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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198400403
Report Date: 06/24/2021
Date Signed: 06/24/2021 10:58:27 AM

Document Has Been Signed on 06/24/2021 10:58 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:FLORES-QUEZADA FAMILY CHILD CAREFACILITY NUMBER:
198400403
ADMINISTRATOR:FLORES-QUEZADA, CRISTINAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(562) 788-3746
CITY:LAKEWOODSTATE: CAZIP CODE:
90712
CAPACITY: 14TOTAL ENROLLED CHILDREN: 0CENSUS: 0DATE:
06/24/2021
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Cristina Flores, ApplicantTIME COMPLETED:
11:15 AM
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Licensing Program Analyst (LPA) T. Tran arrived at the property address 2111 Dashwood St. Lakewood CA 90712 to conduct a pre-licensing inspection. LPA met with applicant Cristina Flores, applicant's husband and applicant's three minor children.

About 9:20 AM, we toured the home inside and outside. Applicant own the home, a copy of the control of property has been received. Applicant does not have the $300,000 liability insurance and plans to use the affidavit. Applicants have completed First Aid, CPR and preventative health training. All adults living in the home have been live scanned, cleared and associated to the home. The requested capacity is 14. Applicant states services will be provided Monday-Friday 6:00 AM- 6:00 PM. The applicant understands child care must be provided in the “primary” residence of the applicant and no storage unit, garage or alternative structure may be used for child care unless pre-approved in writing by the licensing agency.

This is a two level dwelling townhouse. The first level consists of a play room with a half bathroom, a kitchen, a living room/dinning room, and an attached garage. The entire second floor is off-limit to daycare children with four bedrooms and two bathrooms. LPA observed a safety gate by the stairway. Primary child care area conducts in the play room. Children do have access to the living room/dinning room and kitchen for meal time. LPA observed a crib available for caring infant located in the dinning area. LPA observed the kitchen cabinets that stored for cleaning products and sharp objects with proper latch. The backyard is fenced no hazardous objects. LPA observed all cleaning supplies, chemicals, solvents and medications are stored out of reach and inaccessible to children; poisons are locked and inaccessible to children. Applicant states there are no guns in the home. There are no bodies of water accessible to children on the property. LPA a small outdoor winnie dog kept separated from the children play yard.
The fire extinguisher is rated at least 2A-10BC mounted in the kitchen area and two working smoke detector/carbon monoxide located in the dinning room and playroom. LPA observed a complete first aid kit located entry of the home. Page 1-4
SUPERVISORS NAME: Trevino Cochran
LICENSING EVALUATOR NAME: Tiffanie Tran
LICENSING EVALUATOR SIGNATURE: DATE: 06/24/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/24/2021
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 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: FLORES-QUEZADA FAMILY CHILD CARE
FACILITY NUMBER: 198400403
VISIT DATE: 06/24/2021
NARRATIVE
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When children are being cared for on both floors of a multiple story home, both the upstairs and downstairs must be barricaded when day care children are on both floors. A safety gate in front of the room may be used to prevent access to stairs rather than a barricade directly on the stairway.

Incidental Medical Services (IMS) policy was discussed. Applicant did not service children with IMS during this time. 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

As a Licensee the following documents that are to remain posted during business hours: Facility License (LIC 203), Emergency Disaster Plan (LIC610a), Notification of Parents' Rights Poster (PUB 394), Child Care Facility Roster (LIC9040), Complaint Hotline Flyer. Children's records shall contain the following: LIC 282 Affidavit Liability Insurance, LIC 627/Consent for Medical Treatment, LIC 700/ID and Emergency Information, LIC 995A/Parent's Rights, LIC995E/Caregiver Background Check, LIC 9150/Parent Notification, LIC 9212/Parent's Responsibilities, PM 286/Immunization (Blue) Card.
Employee records must be maintained by the applicant and shall contain the following: A review of the employee records was conducted. All employee must have the following in their facility file: LIC 9052/Employee Rights, LIC 9108 Mandated Reporter Form, An employment contract or application containing the following information: Employees Full Name, Date of Birth, Driver's License Number, Date of Employment, Documentation of Health and Safety Training, Duties of the employee. Records for employees as well as children must be maintained for 3 years after separation for the FCCH.

At the time of acceptance of each child into care, the licensee shall provide the child's parent or authorized representative with a copy of the notice Family Child Care Home Notification of Parents' Rights, LIC 995A, the Caregiver Background Check Process, LIC 995E and the Family Child Care Consumer Awareness Information LIC 9212.(which replaces former publication PUB 72). Violations of these requirements are serious and are subject to progressive (monetary) civil penalties.

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SUPERVISORS NAME: Trevino Cochran
LICENSING EVALUATOR NAME: Tiffanie Tran
LICENSING EVALUATOR SIGNATURE:

DATE: 06/24/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/24/2021
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: FLORES-QUEZADA FAMILY CHILD CARE
FACILITY NUMBER: 198400403
VISIT DATE: 06/24/2021
NARRATIVE
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Applicant is advised that effective January 1 2012 only non-flavored, unsweetened nonfat (fat free skim, 0%) or low-fat (1%) milk can be served to children. No beverages with added sweeteners can be served (this includes sodas, sweet teas, juice drinks with added sugars, flavored milks and diet drinks) A maximum of one serving (4-6 ounces for 1 to 6 year olds) of 100% juice will be allowed per day.

Applicant’s responsibility to know the regulations as well as anyone who assists in providing care. LPAs advised on how to access quarterly reports, forms, and regulations for Child Care online at www.cdss.ca.gov. to stay informed of any changes or updates to the regulations. Applicant was informed of the responsibility to report suspected Child Abuse by calling the Child Abuse Hotline at 1-800-540-4000. Also call the Community Care Licensing (CCL) offices and follow up with a written Unusual Incident/Injury Report (LIC 624B). Applicant was informed all adults living or working in the home must have a criminal record clearance prior to living or working in the home. The presence of adults in the home without Criminal Record Clearance or Exemption will be cited and civil penalty assessed for $100 per day. The applicant may find additional information and forms on the DSS website at www.ccld.ca.gov including information on the Live Scan application (LIC 9163). Appointments can be made for Live Scan at 1-800-315-4507. LPAs discussed AB633 and informed applicant that, upon receipt of a Type A deficiency, Applicant shall post and provide copies of this licensing report to parent/guardians of children in care at the facility and to parents/guardians of children newly enrolled at the facility during the next 12 months. Copies of the reports must also be provided to each parent when a serious deficiency, Type A, is cited. Applicant was advised that the Notice of Site Visit must be posted at the entrance of the facility for a period of 30 days. If a serious violation is cited, a copy of the licensing report (LIC809 or LIC9099) must also be posted for 30 days. If these requirements are not met, civil penalties in the amount of $100 per violation will be assessed. Applicant was advised that inaccessibility of hazards must be constantly reassessed depending on the children in care. Applicant must have the facility’s phone number at all times; if the phone number is changed, licensing must be notified. State law prohibits baby walkers, bouncy seats, exersaucers and any other items that fall into that category.

LPA discussed an individual infant sleeping plan shall completed for each infant up to 12 months of age. Licensee must physically check on the sleeping infant(s) every 15 minutes and document the condition of the infant(s). In addition, LPA provided the safe sleep for baby pamphlet. Each infant shall be constantly supervised and under direct visual observation by an adult person at all times. Under no circumstances shall any infant be left unattended. In order to visually observed and supervise sleeping infants there should be no obstruction to the view of the infants, which could include transparency walls and/or half walls. LPA recommend that infants sleep safest in crib with no bumpers, pillows, blankets, or toys, and on their backs, and every sleep time counts to reduce the risk of SIDS and other sleep-related causes of infant death

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SUPERVISORS NAME: Trevino Cochran
LICENSING EVALUATOR NAME: Tiffanie Tran
LICENSING EVALUATOR SIGNATURE:

DATE: 06/24/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/24/2021
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: FLORES-QUEZADA FAMILY CHILD CARE
FACILITY NUMBER: 198400403
VISIT DATE: 06/24/2021
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LPA informed the effects of lead exposure for children between ages 1-6 years old are the most at risk for lead poisoning. A copy of lead exposure was provided. Licensee was informed of responsibility to report suspected Child Abuse by calling the Child Abuse Hotline at 1-800-540-4000. Also call the Community Care Licensing office and follow up with a written Unusual Incident/Injury Report (LIC 624B). Licensee is reminded that smoking is prohibited on the premises. The facility was informed that the presence of teachers in the facility without Criminal Record Clearance or Exemption will be cited and civil penalty assessed for $100 per day. The facility may find additional information and forms on the Department’s website at www.ccld.ca.gov including information on the Live Scan application (LIC 9163). Appointments can be made for Live Scan at 1-800-315-4507. LPA advised to read the Child Care quarterly updates every season as the come out to stay informed of any changes or updates to the regulations. LPA informed the Child Care Advocate Program (CCAP) provide many other helpful resources to the licensees and the public. Visit www.cdss.ca.gov to receive important updates.

Beginning January 1, 2018, Health and Safety Code 1596.8662 requires all licensed providers, applicants, directors and employees to complete training as specified on their mandated reporter duties and to renew their training every two years. Volunteers are encouraged but not required to take the training. Existing licensees must meet requirements by March 30, 2018. New employees shall have 90 days from date of employment to complete training as required. This training requirement may be met by using the Department’s Office of Child Abuse Prevention (OCAP) online training modules. Visit: www.mandatedreporterca.com

Applicant is reminded that smoking is prohibited on the premises during hours of operation.



Effective today 06/24/2021, the facility is licensed to serve up to either 14 children, no more than 3 infants, and at least 2 school age children.

This report must be kept available for public review for three years.

An exit interview was conducted, and a copy of this report was provided to the noted person.

Page 4-4

SUPERVISORS NAME: Trevino Cochran
LICENSING EVALUATOR NAME: Tiffanie Tran
LICENSING EVALUATOR SIGNATURE:

DATE: 06/24/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/24/2021
LIC809 (FAS) - (06/04)
Page: 4 of 4