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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198020326
Report Date: 09/14/2023
Date Signed: 09/14/2023 03:08:47 PM

Document Has Been Signed on 09/14/2023 03:08 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:CANCHOLA & GUILLEN FAMILY CHILD CAREFACILITY NUMBER:
198020326
ADMINISTRATOR:J CANCHOLA & G. GUILLENFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(909) 802-6239
CITY:PICO RIVERASTATE: CAZIP CODE:
90660
CAPACITY: 14TOTAL ENROLLED CHILDREN: 32CENSUS: 3DATE:
09/14/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Licensee, Gerardo GuillenTIME COMPLETED:
03:15 PM
NARRATIVE
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At 1:00 pm Licensing Program Analysts (LPAs) Roxana Lopez and Shushanik Safaryan conducted an unannounced required 1 year inspection to the above facility. A COVID risk assessment was conducted upon entry. LPA met with Gerardo Guillen, Licensee who guided analysts on a tour of the facility. Per Licensee, there are 32 children that are currently enrolled. A current children’s roster was available for review. There were 3 children present upon arrival- 3 being infants. Also present were 2 assistants.

The licensee states that 2 adults and 6 children currently live in the home. Per Licensee, they currently have 2 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 weapons stored in the home.

This is a two story home which consists of 4 bedrooms, 2.5 bathrooms, living room, dining room, family room, kitchen, garage and backyard (fenced). The children have access to living room, dining room, family room, kitchen, the restroom located on the first floor near the living room and backyard fenced.

Per licensee, areas off limits to children and parents include entire second floor, 4 bedrooms, 2 bathrooms and garage. The LPA toured all areas used by children during this visit. LPA observed a baby gate at the bottom and at the top of the stairs making second floor inaccessible.

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SUPERVISORS NAME: Brandi VanOosten
LICENSING EVALUATOR NAME: Roxana Lopez
LICENSING EVALUATOR SIGNATURE: DATE: 09/14/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/14/2023
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 6
Document Has Been Signed on 09/14/2023 03:08 PM - It Cannot Be Edited


Created By: Roxana Lopez On 09/14/2023 at 02:27 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: CANCHOLA & GUILLEN FAMILY CHILD CARE
FACILITY NUMBER: 198020326

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/14/2023

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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2
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4
Based on record review, the licensee did not comply with the section cited above in that staff # 4 is missing current mandated reportedr training certificate which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 10/14/2023
Plan of Correction
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4
Per Licensee, they will have staff # 4 complete training and they will submit copy of current certificate by poc due date of 10/14/2023.
Type B
Section Cited
CCR
102417(g)(7)
An emergency information card shall be maintained for each child and shall include the child's full name, telephone number and location of a parent or other responsible adult to be contacted in an emergency, the name and telephone number of the child's physician and the parent's authorization for the licensee or registrant to consent to emergency medical care.

This requirement is not met as evidenced by:
Deficient Practice Statement
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2
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4
Based on record review, the licensee did not comply with the section cited above in that child # 1,2 and 4 are missing the LIC 627 consent of medical treatment on file which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 09/22/2023
Plan of Correction
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Per Licensee, they will provide form to parents and submit copies to LPA by POC due date of 9/22/2023
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: 09/14/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/14/2023


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 CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME: CANCHOLA & GUILLEN FAMILY CHILD CARE
FACILITY NUMBER: 198020326
VISIT DATE: 09/14/2023
NARRATIVE
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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 and a cellphone that stays at the facility during operation hours. There is ventilation and heating (central). The following was observed and reviewed during this inspection.

Detergents, cleaning compounds, and medications were observed to be inaccessible to children. Poisons are locked in a high cabinet above the refrigerator in the kitchen. The restroom that children use was observed to be safe and sanitary.

LPA Lopez did observed a fireplace in the family room which was barricaded and inaccessible for children in care. The valve on the required 2A 10BC fire extinguisher indicates fully charged and was serviced on 8/11/2023, 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 7/1/2023. -

Emergency Disaster Plan, Parent’s Rights Poster and the Facility License were observed to be posted in the entrance of the home.
The home is observed to be clean and orderly. 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. There are toys available for children. Appropriate sleeping arrangements and playpens were observed.
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-andresources/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.-----------------page 2 of 5 ---------------------------------
SUPERVISORS NAME: Brandi VanOosten
LICENSING EVALUATOR NAME: Roxana Lopez
LICENSING EVALUATOR SIGNATURE:

DATE: 09/14/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/14/2023
LIC809 (FAS) - (06/04)
Page: 3 of 6
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: CANCHOLA & GUILLEN FAMILY CHILD CARE
FACILITY NUMBER: 198020326
VISIT DATE: 09/14/2023
NARRATIVE
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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. LPA did not observe any objects that can pose a danger to children on the outdoor yard.

LPA’s did observed two cages with birds in the backyard.

The licensee is observed to be operating within the license capacity limitations.

At 1:30 pm children’s records were reviewed, LPA’s observed that Child # 1,2 and 4 were missing the LIC 627 consent of medical treatment.

The licensee and other personnel have completed training on preventive health practices including Pediatric First Aid and CPR. The licensee's Pediatric First Aid and CPR expires on 7/2025. There are first aid supplies available.

LPA observed that the Licensee and assistant do have proof of immunization record.

At 1:45 LPAs observed that Staff # 4 does not have current Mandated Reporter AB 1207 compliant Child Care Training Certificate on file.

LPA issued a copy of the LIC 857 Children’s Records Review and the LIC859 Staff Records Review to the licensee during this inspection. ------------------------------------------page 3 of 5--------------------------

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

DATE: 09/14/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/14/2023
LIC809 (FAS) - (06/04)
Page: 4 of 6
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: CANCHOLA & GUILLEN FAMILY CHILD CARE
FACILITY NUMBER: 198020326
VISIT DATE: 09/14/2023
NARRATIVE
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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 child care by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.

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

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.

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

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 --------------page 4 of 5---------------------------------------------------

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

DATE: 09/14/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/14/2023
LIC809 (FAS) - (06/04)
Page: 5 of 6
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: CANCHOLA & GUILLEN FAMILY CHILD CARE
FACILITY NUMBER: 198020326
VISIT DATE: 09/14/2023
NARRATIVE
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 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

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.



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

Exit interview conducted and report was reviewed with Licensee Gerardo Guillen

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

DATE: 09/14/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/14/2023
LIC809 (FAS) - (06/04)
Page: 6 of 6