198400654-12-7-2022-54-CC-RDEO-CLVQXP-20221207113351

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 198400654
Report Date: 12/07/2022
Date Signed: 12/07/2022 11:34:00 AM

Document Has Been Signed on 12/07/2022 11:34 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:	AMAYA FAMILY CHILD CARE		FACILITY NUMBER:	198400654
ADMINISTRATOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY: 8	TOTAL ENROLLED CHILDREN: 0	CENSUS: 0	DATE:	12/07/2022
TYPE OF VISIT:	Prelicensing	UNANNOUNCED	TIME BEGAN:	09:00 AM
MET WITH:	Applicants - Jose David Amaya and Diego Alexander Amaya		TIME COMPLETED:	11:50 AM

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 12/07/22 at 9:00 AM. LPA met with co-applicants Jose Amaya and Diego Amaya, who guided LPA on a tour of the home. Per applicant, children whom live in the home and were verified via LIC 279B. Individuals residing in the home have been discussed and noted. The applicant is requesting a small family childcare home license. Per applicants, operation hours will be 7 days a week, 23 hours a day. Applicants state 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 two story home that consists of 3 bedrooms, 2 bathrooms, Living Room, Dining Room, Kitchen, Laundry Area, Front yard and backyard (fenced). The garage area has been converted into a living space and also includes an additional living room, bedroom, bathroom, and kitchen/dining area. The off-limit areas include 2 bedrooms, 1 bathroom, kitchen, backyard area, and garage living space. Stairs are made inaccessible using a safety gate. The applicant understands that licensing staff may have access to off-limit areas during inspection visit if necessary. Main care area is located in the living room. LPA observed a child sized table, child sized chairs, age appropriate toys, a wall mounted infant changing table and a wall mounted television. A safety gate was observed at the entrance of the kitchen making it inaccessible. Kitchen was observed to have locks on the cabinets beneath the sink and under the counter. LPA observed cleaning supplies beneath the kitchen sink. No sharp or pointy objects were observed to be accessible in the off-limits kitchen. The downstairs bedroom was observed to have a couch, an infant crib, and napping cots. The bathroom designated for children in care was observed to be sanitary with an operable faucet, sink, and toilet. Child locks were observed beneath the bathroom sink making the contents inaccessible. The front yard play area was observed to have perimeter fencing. A tetherball pole, child sized tables, child sized chairs and children's play equipment were observed in the front yard play area. Per applicant there are no pets, there are no firearms or weapons stored (page 1 of 3)

SUPERVISORS NAME: Trevino Cochran
LICENSING EVALUATOR NAME: Randy Derraco
LICENSING EVALUATOR SIGNATURE:	DATE: 12/07/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/07/2022

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: AMAYA FAMILY CHILD CARE	FACILITY NUMBER: 198400654
	VISIT DATE: 12/07/2022

NARRATIVE

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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, with a service tag dated 10/03/22. Smoke and carbon monoxide detector were tested and are operable.

Areas that will be used by children were inspected for safety, comfort, cleanliness. LPA observed operable telephone service, ventilation and heating (central). The applicants were 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 licensee 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 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.

The applicant states that they will provide food for children in care. Applicant's understand that any food brought from the children’s homes shall be labeled with child’s name and properly stored or refrigerated.

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. Assistants have required training's and 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) (page 2 of 3)

SUPERVISORS NAME: Trevino Cochran
LICENSING EVALUATOR NAME: Randy Derraco
LICENSING EVALUATOR SIGNATURE:	DATE: 12/07/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/07/2022

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: AMAYA FAMILY CHILD CARE	FACILITY NUMBER: 198400654
	VISIT DATE: 12/07/2022

NARRATIVE

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and link to publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: 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

LPA discussed and provided the following documents:
-LIC 9040 - Child Care Facility Roster
-LIC 9227 (spanish) - Individual Infant Sleep Plan
-Infant Sleep Chart
-Safe Sleep FAQ (spanish)
-LIC 311D (spanish) - Forms to be kept in your family child care home
-PIN 20-24-CCP - Recently Approved Safe Sleep Regulations in Effect
-Capacity Regulations for Family Child Care Home License
-LIC 624B - Unusual Incident Report

Applicant is requesting a small family child care license. 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 co-applicants Jose David Amaya and Diego Alexander Amaya.

(page 3 of 3)

SUPERVISORS NAME: Trevino Cochran
LICENSING EVALUATOR NAME: Randy Derraco
LICENSING EVALUATOR SIGNATURE:	DATE: 12/07/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/07/2022

LIC809 (FAS) - (06/04)

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