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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198021022
Report Date: 07/22/2022
Date Signed: 07/22/2022 05:39:06 PM

Document Has Been Signed on 07/22/2022 05:39 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:BRISENO FAMILY CHILD CAREFACILITY NUMBER:
198021022
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 0DATE:
07/22/2022
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
02:20 PM
MET WITH:Licensee, Eloisa BrisenoTIME COMPLETED:
05:45 PM
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An announced Pre-Licensing Inspection was conducted by Licensing Program Analyst (LPA) Lilli Babcock. A risk assessment was conducted upon entry and appropriate COVID PPE was used. The purpose of today's visit is to inspect and evaluate facility for initial licensure, Applicant is applying for a Small Family Child Care Home. Present during this inspection was Applicant, and a family member to assist with translation.

Per applicant, family members residing in the home are 2 adults and no children. Per applicant, operation hours will be Monday to Friday, 5:30 AM to 5:30 PM. Applicant states that she will care for children 0-13 years of age.

During this inspection the following was observed:

All areas identified on the facility sketch were inspected, including but not limited to, all off limit areas. This is a one-story home that consists of 2 bedrooms, 1 bathroom, kitchen, dining room, living room, laundry room, front yard, backyard, and garage.

Per applicant, the children will use 1 bathroom, living room and front yard. Areas that will be used by children were inspected for safety, comfort, cleanliness, ventilation and heating. Detergents, cleaning compounds, medicines, sharp objects and hazardous items that can pose a danger to

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SUPERVISORS NAME: Brandi VanOosten
LICENSING EVALUATOR NAME: Lilli Babcock
LICENSING EVALUATOR SIGNATURE: DATE: 07/22/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/22/2022
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: BRISENO FAMILY CHILD CARE
FACILITY NUMBER: 198021022
VISIT DATE: 07/22/2022
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children are inaccessible in areas designated for children. The applicant states that there are no poisons on the premises.

Areas off limits to children and parents are: 2 bedrooms, kitchen, dining room, laundry room, garage, and backyard. All areas inaccessible for children were observed to have a child-proof doorknob, lock, and or a security gate making them inaccessible for children in care. The applicant understands that licensing staff may have access to off-limit areas during inspection visit if necessary.

LPA observed a fire extinguisher located in the kitchen. The valve on the 2A10BC fire extinguisher indicates fully charged and was purchased on 7/19/22 as indicated on the receipt. Smoke and carbon monoxide detectors were tested during the inspection and observed to be operable.

There are toys available for children. LPA observed sleeping arrangements in the form of mats and a crib. LPA advised applicant of safe sleep regulations.

The applicant states that they will provide food for children in care and is planning to apply for the food program.

The applicant has completed the required Health and Safety Training, Nutrition and Lead Training, Mandated Reporter Training, and Pediatric First Aid and CPR. There are first aid supplies available.

Per applicant, there are firearms or weapons, fireplaces, or bodies of water in the facility and LPA did not observe any on this day.
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SUPERVISORS NAME: Brandi VanOosten
LICENSING EVALUATOR NAME: Lilli Babcock
LICENSING EVALUATOR SIGNATURE:

DATE: 07/22/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/22/2022
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: BRISENO FAMILY CHILD CARE
FACILITY NUMBER: 198021022
VISIT DATE: 07/22/2022
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The children will use the front yard for outdoor play. The front yard was observed to be fenced. The front yard is surrounded on 3 sides by a wrought iron fence with pointed finials. Applicant will submit a plan to ensure the safety of children playing in the front yard.

Applicant states that they will care for infants. LPA discussed the safe sleep regulations with Applicant 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 Applicant 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 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

At 4:15 pm the following was discussed with the applicant:

· 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. Civil Penalties will be assessed if not in compliance.
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SUPERVISORS NAME: Brandi VanOosten
LICENSING EVALUATOR NAME: Lilli Babcock
LICENSING EVALUATOR SIGNATURE:

DATE: 07/22/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/22/2022
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: BRISENO FAMILY CHILD CARE
FACILITY NUMBER: 198021022
VISIT DATE: 07/22/2022
NARRATIVE
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· In the absence of the licensee a qualified adult must be present supervising the children; a qualified adult is an individual who has a valid and current Pediatric First Aid and CPR training, Immunizations (TDAP, MMR, Influenza), mandated reporter training and a valid criminal record clearance associated to the facility license.
· Annual fees must be paid promptly and by the due date or a late fee shall be assessed and/or the License may be terminated.
· The fire extinguisher type 2A-10BC must be serviced annually or as often as necessary. Smoke and carbon monoxide detectors should be checked and batteries replaced as needed.
· Reporting Requirements: Changes should be reported to the Department as soon as they occur such as construction, remodeling, telephone number changes and/or if you move from your home.
· Reporting Requirements: Any unusual incidents or injuries must be reported to the Department within 24 hours via telephone and within seven (7) days in writing.
· Fire and safety drills must be performed every six months and documented for review by the Department.
· Smoking is prohibited in a family childcare home.
· Children and Staff records must be maintained and updated as needed and must be available for review by the Department.
· 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.
· Inspection Authority: All adults living and working in the home shall be made of aware of the Department’s right to inspection the home, which includes, but is not limited to the right to enter the home when children are being cared for, interview children and adults and review documentation.
· The facility license number must be on all advertisements, publications or announcements with
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SUPERVISORS NAME: Brandi VanOosten
LICENSING EVALUATOR NAME: Lilli Babcock
LICENSING EVALUATOR SIGNATURE:

DATE: 07/22/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/22/2022
LIC809 (FAS) - (06/04)
Page: 2 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: BRISENO FAMILY CHILD CARE
FACILITY NUMBER: 198021022
VISIT DATE: 07/22/2022
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the intent to attract clients.
· Isolation for Ill children: When a child is ill he/she shall be separated from other children (reference 102417(e) Operation of a Family Child Care Home).
· Liability Insurance was discussed; LPA advised applicant to review Title 22 Regulation 102417(m)(1) for additional information.

· Immunization Requirement: H&S 1597.622: Commencing September 1, 2016, a person shall not be employed or volunteer at a family day care home if he or she has not been immunized against influenza, pertussis, and measles. The licensee and all adults working with children have proof of immunizations.

· Mandated Reporter Training: H&S 1596.8662: Beginning January 1, 2018, all licensed providers, applicants, directors and employees to complete training as specified on mandated reporter duties. Training is available at: www.mandatedreporterca.com

LPA reviewed and issued the LIC 311D - Forms/Records to Keep in Your Family Child Care Home. All required forms listed were explained and were provided to the applicant during the visit.



LPA advised the applicant how to access forms, regulations and quarterly updates on the Child Care Licensing website at: www.ccld.ca.gov.

OTHER INFORMATION AND FORMS PROVIDED:
· Handouts provided for Safe Sleeping practices
· Capacity Handout for a Small Family Child Care Home and Large Family Child Care Home was Page 5 of 6
SUPERVISORS NAME: Brandi VanOosten
LICENSING EVALUATOR NAME: Lilli Babcock
LICENSING EVALUATOR SIGNATURE:

DATE: 07/22/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/22/2022
LIC809 (FAS) - (06/04)
Page: 6 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: BRISENO FAMILY CHILD CARE
FACILITY NUMBER: 198021022
VISIT DATE: 07/22/2022
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provided.
· Lead Exposure Flyer

LPA consulted with applicant regarding COVID-19 health and safety guidelines on this date.


The applicant’s signature on this report acknowledges that they have signed the Application for a Family Child Care Home License (LIC 279) under the penalty of perjury that the statements on the application and any attachments are correct.

Applicant is seeking to provide care for 8 children from birth -13 years old. Based upon today’s inspection, applicant will submit a plan to ensure children will not be injured by the pointed finials on the front fence, while playing in the front yard.

The application will be submitted for final review to the department once the safety plan for the front yard fence has been received. Once licensed, the applicant is required to adhere to the terms and limitations stated on the license.


Exit interview conducted and report was reviewed with Applicant Eloisa Briseno.

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SUPERVISORS NAME: Brandi VanOosten
LICENSING EVALUATOR NAME: Lilli Babcock
LICENSING EVALUATOR SIGNATURE:

DATE: 07/22/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/22/2022
LIC809 (FAS) - (06/04)
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