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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198400251
Report Date: 10/26/2022
Date Signed: 10/26/2022 10:32:26 AM

Document Has Been Signed on 10/26/2022 10:32 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 CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME:CUEVAS FAMILY CHILD CAREFACILITY NUMBER:
198400251
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 4CENSUS: 2DATE:
10/26/2022
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Maria Cuevas, LicenseeTIME COMPLETED:
11:00 AM
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Licensing Program Analyst (LPA) Katrina Chicote conducted an Announced – Prelicensing Inspection for a capacity increase on 10/26/2022 at 9:30 AM to the above facility. Fire clearance was granted for facility on 10/07/2022. LPA was taken on a guided tour of the facility both indoors and outdoors. Adults in the home were discussed and all have criminal record clearance. Also present was A1, Licensee’s Assistant, who provided translation as Licensee is Native Spanish speaker. There were two infants in care during today’s inspection. Licensee states that there are currently four children enrolled. The children's roster was reviewed and is current. Emergency Disaster Plan, License, and Parents’ Rights were posted at the time of inspection. Disaster drill log was also available during today’s inspection, last disaster drill conducted on 06/06/2022.

This is a single-story home which consists of three bedrooms and two bathrooms, kitchen, living room, dining room, and detached garage. Main Care Areas used by the children include the Living Room (located upon entry of the home), Dining Room (located next to Living Room), and Bathroom 1 (located to the left of Living Room). Per Licensee, areas off limits to children and parents include entire rear of home that includes all bedrooms and Bathroom 2 and Kitchen is only used as a walkway to access outdoor play area. At 9:33 AM, LPA observed that there is a baby gate separating areas used by children and off-limits area. At 9:35 AM, LPA observed a child safety door knob on Bedroom 1, making it inaccessible.

All areas identified on the facility sketch as accessible to children were inspected to ensure that they are clean and orderly with ventilation and heating for the safety of the children. LPA observed central air and ceiling fans through out the home. There is a working telephone maintained in the home. At 9:32 AM, LPA observed Living Room to have two couches, play kitchen, tall doll house, and other age appropriate toys, free of loose and sharp parts available for children. LPA observed two wooden cribs
Report continues- Page 1 of 5
SUPERVISORS NAME: Trevino Cochran
LICENSING EVALUATOR NAME: Katrina Chicote
LICENSING EVALUATOR SIGNATURE: DATE: 10/26/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/26/2022
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 CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME: CUEVAS FAMILY CHILD CARE
FACILITY NUMBER: 198400251
VISIT DATE: 10/26/2022
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in Living Room used for Infant sleep that is out of the walkway. At 9:36 AM, LPA observed Dining Room to have circular dining table with four chairs, shelving unit with bins filled with art materials, board games, and other age appropriate toys. At 9:40 AM, LPA observed Bathroom 1 to have operable toilet and sink, adequate handwashing and toileting supplies, floor free of hazards, under cabinet sink to have operable child safety lock, medicine cabinet used for storing toothbrushes, and storage unit over toilet to have toileting supplies. LPA observed electrical cover outlets all through the home. Detergents, cleaning compounds, medications, sharp knives and utensils, and other items which can pose a danger to children are inaccessible. At 9:37 AM, LPA observed these items to be stored in off limits Kitchen area with operable child safety locks. The Licensee states that there are no poisons in the home. The Licensee does understand that poison must be locked with a key or combination lock. Per Licensee, they provide food for children in care.

Per Licensee, the children will have access to side yard area for outdoor play. At 9:42 AM,LPA observed side yard has concrete through out, shade, and adequate perimeter fencing through-out the yard. LPA observed side yard is accessible through side door in Kitchen. LPA observed plastic play house, ride along toys, and other age appropriate toys free of loose and sharp parts available for the children in the side yard. Licensee states rear of the backyard and detached garage is off limits to children in care. LPA observed door to detached garage to be locked and rear area of backyard to have child safety gate making area inaccessible. At 9:45 AM, LPA observed there is a pool in the backyard of the home. LPA observed a gate 5 feet tall, with door swinging outward to have self latching lock and to be locked with a key at time of inspection that meets Title 22 Regulation requirements. LPA observed a small dog in backyard that is kept in a dog carrier at time of inspection, per Licensee dog is kept separate from daycare children.

Per Licensee, there are no weapons, firearms in the home and LPA observation did not observe any weapons or firearms at time of inspection.

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SUPERVISORS NAME: Trevino Cochran
LICENSING EVALUATOR NAME: Katrina Chicote
LICENSING EVALUATOR SIGNATURE:

DATE: 10/26/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/26/2022
LIC809 (FAS) - (06/04)
Page: 2 of 5
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: 10/26/2022
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At 9:41 AM, LPA observed the valve on the required 2A 10BC fire extinguisher indicates fully charged with proof of purchase receipt on 11/26/2021. At 9:43 AM, LPA observed smoke and carbon monoxide detectors are in operable condition at time of inspection. At 9:44 AM, LPA observed first Aid kit is kept in the Kitchen. The Licensee has current Pediatric First Aid and CPR. Proof of immunization against influenza, pertussis, and measles was readily available during today’s inspection. The Licensee has also taken the Mandated Reporter Training
—CPR Card valid until: 03/2024
—Mandated Reporter AB1207 Completed: 04/28/2021

The following was discussed with the Licensee:
Incidental Medical Services (IMS)
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
· Rooms that are off limits need to be made off limits during operating hours.
· Licensee (or facility representative) 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.
· 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.
Report Continues - Page 3 of 5
SUPERVISORS NAME: Trevino Cochran
LICENSING EVALUATOR NAME: Katrina Chicote
LICENSING EVALUATOR SIGNATURE:

DATE: 10/26/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/26/2022
LIC809 (FAS) - (06/04)
Page: 3 of 5
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: 10/26/2022
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·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 child care home.
· Children and Staff records must be maintained and updated as needed and must be available for review by the Department for a minimum of 3 years.
· No infant walkers, No Johnny jumpers, No saucer chairs, No incline sleepers 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.
· The Licensee was advised that inaccessibility of hazards must be constantly reassessed depending on the children in care.
Report Continues - Page 4 of 5
SUPERVISORS NAME: Trevino Cochran
LICENSING EVALUATOR NAME: Katrina Chicote
LICENSING EVALUATOR SIGNATURE:

DATE: 10/26/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/26/2022
LIC809 (FAS) - (06/04)
Page: 4 of 5
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: 10/26/2022
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· 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 discussed the safe sleep regulations with licensee [or facility representative] 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 licensee [facility representative] 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.

Based on LPA's observation today, 10/26/2022, LPA will submit to Manager for review and approval for a capacity increase to a large family child care home license. Pending approval, once licensed, Licensee is required to comply with the terms and limitations stated on the license.



Exit interview was conducted and report was reviewed with the Licensee (or Facility Representative), Maria Cuevas.

Report Ends - Page 5 of 5
SUPERVISORS NAME: Trevino Cochran
LICENSING EVALUATOR NAME: Katrina Chicote
LICENSING EVALUATOR SIGNATURE:

DATE: 10/26/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/26/2022
LIC809 (FAS) - (06/04)
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