off limits to children are: Garage, two bedrooms, one bathroom and kitchen.
All areas that are accessible to children were inspected for safety, comfort, and cleanliness. The following was observed and reviewed during this inspection: LPA observed required posted documentation- Facility license, Publication (PUB) 394- Notification of Parent Rights. LPA observed a current facility roster LIC 9040 and a disaster drill log. Last documented drill was conducted on 4/13/23. There is an operable carbon monoxide detector and an operable smoke detector in the facility. LPA observed a 2A10BC Fire Extinguisher in the living room which indicated full and was last serviced in January 2023 per the service tag. 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 in the children's dining/activity area and in the activity room. One bedroom is open for napping for younger children. LPA observed two play yards in this room. At the moment, Licensees do not provide care for infants but younger children are transitioning out of the play yards.
SUPERVISORS NAME: Valarie Cook
LICENSING EVALUATOR NAME: Jeanette Estrada
LICENSING EVALUATOR SIGNATURE: DATE: 05/04/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/04/2023
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 CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME: ELIZARRARAZ FCC
FACILITY NUMBER: 198017895
VISIT DATE: 05/04/2023
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Sharp objects, detergents and cleaning compounds are inaccessible. Knives are kept in a latched kitchen cabinet, cleaning compounds and detergents are kept in the off limits garage. Personal medicine is kept in the off limit bedrooms and at the moment, there are no children enrolled who require medication. Heating and ventilation was evaluated. LPA observed an A/C wall unit in the day care activity room. LPA observed a barricaded wall heater in the living room.
The children use the restroom next to the day care activity room. LPA did not observe cleaning products or medicine in the restroom. Per Licensees, children use the backyard for outdoor play. LPA observed age appropriate toys for children in the backyard. Per Licensee, Children are supervised while playing outside. Per Licensees, poisons are kept in the off limits garage. There is no access from inside the home to the 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 in the napping room, separated from other children in care. Per Licensees, there are no firearms or weapons stored in the home. LPA did not observe any pools or spas, or other bodies of water. There are no pets in the home.
Infant Care: Currently licensees do not have infants enrolled. LPA discussed the following with Licensee: Napping equipment shall not block entrances or exits. There shall be no loose objects in the crib or hanging off the sides of the crib. Licensee was advised Infants shall not be swaddled in care. Car seats shall not be used for sleeping. LPA 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.
Overnight Care: There is no overnight care provided at the moment. LPA 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. Licensee was advised children's records shall contain (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
Staff records were reviewed: Both Licensees Pediatric CPR/First Aid issued by the American Red Cross was completed on 10/30/21. Licensee's (Rigoberto Elizarraz) Mandated Reporter training was last completed in 2018. Licensee (Miroslava Elizarraraz has not completed mandated reporter training. Both Licensees have proof of immunization to measles, pertussis and flu and have TB clearance.
SUPERVISORS NAME: Valarie Cook
LICENSING EVALUATOR NAME: Jeanette Estrada
LICENSING EVALUATOR SIGNATURE:

DATE: 05/04/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/04/2023
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 CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME: ELIZARRARAZ FCC
FACILITY NUMBER: 198017895
VISIT DATE: 05/04/2023
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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
During inspection the child present was observed to be treated with dignity and respect, they were observed to be receiving safe, healthful and comfortable accommodations, furnishings and equipment, and free from corporal and/or unusual punishment.
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.
Based on the LPA's observations and records review one type B citation will be cited today 5/4/23. Citation is regarding the incomplete Mandated Reporter training for both Licensees.
Exit interview conducted and report was reviewed with both Licensees. 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: 05/04/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/04/2023
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 05/04/2023 04:04 PM - It Cannot Be Edited


Created By: Jeanette Estrada On 05/04/2023 at 11:21 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 CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME: ELIZARRARAZ FCC
FACILITY NUMBER: 198017895

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/04/2023

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 Record Review and Interview, the licensees did not comply with the section cited above in 2 out of 2 files reviewed which did not contain a valid mandated reporter training certificate which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 06/05/2023
Plan of Correction
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Per Licensees, they will both complete the Mandated Reporter for child care providers training and submit copy of certificates to LPA via picture. LPA advised that training is available in Spanish.
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:Valarie Cook
LICENSING EVALUATOR NAME:Jeanette Estrada
LICENSING EVALUATOR SIGNATURE:
DATE: 05/04/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/04/2023


LIC809 (FAS) - (06/04)
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