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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198019362
Report Date: 02/06/2025
Date Signed: 02/07/2025 02:07:01 PM

Document Has Been Signed on 02/07/2025 02:07 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:JIMENEZ FAMILY CHILD CAREFACILITY NUMBER:
198019362
ADMINISTRATOR/
DIRECTOR:		ADRIANA JIMENEZFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(562) 704-5820
CITY:NORWALKSTATE: CAZIP CODE:
90650
CAPACITY: 14TOTAL ENROLLED CHILDREN: 12CENSUS: 0DATE:
02/06/2025
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:45 PM
MET WITH:Adriana JimenezTIME VISIT/
INSPECTION COMPLETED:
04:15 PM
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On February 6, 2025, at 1:45pm Licensing Program Analyst (LPA) A. Carter conducted an Unannounced Annual Random inspection and met with licensee Adriana Jimenez. LPA disclosed the purpose of the inspection and was granted entry into the facility. Licensee was provided a copy of the Facility Entrance Checklist.
All adults associated to the home were found to have criminal record clearance. There were zero (0) daycare children present during today’s inspection. Licensee states that there are currently twelve (12) children enrolled. The children's roster was reviewed and is current. Licensee provides care to children ranging in ages from newborn to 11 years old. Licensee reports the facility’s hours of operation are Monday through Friday from 6:00am to 11:00pm. Licensee does not provide overnight care but does provide transportation.
This is a single story home which consists of three (3) bedrooms, two (2) bathrooms, kitchen, living room, and attached garage. Areas used by the children include the living room, hallway bathroom, two (2) bedrooms one used as the playroom and the other used for napping. The kitchen is used in passing. Per Licensee, areas off-limits include master bedroom and bathroom, and attached garage. The licensee does understand that licensing staff may have access to off-limit areas during inspection visit if necessary. LPA observed that there is a safety gate separating areas used by children and off-limits area. Per licensee, off limit areas doors are closed during operating hours, observed by LPA.
All areas identified on the facility sketch as accessible to children were inspected to ensure that they are clean and orderly with ventilation and heating for the safety and comfort of the children.
LPA observed required posted documentation in the playroom which included: Facility License, Publication (PUB) 394- Notification of Parent Rights and Licensing Form (LIC) 9148- Earthquake Preparedness form. LPA observed Disaster drill log, last drill conducted on 09/15/2024. Smoke and carbon monoxide detector located in the hallway were tested and are operable at the time of inspection. LPA observed the AB10BC fire extinguisher with last date of August 23, 2024. The facility has central air and heating and maintains telephone service cell phone.
Report continues- Page 1 of 4
SUPERVISORS NAME: Denise Gibbs
LICENSING EVALUATOR NAME: Andrea Carter
LICENSING EVALUATOR SIGNATURE: DATE: 02/06/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/06/2025
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 4
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: JIMENEZ FAMILY CHILD CARE
FACILITY NUMBER: 198019362
VISIT DATE: 02/06/2025
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LPA observed age appropriate toys and learning material available such as charts, circle time area, toddler size tables and chairs, books for reading, blocks, and a play kitchen free of loose and sharp parts. There is a screened electric fireplace in the living room. Sharp objects, detergents and cleaning compounds were inaccessible. Knives are stored in the upper kitchen cabinet. Medicine is stored in the hallway cabinet secure by a safety latch. Cleaning compounds are stored in a latched cabinet under the sink. Detergents are kept in the outside laundry shed inaccessible to children. The Licensee states that there are no poisons in the home. The Licensee does understand that poison must be locked. The Licensee was advised that inaccessibility of hazards must be constantly reassessed depending on the children in care. The isolation area for sick children waiting to be picked is one of the bedrooms, supervised away from the other children in care. Per licensee, food is provided for children in care. LPA reminded licensee that any food brought from the children’s homes shall be labeled with child’s name and properly stored or refrigerated.
The children will have access to the backyard for outside play. LPA observed age appropriate toys such as scooters, a play structure with a slide, climbing structure, and caterpillar crawl tunnel. Play area is completely covered with a tent providing ample shading for children in care. The is an above ground pool and locked laundry shed in the backyard inaccessible to children. The pool is surrounded by a 5 foot fence which does not obscure the view of the pool and has a gate that swings away from the pool and has a self- latching device. The gate to the pool is kept locked and you need a key to access. PIN 25-01 was provided by LPA to licensee to review new pool safety requirements. LPA observed yard has grass and adequate perimeter fencing through-out the property. Play area is free of loose and sharp articles or objects and all trees, shrubs, and plants are maintained.

Infant Care: Currently licensee has one (1) infant under 24 months enrolled. LPA observed the play yard used for the enrolled infant. LPA discussed the following with Licensee: Napping equipment does not block entrances or exits. There shall be no loose objects in the crib / play yard or objects hanging off the sides of the crib / play yard. Infants shall not be swaddled in care. Car seats shall only be used for transportation purposes and 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. Report continues- Page 2 of 4
SUPERVISORS NAME: Denise Gibbs
LICENSING EVALUATOR NAME: Andrea Carter
LICENSING EVALUATOR SIGNATURE:

DATE: 02/06/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/06/2025
LIC809 (FAS) - (06/04)
Page: 2 of 4
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: JIMENEZ FAMILY CHILD CARE
FACILITY NUMBER: 198019362
VISIT DATE: 02/06/2025
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Children’s records were not reviewed. There were no enrolled children at time of inspection. LPA advised license that all children files shall include (LIC) 282- Affidavit Regarding Liability Insurance, Immunization's Records, LIC 700- Identification and Emergency Information, LIC 627- Consent for Medical Treatment, LIC 995A Notification of Parents’ Rights, and documentation of 15-minute Infant Sleep Check (0-24 months).

Licensee's Pediatric CPR / First Aid is valid until: 03/23/26.
Mandated Reporter training completed on: 05/05/23 valid for 2 years. Licensee had required Immunization records and proof of TB clearance on file.
· Licensee stated they do not have any children that needs medication administer, or any children with allergies in care at this time.
· Licensee stated that there are no smokers in the home.
· Licensee stated there are no pets in the home. LPA did not observe any pets at time of inspection.
· Licensee stated there are no weapons, or firearms in the home.

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.

LPA 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-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. Report continues- Page 3 of 4

SUPERVISORS NAME: Denise Gibbs
LICENSING EVALUATOR NAME: Andrea Carter
LICENSING EVALUATOR SIGNATURE:

DATE: 02/06/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/06/2025
LIC809 (FAS) - (06/04)
Page: 3 of 4
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: JIMENEZ FAMILY CHILD CARE
FACILITY NUMBER: 198019362
VISIT DATE: 02/06/2025
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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 childcare by connecting them to childcare providers and Resource and Referral Agencies (R&Rs) throughout California.

During the exit interview, the LICENSEE Adriana Jimenez, confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS.

There are no deficiencies cited today, February 6, 2025, in accordance with California Title 22 Regulations.

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

Exit interview conducted and report was reviewed with the licensee Adriana Jimenez.

Appeal Rights given.

Report ends- Page 4 of 4

SUPERVISORS NAME: Denise Gibbs
LICENSING EVALUATOR NAME: Andrea Carter
LICENSING EVALUATOR SIGNATURE:

DATE: 02/06/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/06/2025
LIC809 (FAS) - (06/04)
Page: 4 of 4