198021130-2-3-2023-33-CC-CTUA-CNQ4HZ-20230203180757

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 198021130
Report Date: 02/03/2023
Date Signed: 02/03/2023 06:08:13 PM

Document Has Been Signed on 02/03/2023 06:08 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:	ROBLES FAMILY CHILD CARE		FACILITY NUMBER:	198021130
ADMINISTRATOR:	MARIA ROBLES		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(626) 531-6983
CITY:	AZUSA	STATE: CA	ZIP CODE:	91702
CAPACITY: 14	TOTAL ENROLLED CHILDREN: 0	CENSUS: 1	DATE:	02/03/2023
TYPE OF VISIT:	Prelicensing	UNANNOUNCED	TIME BEGAN:	03:30 PM
MET WITH:	Maria Robles		TIME COMPLETED:	06:15 PM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	On 2/3/2023 at 3:30 pm, Licensing Program Analyst (LPA) Carolyn Tuba conducted an announced Change of Location/Pre-Licensing inspection. A COVID risk assessment was conducted prior to entry and appropriate personal protective equipment were used. The purpose of today’s visit is to inspect and evaluate the facility for initial licensure as a relocation (previous license number 198018637). Applicant is applying for a Large Family Child Care License with a max capacity of 14. Property owner/landlord consent (LIC 9151) is currently on file. The licensee owns the property; per applicant reside in the home. Lease agreement/control of property was received. Fire clearance was granted on 1/25/2023 by L.A. City Fire Department. Individuals residing in the home are 5 adults and 4 children. Operation hours will be Monday through Friday, from 5:00 am to 10:00 pm. Ages to be served are birth to 13 years. Facility is a single-story home, containing 5 bedrooms, 2 bathrooms, kitchen, living room, dining room, playroom, front yard, and backyard. Backyard is fenced. Per Applicant, off-limit areas to the children and parents will be 5 bedrooms, 1 bathroom, and front yard. Per Applicant, areas accessible to children and parents will be living room, dining room, kitchen, bathroom located in hallway, a playroom, backyard. Upon entering the home, LPA observed the A/C is central air made inaccessible to the children in care. Entering the home, LPAs observed the fire alarm and carbon monoxide installed in the living room and the playroom. A carbon monoxide and smoke detector were observed and tested. LPAs observed a First Aid kit in the playroom.

SUPERVISORS NAME: Ana Chico
LICENSING EVALUATOR NAME: Carolyn Tuba
LICENSING EVALUATOR SIGNATURE:	DATE: 02/03/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/03/2023

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: ROBLES FAMILY CHILD CARE	FACILITY NUMBER: 198021130
	VISIT DATE: 02/03/2023

NARRATIVE

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Kitchen cabinets were observed to have safety latches and knives and sharp objects were observed to be made inaccessible to the children in care. Applicants confirmed that facility will be providing meals and snacks and utilizing food service.

In the living room LPA observed a Fire Extinguisher serviced on 1/16/2023. Parent board was not mounted, but according to licensure will be mounting and taking a picture and sending to LPA. LPA observed variety of age appropriate materials. LPA observed napping mats and a pack n play yard. LPA discuss new Safe Sleep Regulations and directed applicants to the department’s website.

The home currently has 2 dogs (1 large and 1 small) that will be locked up during hours of operation. The home currently has a firearm that is locked in a safe that requires a code and ammunition is stored away from the firearm).

The outdoor space is located towards the back area of the home. Applicants will walk children outside off of the living room sliding glass door. LPA observed a large space with an outdoor age- appropriate toys. The area is covered with grass and some areas have artificial grass. LPA observed the backyard to have a cover to provide shade in the patio/backyard area. LPA will be returning for a follow-up visit due to licensure to have just moved into the home a week ago and has some hazards in the backyard that need to be removed or create a barrier.

Applicant will be submitting the Health, Nutrition, Safety & Lead training and proof of immunization for daughter who will be assisting her.

Applicant submitted proof of immunization, copy of CPR and First Aid expiring October 2023. Applicant submitted proof of Mandated Reporting Certificate Training which expires on 1/17/2025.

Applicant submitted LIC 508, LIC 9217, LIC 9182 and LIC 9108 to the LPA during the inspection visit. Applicant will be send LPA LIC 508, LIC 9182 and LIC 9108 for all adults living in the home and working with children via mail or during return visit.

SUPERVISORS NAME: Ana Chico
LICENSING EVALUATOR NAME: Carolyn Tuba
LICENSING EVALUATOR SIGNATURE:	DATE: 02/03/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/03/2023

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: ROBLES FAMILY CHILD CARE	FACILITY NUMBER: 198021130
	VISIT DATE: 02/03/2023

NARRATIVE

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LPA provided the Safe Sleep regulation and PIN 20-24-CCP and the Infant Sleep Plan LIC 9227 for when Applicant is ready to enroll infants. All equipment used for napping must follow Federal Safety guidelines.

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.

LPA reviewed with applicant that napping equipment should not block entrances or exits. Infant mattresses must be firm with tightly fitted sheets. Loose object, bumpers, objects hanging, or objects attached to the cribs/play yards are not allowed. Each infant should have their own crib/play yard and bedding. LPA informed applicant of new Safe sleep regulations, including LIC 9227 Infant Sleep Plan for infants under 12 months, 15-minute sleep check documentation for infants 0-24 months. Applicant states that infants and children in care will sleep in living room.

LPA discussed UIRs (Usual Incident Reports) and what should be reported to the Department to the On-duty Analysts and submit UIRs by mail, fax or email within 7 days. LPA advised applicant to ensure they are following the guidance from the local health authorities in order to prevent and reduce the transmission of diseases.

The isolation area for a sick child waiting to be picked up will be in the living room near the sofa area.

SUPERVISORS NAME: Ana Chico
LICENSING EVALUATOR NAME: Carolyn Tuba
LICENSING EVALUATOR SIGNATURE:	DATE: 02/03/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/03/2023

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: ROBLES FAMILY CHILD CARE	FACILITY NUMBER: 198021130
	VISIT DATE: 02/03/2023

NARRATIVE

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The following was discussed with the applicant:

· 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 adult/infant CPR & Pediatric First Aid certification, TB clearance, immunization, Mandated Reporter training certificate www.mandatedreporterca.gov, and a valid criminal record clearance associated to the facility license. A current roster of children enrolled must be available and maintained for a period of three years, even after children no longer are attending the facility.

· 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 child care 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 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. Licensee states she does not have liability insurance but will look into acquiring some.

SUPERVISORS NAME: Ana Chico
LICENSING EVALUATOR NAME: Carolyn Tuba
LICENSING EVALUATOR SIGNATURE:	DATE: 02/03/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/03/2023

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: ROBLES FAMILY CHILD CARE	FACILITY NUMBER: 198021130
	VISIT DATE: 02/03/2023

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OTHER INFORMATION THAT WAS DISCUSSED:
· Never Shake a Baby, Sudden Infant Death Syndrome (SIDS) and Safe Sleeping practices.
Per applicant, there are no dual licenses at this address.

Applicant was reminded that all adults 18 and over living in the home, persons who provide care and supervision to children, and staff who have contact with children, 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.

APPLICANT WILL WAIT UNTIL FACILITY OPENS TO DETERMINE IMS NEEDS:

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: http://www.ada.gov/childqanda.htm

Community Care Licensing Division (CCLD) regularly sends information to licensed facilities, providers, and stakeholders by way of Provider Information Notices (PIN), Program Quarterly Update Newsletters and other important information communication platform. To receive important licensed-related information to licensed facilities, visit the CCLD Important Information website at https://www.cdss.ca.gov/inforesources/community-care-licensing/subscribe and select the Child Care option to receive email communication.

Exit interview conducted and report was reviewed with the applicant, Maria Robles.

SUPERVISORS NAME: Ana Chico
LICENSING EVALUATOR NAME: Carolyn Tuba
LICENSING EVALUATOR SIGNATURE:	DATE: 02/03/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/03/2023

LIC809 (FAS) - (06/04)

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