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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198021022
Report Date: 08/12/2022
Date Signed: 08/12/2022 09:50:21 AM

Document Has Been Signed on 08/12/2022 09:50 AM - 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: 0CENSUS: 2DATE:
08/12/2022
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
08:30 AM
MET WITH:Elosia Briseno, ApplicantTIME COMPLETED:
10:00 AM
NARRATIVE
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An announced Pre-Licensing Follow-up 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, and to inspect the front fence which contained pointed and sharp finials on top of the fence. Applicant is applying for a Small Family Child Care Home. Present during this inspection was Applicant, 2 children, and 2 family members 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 detached garage. The backyard contains a locked shed and a back house which contains one bathroom and one bedroom. Per applicant the back house has an address of 3120 1/2 Baseball Avenue, El Monte, Ca 91732. Applicant provided a copy of an Inspection Record from City of El Monte showing an inspection to an address of 3120 1/2 Baseball Avenue. Per applicant back house does not have any occupants at this time. LPA observed the back house is empty of furniture and people. LPA advised applicant to notify the Department PRIOR to anyone living in the
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SUPERVISORS NAME: Brandi VanOosten
LICENSING EVALUATOR NAME: Lilli Babcock
LICENSING EVALUATOR SIGNATURE: DATE: 08/12/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/12/2022
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: 08/12/2022
NARRATIVE
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back house and to obtain fingerprint clearance and association to facility of any individuals who will be living in the back house PRIOR to anyone moving into the residence.

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 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, and backyard containing detached garage, back house, and shed. 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.
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SUPERVISORS NAME: Brandi VanOosten
LICENSING EVALUATOR NAME: Lilli Babcock
LICENSING EVALUATOR SIGNATURE:

DATE: 08/12/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/12/2022
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: 08/12/2022
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Per applicant, there are firearms or weapons, fireplaces, or bodies of water in the facility and LPA did not observe any on this day.

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. LPA observed applicant covered the pointed finials with foam and zip-tied the foam to the top of the fence. Applicant stated she will replace the foam when needed.

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.

Applicant 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.

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



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

DATE: 08/12/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/12/2022
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
CCLD Regional Office, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME: BRISENO FAMILY CHILD CARE
FACILITY NUMBER: 198021022
VISIT DATE: 08/12/2022
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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

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

Applicant is seeking to provide care for 8 children from birth -13 years old. Based upon today’s inspection, there are no corrections pending at this time. The Family Child Care Home appears to meet Title 22 requirements. The application will be submitted for final review to the Department. 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: 08/12/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/12/2022
LIC809 (FAS) - (06/04)
Page: 4 of 4