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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198400682
Report Date: 03/15/2023
Date Signed: 03/15/2023 11:46:40 AM

Document Has Been Signed on 03/15/2023 11:46 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 S WEST, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME:HERNANDEZ CASTRO & SMITH FAMILY CHILD CAREFACILITY NUMBER:
198400682
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 0CENSUS: 0DATE:
03/15/2023
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
09:15 AM
MET WITH:Applicants - Frank Smith and Kimberly Hernandez CastroTIME COMPLETED:
12:00 PM
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Licensing Program Analyst (LPA) Randy Derraco conducted an announced pre-licensing inspection to the above mentioned address on 03/15/23 at 9:15 AM. LPA met with applicants, Frank Smith and Kimberly Hernandez Castro, who guided LPA on a tour of the home. LPA did not observe any additional adults or children during inspection. Individuals residing in the home have been discussed and noted. The applicant is requesting a small family childcare home license. Per applicant, operation hours will be Sunday through Saturday, 5:00 AM to 3:00 AM. Applicant states that they will care for children 0 to 13 years old.

All areas identified on the facility sketch were inspected, including but not limited to, off limit areas. This is a one story home that consists of 2 bedrooms, 1 bathrooms, Living Room, Den, Dining Room, Kitchen, Detached Garage, Front yard and Backyard (fenced). Off-limit areas include 1 bedroom, Kitchen, Den, Front Yard, and Detached Garage.

Main care areas includes the living room. LPA observed a wall mounted television, child sized table, child sized chairs, Ingenuity feeding table, a leather couch, age appropriate toys and educational posters. A wooden gate was observed to separate the off-limits kitchen area from the main care area. Door knob covers were observed on all door knobs in the home. Bedroom one was observed to have two wooden baby cribs, a wooden baby changing station, additional age appropriate toys and material. LPA observed sleeping cots and sleeping mats stored in the closet of bedroom 1. Per applicants, children showing signs of illness will be separated into bedroom 1 while they await parent pick up. The bathroom was observed to be clean with an operable sink, faucet and toilet. Latch locks were observed on the drawers beneath the sink. LPA observed the cabinet beneath the sink to be empty. The outdoor play area is located in the back yard. LPA observed perimeter fencing, outdoor play equipment, a foldable picnic table and a tree. Applicants state that they intends to have children bring food from home. LPA advised licensee that food brought from home must be individually labeled and properly stored. LPA observed a pet dog on the premises. Per applicants, pet dog


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SUPERVISORS NAME: Karen Chambers
LICENSING EVALUATOR NAME: Randy Derraco
LICENSING EVALUATOR SIGNATURE: DATE: 03/15/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/15/2023
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 3
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MONTEREY PARK S WEST, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME: HERNANDEZ CASTRO & SMITH FAMILY CHILD CARE
FACILITY NUMBER: 198400682
VISIT DATE: 03/15/2023
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will be kept in the off-limits Den of the home. Per applicant, 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 Applicants have a 2A10 BC fire extinguisher in the home with a purchase receipt dated 11/07/22. 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 (wall heater located in off-limit area of home). Detergents, cleaning compounds and hazardous items that can pose a danger to children are made inaccessible in a closet on a high shelf located in the hallway. 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 and in bedroom 1. Applicant does plan on enrolling infants 0-24 months.


LPA discussed the safe sleep regulations with co-applicants 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 co-applicants 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 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.


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: http://www.ada.gov/childqanda.htm.
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SUPERVISORS NAME: Karen Chambers
LICENSING EVALUATOR NAME: Randy Derraco
LICENSING EVALUATOR SIGNATURE:

DATE: 03/15/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/15/2023
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
MONTEREY PARK S WEST, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME: HERNANDEZ CASTRO & SMITH FAMILY CHILD CARE
FACILITY NUMBER: 198400682
VISIT DATE: 03/15/2023
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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 documents were provided and discussed with the applicants:
LIC 311D - Forms/Records to Keep in your Family Child Care Home
PIN 20-24-CCP - Recently Approved Sae Sleep Regulations in Effect
Infant Sleep Chart
LIC 9227 - Individual Infant Sleeping Plan
LIC 624B - Unusual Incident /Injury Report
Assistant's File Checklist
Children's File Checklist
Protect Your Child from Lead in Paint Flyer

Prior to approval for a small family child care license, the following corrections must be observed:

-The side of the home located in the backyard play area needs to be made inaccessible


-A lock on the cabinet that contains cleaning supplies must be installed
-First Aid supplies must be made available

Exit interview conducted and report was reviewed with the co-applicants Frank Smith and Kimberly Hernandez Castro.

(page 3 of 3)

SUPERVISORS NAME: Karen Chambers
LICENSING EVALUATOR NAME: Randy Derraco
LICENSING EVALUATOR SIGNATURE:

DATE: 03/15/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/15/2023
LIC809 (FAS) - (06/04)
Page: 3 of 3