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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198400606
Report Date: 01/27/2025
Date Signed: 01/27/2025 11:44:14 AM

Document Has Been Signed on 01/27/2025 11:44 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
MONTEREY PARK SW RO, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME:AMAYA FAMILY CHILD CAREFACILITY NUMBER:
198400606
ADMINISTRATOR/
DIRECTOR:		AMAYA, J/AMAYA, SFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(562) 285-2740
CITY:LONG BEACHSTATE: CAZIP CODE:
90805
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 1DATE:
01/27/2025
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:15 AM
MET WITH:Licensee- Sandra Amaya TIME VISIT/
INSPECTION COMPLETED:
11:55 AM
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* The Licensee was offered translation services at the start of the visit and they declined.*

On January 27, 2025, at 9:15am, Licensing Program Analyst (LPA) Keneisha Dunlap arrived at the above facility for the purpose of an unannounced Annual Inspection. LPA Dunlap announced the purpose of the visit and was granted entry into the facility by Licensee Sandra Amaya. There are 9 children enrolled, and 1 child present at the time of inspection. The hours of operation are Monday- Sunday from 12:00am-11:00pm. All adults in the home were discussed and background and fingerprinted cleared.

License, facility sketch, earthquake disaster checklist, disaster plan, and PUB 394 posted. Licensee does have a current disaster log drill with the date of 8/15/24. Licensee does have current LIC 9040 (facility roster).

LPA observed the smoke detector and carbon monoxide detector to be operable.

LPA observed a fire extinguisher with tag date of 7/9/24.

This is a two story home that consists of 3 bedrooms, 2 bathrooms, 1 living rooms, and kitchen, (fenced) and backyard. The home has central air and heat system.

Main care areas include 2 bedrooms, 1 bathroom, downstairs living room, and outdoor play area .



The living room is used for children to eat. 1 portable playpen. There are age appropriate chairs and tables. LPA Dunlap observed all equipment to be in good condition.

Bedroom # 2 has changing station, age appropriate furniture and toys. The children nap in this room, and cots are stored in closest area. LPA Dunlap observed all equipment to be in good condition.

Bedroom # 3 has age appropriate furniture and toys, and mounted TV. LPA Dunlap observed all equipment to be in good condition. Page 1 of 5
SUPERVISORS NAME: Karen Chambers
LICENSING EVALUATOR NAME: Keneisha Dunlap
LICENSING EVALUATOR SIGNATURE: DATE: 01/27/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/27/2025
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
MONTEREY PARK SW RO, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME: AMAYA FAMILY CHILD CARE
FACILITY NUMBER: 198400606
VISIT DATE: 01/27/2025
NARRATIVE
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The kitchen area is inaccessible to children with baby gates blocking off the entry. All cabinets and drawers have safety latches. The cabinet underneath the sink has a safety latch making it inaccessible to children. The drawer where knives are stored has safety latch making it inaccessible to children. The stove has stove knob covers.

The bathroom area has a working toilet and sink. The cabinet has a safety latch making it inaccessible to children.

The outdoor area for play with age appropriate toys. LPA Dunlap observed outdoor area to be in good condition, free of sharp, loose, or pointed parts.

Staff Files:

Staff # 1

CPR expiration date of 12/23/25

No Mandated Reporter

Missing immunization record (except TB)

Missing all required licensing documents

Staff # 2

CPR expiration date of 12/23/25

Mandated Reporter expiration date of 2/24/26

Missing immunization record (except TB)

Missing all required licensing documents

At 10:10am, LPA Dunlap observed the following:

2 out 2 staff files missing immunization records. This poses a potential health, safety or personal rights risk to persons in care. Type B Violation will be cited. Page 2 of 5

SUPERVISORS NAME: Karen Chambers
LICENSING EVALUATOR NAME: Keneisha Dunlap
LICENSING EVALUATOR SIGNATURE:

DATE: 01/27/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/27/2025
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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
MONTEREY PARK SW RO, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME: AMAYA FAMILY CHILD CARE
FACILITY NUMBER: 198400606
VISIT DATE: 01/27/2025
NARRATIVE
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1 out of 2 staff missing mandated reporter. This poses a potential health, safety or personal rights risk to persons in care. A Technical Violation will be cited.

2 out 2 staff missing all required licensing documents. This poses a potential health, safety or personal rights risk to persons in care. Type B will be cited. LPA Dunlap provided copies of all required licensing forms that need to be filled out and placed in staff files at time of visit.

Children Files
Child #1
All required licensing forms (except LIC9227) and immunization record are in file.

At 10:30am,LPA Dunlap observed incomplete Safe Sleep logs (dates, and/or times missing) and missing LIC9227.

1 out of 1 children files incomplete safe sleep logs. This poses a potential health, safety or personal rights risk to persons in care. Technical Violation will be cited.

1 out of 1 children files missing LIC9227. This poses a potential health, safety or personal rights risk to persons in care. Technical Violation will be cited. LPA Dunlap provided copy of LIC9227 during visit.

The Licensee stated that they do provide meals for children.



The Licensee has a cell phone that they use.

The Licensee stated they do not have any children that they administer medication to at this time.

The Licensee stated that when children are in sick, they are placed in Bedroom #1.

The Licensee stated there are no firearms in the home.

The Licensee stated that there are no smokers in the home.

The Licensee stated that they do provide transportation for children.
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SUPERVISORS NAME: Karen Chambers
LICENSING EVALUATOR NAME: Keneisha Dunlap
LICENSING EVALUATOR SIGNATURE:

DATE: 01/27/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/27/2025
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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
MONTEREY PARK SW RO, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME: AMAYA FAMILY CHILD CARE
FACILITY NUMBER: 198400606
VISIT DATE: 01/27/2025
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The Licensee stated that they do have first aid kit.

There are no large bodies of water on premises.

To improve the quality and value of the new inspection process, a survey may be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or CARE tools, please send email inquiries to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/inspection-process

Criminal Record Clearance - Family Child Care Homes Licensee Sandra Amaya was reminded that all adults 18 and over living or working in the home, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, 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 for a maximum of 5 days or, if the penalty is for a repeat violation, for a maximum of 30 days per person will be assessed if this regulation is violated.

Safe Sleep

LPA discussed the safe sleep regulations with Licensee Sandra Amaya and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-andresources/safe-sleep as an additional resource. LPA also informed Licensee Sandra Amaya 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.

Incidental Medical Services (IMS)

Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02- CCP. 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: https://www.ada.gov/resources/child-carecenters/.

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SUPERVISORS NAME: Karen Chambers
LICENSING EVALUATOR NAME: Keneisha Dunlap
LICENSING EVALUATOR SIGNATURE:

DATE: 01/27/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/27/2025
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
MONTEREY PARK SW RO, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME: AMAYA FAMILY CHILD CARE
FACILITY NUMBER: 198400606
VISIT DATE: 01/27/2025
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MyChildCarePlan.org – Centers and Family Child Care Homes Licensee Licensee Sandra Amaya was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain child care by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.

Megan’s Law - Family Child Care Homes During the exit interview, the Licensee Sandra Amaya confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS.

A notice of site visit was given and must remain posted for 30 days.

Appeal rights explained and given to Licensee Sandra Amaya.

2 Type B deficiencies will be issued during today’s visit.

3 Technical Violations will be issued during today’s visit.

Exit interview conducted and report was reviewed with the Licensee Sandra Amaya

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SUPERVISORS NAME: Karen Chambers
LICENSING EVALUATOR NAME: Keneisha Dunlap
LICENSING EVALUATOR SIGNATURE:

DATE: 01/27/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/27/2025
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 01/27/2025 11:44 AM - It Cannot Be Edited


Created By: Keneisha Dunlap On 01/27/2025 at 11:05 AM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME: AMAYA FAMILY CHILD CARE
FACILITY NUMBER: 198400606

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/27/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
HSC
1597.622(c)
Administration of Child Day Care Licensing
(c) The family day care home shall maintain documentation of the required immunizations or exemptions from immunization, as set forth in this section, in the person's personnel record that is maintained by the family day care home.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review 2 out of 2 staff files did not have immunization records, the licensee did not comply with the section cited above in for not having immunzation record in files, which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 02/03/2025
Plan of Correction
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Staff must obtain records
Email LPA Dunlap copies of records
Place copies in staff files.
Type B
Section Cited
CCR
102416.1(a)(10)
Personnel Records
(a) Personnel records shall be maintained on each employee and shall contain the following information: (10) A signed and dated copy of the Notice of Employee Rights [LIC 9052, (Rev. 03/03)] as required by Section 102416(a) and Section 102417.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, the licensee did not comply with the section cited above in 2 out 2 staff files did not have the required licensing documents, which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 02/03/2025
Plan of Correction
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Have staff fill out all required forms
Email LPA Dunlap copies of all signed forms
Place copes in staff files.
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Karen Chambers
LICENSING EVALUATOR NAME:Keneisha Dunlap
LICENSING EVALUATOR SIGNATURE:
DATE: 01/27/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/27/2025


LIC809 (FAS) - (06/04)
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