198400632-10-25-2022-54-CC-RDEO-CKJR27-20221025123753

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 198400632
Report Date: 10/25/2022
Date Signed: 10/25/2022 12:38:01 PM

Document Has Been Signed on 10/25/2022 12:38 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:	CONTRERAS FAMILY CHILD CARE		FACILITY NUMBER:	198400632
ADMINISTRATOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY: 8	TOTAL ENROLLED CHILDREN: 0	CENSUS: 0	DATE:	10/25/2022
TYPE OF VISIT:	Prelicensing	UNANNOUNCED	TIME BEGAN:	10:15 AM
MET WITH:	Applicant - Ericka Contreras		TIME COMPLETED:	12:45 PM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	Licensing Program Analyst (LPA) Randy Derraco conducted an announced pre-licensing inspection to the above mentioned address on 10/25/22 at 10:15 AM. LPA met with applicant, Ericka Contreras, who guided LPA on a tour of the home. There were no children present during this inspection. Per applicant, children that reside in the home were verified via LIC 279B. Individuals residing in the home have been noted and discussed. The applicant is requesting a small family childcare home license. Per applicant, operation hours will be Sunday to Saturday 23 hours a day. Applicant states that they will care for children 0-13 years old. All areas identified on the facility sketch were inspected, including but not limited to, off limit areas. This is a 2 story home with a shared wall that consists of 5 bedrooms, 4 bathrooms, 2 Living Rooms, 1 Dining Room, 2 Kitchens, Laundry Area, Front yard and backyard (fenced). Off limit areas include 2 bedrooms, kitchen, laundry area, front yard, and back yard. LPA observed that the home has a shared wall with the entrance to the living space located in the backyard. The living space consists of 3 bedrooms, 3 bathrooms, kitchen and living room. LPA observed stairs in the off limits living space. The entire living space located in the back yard is off-limits. Main care areas include the living room. Parents will enter the facility through the front door. Prior to entrance, applicant states she will conduct self assessment questions and take temperatures of children prior to accepting them into care for the day. LPA observed 2 wooden cribs, a wooden baby changing station, a wall mounted television, a children's carpet, a storage cubby, age appropriate toys and materials. The dining area was observed to have a child sized table, child sized chairs and a Graco brand feeding high chair. A baby gate was observed in the dining area making the kitchen inaccessible. LPA observed child locks on the kitchen cabinet. No sharp objects were observed to be accessible in the kitchen. Per applicant, cleaning supplies are kept locked beneath the kitchen sink. Applicant states that she will provide food for children in care. Applicant understands that any food brought from the children’s homes shall be labeled with child’s (page 1 of 3)

SUPERVISORS NAME: Trevino Cochran
LICENSING EVALUATOR NAME: Randy Derraco
LICENSING EVALUATOR SIGNATURE:	DATE: 10/25/2022

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/25/2022

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: CONTRERAS FAMILY CHILD CARE	FACILITY NUMBER: 198400632
	VISIT DATE: 10/25/2022

NARRATIVE

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name and properly stored or refrigerated. The bathroom designated for children in care was observed to be sanitary with an operable sink and toilet. LPA observed operable telephone service, ventilation and heating (central). The applicant was advised that any poisons must be locked, not just inaccessible. Parent board is visible in the main care area with required postings. Children will nap on cots in the main care area. Applicant does plan on enrolling infants 0-24 months.

LPA discussed the safe sleep regulations with applicant 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 applicant 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.

Per applicant there is a pet dog that is located in the off-limits area of the property. There are no firearms or weapons stored in the home and there are no bodies of water. LPA did not observe any of the above items. LPA observed that the Applicant has a 2A10 BC fire extinguisher in the home, purchase tag dated 07/27/22. Smoke and carbon monoxide detector were tested and are operable.

The applicant has completed the required Health and Safety Training, Nutrition, and Lead Training, Mandated Reporter Training and Pediatric First Aid and CPR. Applicant has proof of required immunization's. There are first aid supplies available.

LPA Provided COVID-19 Technical Assistance by emailing applicant COVID-19 resources and self-assessment prior to visit. LPA discussed self-assessment and answered question regarding COVID-19.

Incidental Medical Services (IMS):

This facility may provide Incidental Medical Services – IMS. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Family Child Care Homes Section 102417. 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:
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SUPERVISORS NAME: Trevino Cochran
LICENSING EVALUATOR NAME: Randy Derraco
LICENSING EVALUATOR SIGNATURE:	DATE: 10/25/2022

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/25/2022

LIC809 (FAS) - (06/04)

Page: 2 of 3

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: CONTRERAS FAMILY CHILD CARE	FACILITY NUMBER: 198400632
	VISIT DATE: 10/25/2022

NARRATIVE

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http://www.ada.gov/childqanda.htm.

LPA advised the applicant how to access forms, regulations and quarterly updates on the Child Care Licensing website at: www.cdss.ca.gov.

The following forms were provided and discussed with the applicant:

-LIC624B - Unusual Incident Report
-LIC9227 - Individual Infant Sleep Plan
-PIN 20-24-CCP - Recently Approved Safe Sleep Regulations in Effect
-LIC 311D - Forms/Records to Keep In Your Family Child Care Home
-LIC 9040 - Child Care Facility Roster
-Infant Sleep Chart
-Small Family Child Care Capacity Flyer

A small family childcare license may be granted upon Licensing Program Manager (LPM) Approval. Once licensed, the applicant is required to comply with the terms and limitations stated on the license.

Exit interview conducted and report was reviewed with the applicant Ericka Contreras.

(page 3 of 3)

SUPERVISORS NAME: Trevino Cochran
LICENSING EVALUATOR NAME: Randy Derraco
LICENSING EVALUATOR SIGNATURE:	DATE: 10/25/2022

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/25/2022

LIC809 (FAS) - (06/04)

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