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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198020316
Report Date: 06/15/2021
Date Signed: 06/15/2021 06:23:27 PM

Document Has Been Signed on 06/15/2021 06:23 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:FLORES FAMILY CHILD CAREFACILITY NUMBER:
198020316
ADMINISTRATOR:CYNTHIA FLORESFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(562) 347-0133
CITY:WHITTIERSTATE: CAZIP CODE:
90604
CAPACITY: 14TOTAL ENROLLED CHILDREN: 0CENSUS: 13DATE:
06/15/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
02:29 PM
MET WITH:Licensee, Cynthia FloresTIME COMPLETED:
06:45 PM
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On 06/15/2021 at 02:29 pm, Licensing Program Analyst (LPA) Jose Guzman conducted an unannounced annual inspection. A risk assessment was conducted prior to entering the facility. LPA met with Licensee Cynthia Flores during today’s inspection. The Licensee's two assistant were also present. There were 13 children present, 2 being infants. Licensee states that there are currently 15 children enrolled. The children's roster was reviewed and is current. Disaster drill log was also available during today’s inspection.
This is a two-story home which consists of 4 bedrooms and 3 bathrooms. Areas used by the children include the living room (day care room), bathroom in the den area, kitchen, dining room, den area (day care room), pool area side yard (fenced) and front yard (not fenced). LPA observed the front yard and it is not fenced. Licensee was advised to have 100% supervision when the children are playing in the front yard. Per Licensee, areas off limits to children and parents include Upstairs: 2 bedrooms and 1 bathroom. Downstairs: 2 bedrooms, 1 bathroom, and detached garage.

Areas accessible to children were inspected to ensure that they are clean and orderly with ventilation and heating for the safety of the children. Licensee states that gas to wall heater was shut off by the gas company, therefore not screened. LPA observed a fireplace in the den area that is screened. Family members residing in the home are 4 adults (criminal record clearances on file). There is a working telephone maintained in the home. Stairs to the upstairs bedrooms were barricaded. There is a pet in the home. Detergents, cleaning compounds, medications, and other items which can pose a danger to children were accessible. Poisons that need to be locked were accessible to children. At 2:50 pm, LPA observed a Raid Ant and Roach Killer on top of a child’s seat. LPA also observed an accessible container of Clorox Bleach in the bathroom cabinet that does not have a lock, a Kingsford charcoal lighter fluid, and two unopen bottles of Modelo alcohol. LPA advised that the items be removed and out of reach to children in care since they pose a health and safety risk to children in care. The licensee does understand that poison must be locked with a key or combination lock.
Report continues- Page 1 of 3
SUPERVISORS NAME: Ana Chico
LICENSING EVALUATOR NAME: Jose Guzman
LICENSING EVALUATOR SIGNATURE: DATE: 06/15/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/15/2021
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: FLORES FAMILY CHILD CARE
FACILITY NUMBER: 198020316
VISIT DATE: 06/15/2021
NARRATIVE
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Per licensee, there are no weapons or firearms. There is a body of water on the premises. LPA observed a pool in the backyard. The pool area has a gate to enter and is right outside the back door in the den area. The gate measures 5’11” and is metal. There is a second mesh gate that surrounds to pool measuring 5’. There are safe toys, play equipment and materials observed for children. Emergency Disaster Plan was posted at the time of inspection. The valve on the required 2A 10BC fire extinguisher indicates fully charged serviced 06/15/2021. Smoke detector in the kitchen and carbon monoxide detector in the hallway were tested and are in operable condition. The Licensee and both assistants have current Pediatric First Aid and CPR, which will expire 12/2022.
Children’s and staff records will be reviewed at a later time.

Rooms that are off-limits need to be made inaccessible during operating hours. No smoking, No infant walkers, No Johnny jumpers, No saucer chairs, No trampolines and any other item that falls into that category are not permitted in the facility. Effective January 1, 2010, licensees of family child care homes are required to ensure that at least one staff member with current training in pediatric first aid and pediatric CPR is on site at all times when children are present.

Mandatory Forms for the children’s files and staff files, requirements for fire drills, earthquake drills and documentation were discussed. Role and responsibilities of being a Mandated Reporter were reviewed. The Licensee was advised how to access forms and Regulations online at www.ccld.ca.gov. Licensee was made aware that it is her responsibility to know the regulations as well as anyone who assists in providing care.

The Licensee was advised that inaccessibility of hazards must be constantly reassessed depending on the children in care. At 2:40 pm, LPA observed an infant sleeping in crib with a pillow, blanket, and toys. A screw holding the crib’s side rail is missing (photos captured). Sudden Infant Death Syndrome (SIDS) and Never-Shake-a-Baby were discussed. A hard copy of A Child Care Provider’s Guide to Safe Sleep was provided. LIC 9227 (Individual Sleeping Plan) for infants up to 12 months was explained and issued to the Licensee. Title 22 Regulation Section 102425(j) Infant Safe Sleep was discussed with the Licensee, including but not limited to documentation that shall be maintained. Licensee was advised that infants shall not be swaddled while in care and all infants up to 12 months should be placed on their back for sleeping.
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SUPERVISORS NAME: Ana Chico
LICENSING EVALUATOR NAME: Jose Guzman
LICENSING EVALUATOR SIGNATURE:

DATE: 06/15/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/15/2021
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: FLORES FAMILY CHILD CARE
FACILITY NUMBER: 198020316
VISIT DATE: 06/15/2021
NARRATIVE
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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
The following was discussed:
· 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 a 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.
· The Licensee shall be present in the home and shall ensure that children are supervised at all times.
· Children shall not be left in park vehicles.
· The capacity specified on the license shall be the maximum number of children for whom care can be provided. · Car seats shall only be used for transportation purposes and shall not be used for sleeping.
· All children in care have the right to receive safe, healthful, and comfortable accommodations, furnishings and equipment.
· When a child shows signs off illness, they will be separated until the nature if the illness is determined.
Upon receipt of this report, the licensee shall post ANY licensing report documenting a type “A” citation. This must remain posted for 30 days during hours of operation. In addition to posting this report, the licensee will also provide copies to the parents of the children in care for up to one year.
A copy of the LIC 9224 - Acknowledgement of Receipt of Licensing Reports was provided.
The Notice of Site Visit (LIC 9213) – must remain posted for 30 days during the hours of operation after each site visit by a licensing representative. Failure to maintain posting as required will result in a civil penalty of $100.00.
The deficiencies listed on the following pages were observed by the LPA and are being cited in accordance with California Code of Regulations Title 22 and/or the Health and Safety Code. Please see attached LIC 809d.
Deficiencies that are being cited need to be cleared to protect the children’s health & safety.
Exit interview was conducted with Licensee. The Licensee was provided a copy of their appeal rights (LIC 9058) and their signature on this form acknowledges receipt of these forms. Page 3 of 3
SUPERVISORS NAME: Ana Chico
LICENSING EVALUATOR NAME: Jose Guzman
LICENSING EVALUATOR SIGNATURE:

DATE: 06/15/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/15/2021
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 06/15/2021 06:23 PM - It Cannot Be Edited


Created By: Jose Guzman On 06/15/2021 at 05:00 PM
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: FLORES FAMILY CHILD CARE
FACILITY NUMBER: 198020316

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/15/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
06/16/2021
Section Cited
CCR
102417

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The home shall be free from defects or conditions which might endanger a child. Safety precautions shall include...: Poisons, detergents, cleaning compounds,... which could pose a danger... shall be stored where they are inaccessible to children. This requirement is not met as evidenced by
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The items were immediately removed by the Licensee and stored in the locked room. The Licensee will provide a declaration with the understanding that chemicals posing a danger to children must be locked with a key or combination lock and will be submitted by POC due date of 06/16/21.
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Based on observation and interview the Licensee did not ensure that Raid Ant & Roach Killer, a container of Clorox bleach, and two unopened bottles of Modelo alcohol were accessible to children which posses an immediate health & safety risk to children in care.
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Type A
06/16/2021
Section Cited
CCR102425(b)

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INFANT SAFE SLEEP: Cribs or play yards shall be free from all loose articles and objects.
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Items not allowed in the crib were immediately removed by the Licensee. The Licensee removed the incomplete crib. Per Licensee, if crib cannot be repaired, the crib will be removed. Licensee will be submit proof of repair by POC due date of 06/16/21.
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Based on observation and interview the Licensee did not ensure the crib being free from a blanket, pillow, and toys which posses an immediate health & safety risk to 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:Ana Chico
LICENSING EVALUATOR NAME:Jose Guzman
LICENSING EVALUATOR SIGNATURE:
DATE: 06/15/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/15/2021


LIC809 (FAS) - (06/04)
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