198400251-6-4-2021-54-CC-RRAS-C3NU97-20210604152241

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 198400251
Report Date: 06/03/2021
Date Signed: 06/04/2021 03:22:58 PM

Document Has Been Signed on 06/04/2021 03:22 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 CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME:	CUEVAS FAMILY CHILD CARE		FACILITY NUMBER:	198400251
ADMINISTRATOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY: 8	TOTAL ENROLLED CHILDREN: 0	CENSUS: 1	DATE:	06/03/2021
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	02:30 PM
MET WITH:	Maria De Jesus Cuevas, Licensee		TIME COMPLETED:	03:45 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	THIS IS AN ELECTRONIC COPY OF A HANDWRITTEN REPORT Licensing Program Analyst (LPA) Rita Ramos conducted an unannounced annual inspection to the above facility on 06/03/2021. LPA arrived at the facility at 2:30PM and met with Maria De Jesus Cuevas, Licensee, who guided analyst on a tour of the facility. Per Licensee, there are no children that are currently enrolled. Licensee’s own child was present upon arrival. This is a one-story home which consists of 3 bedrooms, 2 bathrooms, kitchen, dining room, living room, front yard and backyard (fenced). There is also a garage and behind the garage there is a pool. LPA observed that the pool is fenced in with a rod iron fence and the only entry is via a self-latching door. The children use the bathroom in the hallway via the living room. LPA observed that there is no fireplace in the home. The home has central heating. Per Licensee, areas off limits to children and parents include: all 3 both bedrooms, the garage, and the pool. The licensee provides food for children in care. Individuals who reside in the home were noted and discussed. All adults present in the home have obtained a criminal record clearance or exemption prior to working, residing or volunteering in the licensed childcare home. Licensee states that there are no firearms stored in the home. 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 cellphone that is used and the cellphone stays at the facility during operation hours. There is ventilation. Safe toys play equipment and materials were observed. Detergents, cleaning compounds, medications, and other items which could pose a danger to children were observed to be inaccessible to children. . ---Page 1 of 4

SUPERVISORS NAME: Brandi VanOosten
LICENSING EVALUATOR NAME: Rita Ramos
LICENSING EVALUATOR SIGNATURE:	DATE: 06/03/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/03/2021

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 CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME: CUEVAS FAMILY CHILD CARE	FACILITY NUMBER: 198400251
	VISIT DATE: 06/03/2021

NARRATIVE

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The licensee states that there are no poisons in the home and understands that storage areas for poisons must be locked with a key or combination lock.

The restroom that children use was observed to be safe and sanitary.

The valve on the required 2A 10BC fire extinguisher indicates fully charged and was serviced on 06/25/21, as indicated on receipt. LPA advised the Licensee to service their fire extinguisher before it expires. Smoke and carbon monoxide detectors were tested and are operable.

Licensee is currently not caring for infants. Licensee states that if any infants are enrolled infants will sleep in the living room where they are constantly supervised. LPA discussed appropriate sleeping arrangements. LPA informed Licensee that cribs or play yards shall not hinder the entrance or exit from the sleeping space, mattresses shall be firm and covered with a fitted sheet that overlaps the underside so it cannot be dislodged. LPA did not observe any infants swaddled while in care. LPA advised the Licensee that infants shall be placed on their backs for sleeping and shall be supervised. Infants shall be checked on every 15 minutes and the time of each 15-minute check shall be documented with child’s name and date. The LIC 9227 Individual Infant Sleeping Plan shall be completed for each infant up to 12 months of age. A copy of the LIC 9227 was provided to Licensee.

Currently, there is a back yard behind the driveway and in front of the garage that can be used 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. The licensee states that supervision will always be provided.

The licensee is observed to be operating within the license capacity limitations. LPA did not observe any children left in parked vehicles. Car seats shall only be used for transportation. LPA did not observe any children sleeping in car seats.

The licensee has completed training on preventive health practices including Pediatric First Aid and CPR. The licensee's Pediatric First Aid and CPR expires on 03/2022. There are first aid supplies available. LPA advised that if a child shows signs of illness he/she/they shall be separated from other children. --Pg 2 of 4

SUPERVISORS NAME: Brandi VanOosten
LICENSING EVALUATOR NAME: Rita Ramos
LICENSING EVALUATOR SIGNATURE:	DATE: 06/03/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/03/2021

LIC809 (FAS) - (06/04)

Page: 2 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 CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME: CUEVAS FAMILY CHILD CARE	FACILITY NUMBER: 198400251
	VISIT DATE: 06/03/2021

NARRATIVE

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Children’s records were not reviewed due to no children currently enrolled.

The licensee does have proof of immunization against influenza, pertussis, and measles.

LPA observed that the Licensee does have proof of the Mandated Reporter AB 1207 compliant Child Care Training Certificate on file.

The Licensee does have a pet. If children are in care, the Licensee will ensure that their pet will be placed in the dog run on the side of their home/garage which is gated.

Emergency Disaster Plan, Parent’s Rights Poster and the Facility License were observed to be posted.

LPA did/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.

LPA provided the licensee with a copy of A Child Care Provider’s Guide to Safe Sleep, by American Academy of Pediatrics. LPA also consulted and explained Child Abuse Reporting, Never Shake a Baby, and Safe Sleeping practices.

Incidental Medical Services (IMS):
Per licensee, there are no children enrolled that require IMS at this time. 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 ----Page 3 of 4

SUPERVISORS NAME: Brandi VanOosten
LICENSING EVALUATOR NAME: Rita Ramos
LICENSING EVALUATOR SIGNATURE:	DATE: 06/03/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/03/2021

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 CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME: CUEVAS FAMILY CHILD CARE	FACILITY NUMBER: 198400251
	VISIT DATE: 06/03/2021

NARRATIVE

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LPA advised the licensee to access forms, regulations and quarterly updates online at: www.ccld.ca.gov. LPA also discussed the Provider Information Notices (PINS) on Safe Sleep Awareness: PIN 19-02-CCP, COVID FAQ - PIN 20-11-CCP, Required Lead Testing: PIN 20-01 CCP Effects of Lead Exposure, and Guardian User Account Access - PIN 20-20-CCLD.

Capacity Handout (Small & Large) was provided during this inspection.

At this time, the licensee is in compliance with California Code of Regulations Title 22. No deficiencies cited.

The Notice of Site Visit (LIC 9213) – must remain posted for 30 days during the hours of operation after each site visit made by a licensing representative. Failure to maintain posting as required will result in a civil penalty of $100.00.

Exit interview was conducted with Maria De Jesus Cuevas, Licensee, including, but not limited to Appeal Procedures, Site Visit and Initial Appeal Rights.

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SUPERVISORS NAME: Brandi VanOosten
LICENSING EVALUATOR NAME: Rita Ramos
LICENSING EVALUATOR SIGNATURE:	DATE: 06/03/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/03/2021

LIC809 (FAS) - (06/04)

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