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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198400559
Report Date: 03/29/2022
Date Signed: 03/29/2022 11:50:59 AM

Document Has Been Signed on 03/29/2022 11:50 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:MONROY FAMILY CHILD CAREFACILITY NUMBER:
198400559
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 0CENSUS: DATE:
03/29/2022
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
09:35 AM
MET WITH:Applicant, Jennifer MonroyTIME COMPLETED:
12:30 PM
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Licensing Program Analyst (LPA) Katrina Chicote conducted an Announced-Pre-licensing inspection today, 03/29/22 to the above facility. LPA met with Applicant, Jennifer Monroy, who took LPA on a guided tour of the facility. Adults residing in the home were discussed and all have criminal record clearance. The Applicant is requesting a small family child care home license. Per Applicant, operation hours will be Monday to Friday from 6:00 AM to 6:00 PM. Applicant states that she will care for children 0-12 years of age. Facility is bottom unit of duplex property, upstairs unit has separate address (8015 1/2 Avalon Blvd).

All areas identified on the facility sketch were inspected, including but not limited to, off limit areas. This is a single-story home that consists of four bedrooms, two bathrooms, dining room, living room, kitchen, and backyard.

Per Applicant, the children will have access to Living Room (located upon entry) as Main Care Area, Bathroom 1 (located at hallway entrance to the left), and Bedroom 4 (located to the rear of the home) as access to backyard and sick/isolation area only. Areas that will be used by children were inspected for safety, comfort, cleanliness, telephone service (cell phone), ventilation and heating. At 10:01 AM, LPA observed wall heater that is covered in hallway. At 10:03 AM, LPA observed child size tables and eight chairs in center of Main Care Space, a couch, television hanging on wall, shelves and cubbies filled with puzzles, art materials, books, soft plush toys, and other age appropriate toys available for children. At 10:05 AM, LPA observed Bathroom 1 to have operable toilet and sink, adequate hand washing and toileting supplies, and an operable child safety lock on under cabinet sink and medicine cabinet. The Applicant was advised that any poisons such as detergents, cleaning compounds, and medicines must be made inaccessible or stored somewhere with a key or combination lock.
Report Continues - Page 1 of 5
SUPERVISORS NAME: Trevino Cochran
LICENSING EVALUATOR NAME: Katrina Chicote
LICENSING EVALUATOR SIGNATURE: DATE: 03/29/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/29/2022
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: MONROY FAMILY CHILD CARE
FACILITY NUMBER: 198400559
VISIT DATE: 03/29/2022
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Based on the Facility Sketch submitted, areas off limits to children are the Dining Room, Kitchen, Bedrooms 1-3 and Bathroom 2 located inside Bedroom 1. At 10:09 AM, LPA observed an operable child safety gate blocking Dining Room and Kitchen from Main Care Space, making area inaccessible. At 10:12 AM, LPA observed off limits Bedroom 1-3 to have signs posted on each door and operable child proof door knobs on each door. The Applicant understands that licensing staff may have access to off-limit areas during inspection visit if necessary.

The Applicant states that they will provide food for children in care. Per Applicant, children will eat in Main Care Space. Main Care Space will also be used for napping. LPA observed standard blue cots that were being stored in off limits bedroom. Per Applicant, she is going to obtain a crib and changing table for infant care provided by Crystal Stairs.

Per Applicant, the children will use the backyard for outdoor play. At 10:15 AM, LPA observed backyard, which is accessible through a sliding glass door through Bedroom 4, to be completely fenced in. LPA observed concrete through out yard with an area to the right that is separated by a wooden fence to have turf grass, plastic playhouse, play tents, and plastic slide well maintained available for children. LPA observed concrete area to have ride along toys, soccer net, and basketball hoop well maintained. LPA observed two storage sheds in backyard with operable lock at time of inspection. LPA observed storage shed contents to have paint cans, pots, cooking supplies, and extra first aid supplies.

At 10:18 AM, LPA observed the valve on the required 2A 10BC fire extinguisher indicates fully charged. with proof of purchase receipt. At 10:20 AM, LPA observed dual smoke and carbon monoxide detector is in operable condition at time of inspection. Per Applicant, First Aid kit is kept in Main Care Area LPA observed First Aid kit and was inventoried for necessary supplies. The Applicant has current Pediatric First Aid and CPR. Proof of immunization against influenza, pertussis, and measles was readily available during today’s inspection. The Applicant has also taken the Mandated Reporter Training
—CPR Card valid until: 07/02/2023
—Fire Extinguisher was purchased on: 10/19/2022
—Mandated Reporter AB1207 Completed: 01/06/2022
Report Continues - Page 2 of 5
SUPERVISORS NAME: Trevino Cochran
LICENSING EVALUATOR NAME: Katrina Chicote
LICENSING EVALUATOR SIGNATURE:

DATE: 03/29/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/29/2022
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: MONROY FAMILY CHILD CARE
FACILITY NUMBER: 198400559
VISIT DATE: 03/29/2022
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Per Applicant, there are no firearms, or weapons in the home. LPA did not observe these items or any bodies of water around the premises. Applicant states she has a small dog that will be kept separate from day care children. LPA did not hear dog during entire time of inspection.

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 for a minimum of 3 years.
· No infant walkers, No Johnny jumpers, No saucer chairs, 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
Report Continues - Page 3 of 5
SUPERVISORS NAME: Trevino Cochran
LICENSING EVALUATOR NAME: Katrina Chicote
LICENSING EVALUATOR SIGNATURE:

DATE: 03/29/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/29/2022
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: MONROY FAMILY CHILD CARE
FACILITY NUMBER: 198400559
VISIT DATE: 03/29/2022
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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

Infant Care: Applicant states that they will care for infants.


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.

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 forms.


Report Continues - Page 4 of 5
SUPERVISORS NAME: Trevino Cochran
LICENSING EVALUATOR NAME: Katrina Chicote
LICENSING EVALUATOR SIGNATURE:

DATE: 03/29/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/29/2022
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: MONROY FAMILY CHILD CARE
FACILITY NUMBER: 198400559
VISIT DATE: 03/29/2022
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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

OTHER INFORMATION AND FORMS PROVIDED:
- LIC 9227
- Safe Sleep Regulation PINs
- Capacity Worksheet
- Lead Safety information

Per Applicant, there are no dual licenses at this address.

The Applicant’s signature on this report acknowledges that they have signed the Application for a Family Child Care Home License (LIC 279) under the penalty of perjury that the statements on the application and any attachments are correct.

Based on LPA's observations, LPA recommends facility to be licensed for a small family child care home. Pending review of Supervisor, a small family child care licensee will be granted. Once licensed, the Applicant is required to comply with the terms and limitations stated on the license.

Exit interview was conducted with Applicant, Jennifer Monroy, who acknowledges receipt of report.
Report Ends - Page 5 of 5
SUPERVISORS NAME: Trevino Cochran
LICENSING EVALUATOR NAME: Katrina Chicote
LICENSING EVALUATOR SIGNATURE:

DATE: 03/29/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/29/2022
LIC809 (FAS) - (06/04)
Page: 5 of 5