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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198400375
Report Date: 03/01/2021
Date Signed: 03/16/2021 03:48:03 PM

Document Has Been Signed on 03/16/2021 03:48 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:CASTRO AMAYA FAMILY CHILD CAREFACILITY NUMBER:
198400375
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 0CENSUS: 0DATE:
03/01/2021
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Jasmine Castro-Amaya - ApplicantTIME COMPLETED:
02:15 PM
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Due to COVID – 19 and the Department of Public Health (DPH) guidelines of social distancing, a pre-licensing tele-inspection was conducted via Facetime on 03/01/21 at 1:00 PM. Licensing Program Analyst (LPA) Randy Derraco met with applicant Jasmine Castro Amaya via Facetime app.

All areas identified on the facility sketch were inspected, including but not limited to, off limit areas. This is a 3-bedroom, 2 and ½ bathroom, 1 story home with a living room, kitchen and 1 care garage. The back yard will be used as an outdoor play area and the front yard will be off limits to children in care.

Applicant took LPA on a guided tour of home. LPA observed the wall to the left of the front door to be designated for required postings. Upon entry, applicant has a table stand that has hand sanitizer and plastic storage box with gloves, disposable face masks and a touchless thermometer. LPA observed a 2A-10BC fire extinguisher to be fully charged and serviced last on 11/23/20. A service tag was not observed on the fire extinguisher. Applicant states will send receipt to LPA via email. LPA advised applicant to keep hand sanitizer out of reach of children. On the floor next to the stand, applicant has a black storage bin with a yellow cover that contains emergency supplies such as blankets, food, flashlights and water. At the end of the wall is an entrance to the hallway that leads to two bedrooms and a full bathroom. LPA observed a doorknob cover on each door. Bedroom was observed to be empty. Applicant states bedroom will be off limits however plans to make it an office space in the future. LPA observed a door lock in addition to the doorknob cover to bedroom 1 making the space inaccessible. LPA observed bedroom 2 to have a ceiling fan, a working smoke detector, a rug, two child sized chairs, a child book rack and posters on the wall. LPA observed a sliding mirrored closet to contain 9 sleeping cots and additional reading material for children in care. LPA observed the closet doors to have locks in the top corners of each side making the contents inaccessible. Applicant states bedroom 2 will be used to separate children showing signs of illness if needed. LPA observed a full bathroom next to bedroom 2. The toilet and faucet were observed to be clean and the bathtub to be free of hazards. LPA observed child proof locks on the cabinets underneath the sink. LPA
SUPERVISORS NAME: Trevino Cochran
LICENSING EVALUATOR NAME: Randy Derraco
LICENSING EVALUATOR SIGNATURE: DATE: 03/05/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/05/2021
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: CASTRO AMAYA FAMILY CHILD CARE
FACILITY NUMBER: 198400375
VISIT DATE: 03/01/2021
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observed a hallway closet to contain a storage space for age appropriate toys. A digital thermostat to control the central heat and air conditioning was observed in the hallway. LPA observed a child proof lock on the hallway closet door making the contents inaccessible. LPA also observed a separate broom closet to contain brooms.

Applicant states that the living room area will be used as the main care area. The main care area contains a sectional couch, a wall mounted flat screen television, age appropriate toys, a cubby storage box for children’s personal items, a Lakeshore wooden baby changer, a Graco 3 point harness high chair (model # REG N PA-24833), a Lakeshore baby crib (model # 2532040, dated: 06/2019), a child sized table with 4 child sized chairs, a children’s play rug, two ceiling fans and a coffee table. Applicant states she will provide corner and edge bumpers for the coffee table or will get rid of coffee table. LPA observed a working smoke detector and carbon monoxide detector in the main care area. LPA observed a doorway leading to an off-limits single car garage. A washer, dryer, laundry detergent, and a treadmill was observed in the off- limits garage. Applicant states garage space will be used as a storage area. LPA observed the garage door to have a knob cover and a lock making contents inaccessible to the main care area. LPA observed a 2nd doorway leading to the off-limits master bedroom and off-limits master bathroom. LPA observed the door to have a knob cover and a lock making the room inaccessible to the main care area. LPA observed a 3rd doorway leading to the ½ bathroom. The toilet and faucet were observed to be clean. A child proof lock was observed beneath the sink cabinet making contents inaccessible.

LPA observed the entrance to the kitchen to be inaccessible by a child proof gate. A bar area with 4 stools was observed to be attached to the kitchen and will serve as the homes dining area. Applicant states that during business hours, the stools will be put into storage. LPA observed that all drawers and cabinets were made inaccessible with child proof locks. The refrigerator and freezer were observed to be cleaned. Applicant states that she will provide meals to the children in care. A child proof electrical outlet was observed in the kitchen’s dining area. Applicant states that all electrical outlets in the home are child proof. A medium sized fish tank and a fishbowl were observed in the kitchen area. LPA observed a Johnson and Johnson all purpose first aid kit stored in the kitchen cabinet. Applicant states she does not have a firearm and does not smoke.

(Page 2)
SUPERVISORS NAME: Trevino Cochran
LICENSING EVALUATOR NAME: Randy Derraco
LICENSING EVALUATOR SIGNATURE:

DATE: 03/05/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/05/2021
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: CASTRO AMAYA FAMILY CHILD CARE
FACILITY NUMBER: 198400375
VISIT DATE: 03/01/2021
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LPA observed a sliding glass door that leads to the backyard play area. A second 2A-10BC fire extinguisher was observed to be fully charged and mounted on the wall next to the sliding glass door leading towards the backyard. A white metal gate located in the backyard, leading to the side of the home, was observed to have a lock making the area inaccessible. LPA observed the backyard to have a plastic table with 4 round seats attached, a tether ball game, children tricycles, a toy caterpillar tunnel, and age appropriate toys. All outdoor equipment was observed to be kept on the cemented area of the backyard. LPA observed a grey brick planter in the grass area along the two walls of the backyard. The planter is approximately ankle high and no plants were observed to be growing. LPA observed a second white gate with a pad lock located on the opposite side of the backyard entrance. The home’s air conditioning unit and tankless water heater are kept in this area and were observed to be inaccessible to the backyard.

· 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.
· 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 child care home.
· Children and Staff records must be maintained and updated as needed and must be available for review by the Department. (Page 3)
SUPERVISORS NAME: Trevino Cochran
LICENSING EVALUATOR NAME: Randy Derraco
LICENSING EVALUATOR SIGNATURE:

DATE: 03/05/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/05/2021
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: CASTRO AMAYA FAMILY CHILD CARE
FACILITY NUMBER: 198400375
VISIT DATE: 03/01/2021
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· 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.
· 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 Applicant states that they will care for infants. LPA advised the applicant that an Individual Infant Sleeping Plan (LIC 9227) must be completed and maintained at the facility in the infant’s file. The plan must be signed and dated by the infant’s authorized representative and be available for the Department to review. LPA referred applicant to Department’s website: https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep and to Title 22 Division 12 Chapter 1 Article 6 section 102425 regarding safe sleep regulations.
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 4)
SUPERVISORS NAME: Trevino Cochran
LICENSING EVALUATOR NAME: Randy Derraco
LICENSING EVALUATOR SIGNATURE:

DATE: 03/05/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/05/2021
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: CASTRO AMAYA FAMILY CHILD CARE
FACILITY NUMBER: 198400375
VISIT DATE: 03/01/2021
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LPA advised the applicant how to access forms, regulations and quarterly updates on the Child Care Licensing website at: www.ccld.ca.gov. LPA reviewed and issued the Forms/Records to Keep in Your Family Child Care Home (LIC 311D) and provided the following forms via email and mailed a physical copy:

CHILDREN FORMS/RECORDS - Children’s files must contain the following documents/information:
Identification and Emergency Information (LIC 700), Consent for Emergency Medical Treatment (LIC 627), Notification of Parent’s Rights (LIC 995A), Caregiver Background Check Process (LIC 995E), Family Child Care Consumer Awareness Information (LIC 9212), Consent/Verification for Nebulizer Care (LIC 9166), California School Immunization Record, Parent Notification for Additional Children in Care (LIC 9150), Affidavit Regarding Liability Insurance (LIC 282), Acknowledgment of Receipt of Licensing Reports (LIC 9224).

FACILITY FORMS/RECORDS - Facility files must contain the following documents/information:
Personnel Records: As required in Title 22 Regulations 102416.1, Unusual incident/Injury Report (LIC 624B): Child Care Facility Roster (LIC 9040), Notice of Employee Rights (LIC 9052), Statement Acknowledging Requirement to Report Suspected Child Abuse (LIC 9108), Property Owner/Landlord Consent (LIC 9149), Property Owner/Landlord Notification Form (LIC 9149).

INFORMATION TO BE POSTED IN YOU FAMILY CHILD CARE HOME – You are required by Law to post the following:


Facility License (LIC 203), Emergency Disaster Plan (LIC 610A), Earthquake Preparedness Checklist (LIC 9148), Notification of Parent’s Rights (PUB 394). A Notice of Site Visit (LIC 9213): Must be posted for 30 days after each site inspection by a Licensing Representative. Any Licensing Report documenting a Type “A” deficiency must be posted for 30 days during the hours that children are in care. Any Licensing Report or other document verifying compliance or non-compliance with the Department’s order to correct a Type “A” deficiency must be posted for 30 days during the hours that children are in care.

An exit interview was conducted with Applicant, Jasmine Castro Amaya, and a copy of this report was signed by LPA Randy Derraco. This report will be sent via email to Applicant who agrees to sign and date the report. This report was sent via email and an electronic read receipt confirms receiving the report.

(Page 5)

SUPERVISORS NAME: Trevino Cochran
LICENSING EVALUATOR NAME: Randy Derraco
LICENSING EVALUATOR SIGNATURE:

DATE: 03/05/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/05/2021
LIC809 (FAS) - (06/04)
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