304314050-10-3-2022-06-CC-MMAK-CJUPGF-20221003111816

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 304314050
Report Date: 10/03/2022
Date Signed: 10/03/2022 11:18:23 AM

Document Has Been Signed on 10/03/2022 11:18 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, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868

FACILITY NAME:	RABANAL, MARIA		FACILITY NUMBER:	304314050
ADMINISTRATOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY: 8	TOTAL ENROLLED CHILDREN: 8	CENSUS: 6	DATE:	10/03/2022
TYPE OF VISIT:	Case Management - Licensee Initiated	UNANNOUNCED	TIME BEGAN:	08:30 AM
MET WITH:	Licensee		TIME COMPLETED:	11:45 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	Page 1 of 4 Licensing Program Analyst (LPA) Mahnaz (Nancy) Malek conducted an unannounced case management inspection for the purpose of increasing capacity from Small Family Childcare Home to Large Family Childcare Home. LPA met with the Licensee, Maria Rabanal, Maria who provided care and supervision to 6 children of whom 2 were under 2 years old. LPA also met with licensee's spouse, Ruben Rabanal. A review of the Facility Personnel Report Summary indicates adult residents, who require caregiver background check clearances, transfers, exemptions have been obtained and they are cleared. Licensee stated, she is not currently registered with any Resource Foster Care agency or holds a Resource foster parent license. Licensee was reminded if changes, to notify the licensing office. Operation hours are Monday to Friday 7:00 AM to 6:00 PM and care and supervision shall be provided to children ages 4 months to 6 years. All areas identified on the facility sketch were inspected, including but not limited to, off limit areas. This is a two story family home with 4 bedrooms, 3 full bathrooms, family room, living with dining area, kitchen, laundry room in the attached garage and back yard with two side yards. Areas that are used by children were inspected for safety, comfort, cleanliness, telephone service (cell phone is the primary contact phone. Ventilation and heating. There is central heat in the home. Home has ceiling vents for air flow. The A/C unit is side yard ( inaccessible to children) Detergents, cleaning compounds, medicines, sharp objects and hazardous items that can pose a danger Continued on page 2

SUPERVISORS NAME: Rina Lopez
LICENSING EVALUATOR NAME: Mahnaz Malek
LICENSING EVALUATOR SIGNATURE:	DATE: 10/03/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/03/2022

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, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868

FACILITY NAME: RABANAL, MARIA	FACILITY NUMBER: 304314050
	VISIT DATE: 10/03/2022

NARRATIVE

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to children are inaccessible in areas designated for children stored in the locked laundry room. The Licensee states (that there are no poisons on the premises). Licensee was advised that any poisons must be locked with a key or combination lock.

Licensee has designated living room, dinning room, kitchen area, and one bedroom in downstairs and all the upstairs area and garage as off limit areas. Licensee has installed child safety gates between the children's area and off limit area in the downstairs and has made the upstairs inaccessible to children by installing a child safety gate in front of the stairs. There is a child proof door knob on the handle of the bedroom downstairs which is off limit to children.. Garage door is in the living area with two bolted locks installed.

During this inspection, LPA observed the designated off limits areas were closed and locked.

Areas Designated for Day care activities: Parents and children enter the home, through the main door of the home, the children shall walk through the living/ dining area, kitchen into the family room the designated Day care room. The designated Day care room is also for infant care, which was observed to have the required Infant items. There are wooden cribs arranged at the side wall of the room with changing table, storage cubbies on one side of the room and other side is where all the activities are arranged for children. The room also has small table with chairs used during dining time and additional activities . High chairs are placed in the corner and rearranged as needed. Licensee has age appropriate furniture, toys and educational items for the ages to be served.

The bathroom is located in the living room, children shall walk from the day care room to access the bathroom, it has a small step stool and toddler toilet seat for the younger toddlers. There is a cabinet under the sink with a safety lock installed. The children's bathroom was observed to be safe and free of hazardous items.

Licensee shall provide Breakfast, AM/PM snacks, lunch if food is brought from home and these containers shall be labelled with their names by the parents and stored accordingly.

Control of property was reviewed.

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SUPERVISORS NAME: Rina Lopez
LICENSING EVALUATOR NAME: Mahnaz Malek
LICENSING EVALUATOR SIGNATURE:	DATE: 10/03/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/03/2022

LIC809 (FAS) - (06/04)

Page: 2 of 4

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868

FACILITY NAME: RABANAL, MARIA	FACILITY NUMBER: 304314050
	VISIT DATE: 10/03/2022

NARRATIVE

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LPA's discussed the Safe Sleep practice with the Licensee Maria Rabanal.
Safe to Sleep Campaign: https://safetosleep.nichd.nih.gov/materials
LPA reviewed with applicant the following safe sleep best practices:
· Always place infants on their backs for sleeping
· Use only a tight-fitting sheet on the crib or play yard mattress
· Do not hang any items from the crib or above the crib
· Keep all items, including blankets, out of the crib or play yard
· Pacifiers may be used if they do not have items attached to them
· Infants should not be swaddled or have any items covering them while sleeping
· The temperature of the room should be comfortable enough for an adult to wear a T-shirt and not be too hot or too cold.
Licensee shall maintain LIC 9227 form & Sleeping plan in the infant file.
Hard copy and link of Child Care Providers Guide to Safe Sleep provided to licensee on this day: https://www.cdph.ca.gov/programs/SIDS/Documents/SIDSchildcaresafesleep.pdf
OUTDOOR PLAY AREA: The outdoor area is all fenced with concrete, mats and grass flooring. Several age appropriate toys and climbing structures are arranged.. Back yard has sufficient shade provided by an umbrella & building shade. Back yard is safe for outdoor activities.
There are no firearms, weapons, bodies of water in the home.

Licensee has one small pet dog (Shihtzu Poodle) which shall remain in the off limit areas during hours of operation.

The value on the 2A10 BC fire extinguisher indicates fully charged, as indicated on service tag observed. Smoke and carbon monoxide detectors were tested and are operable.

APPLICANT WILL WAIT UNTIL FACILITY OPENS TO DETERMINE IMS NEEDS: 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: http://www.ada.gov/childqanda.htm.

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SUPERVISORS NAME: Rina Lopez
LICENSING EVALUATOR NAME: Mahnaz Malek
LICENSING EVALUATOR SIGNATURE:	DATE: 10/03/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/03/2022

LIC809 (FAS) - (06/04)

Page: 3 of 4

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868

FACILITY NAME: RABANAL, MARIA	FACILITY NUMBER: 304314050
	VISIT DATE: 10/03/2022

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Review of records to be maintained : LPA reviewed with the Licensee, Maria Rabanal the LIC 311D, Forms/Records To Keep In Your Family Child Care Homes, children’s forms/records, facility forms/records, and information to be posted.

OTHER INFORMATION AND FORMS PROVIDED: Capacity Handout for a Large Family Child Care Home. LPA explained the age requirements for the enrolled children ensuring that when there are 8 children, at least one child is enrolled in Kindergarten or 6 years old, to be in compliance with Title 22 requirements and additional forms were given to the applicant.

LPA reviewed Title 22 Regulation Section 102423 Personal Rights including but not limited to: no intimidation, no humiliation, and no corporal punishment.

Six children's files who were present today were reviewed and they were in compliance. Roster were complete. Mandated Reporter Training certificate expires 8/24/23 and CPR and 1st aide expires 5/30/2024. Every 15 minutes check on infants' log were reviewed. The facility at the time of Pre-licensing inspection is in compliance for a (Large Family Child Care Home) with Title 22 Regulations.

A notice of site visit was given and must remain posted on, or immediately adjacent to, the interior side of the main door for 30 days.

A copy of this report and Appeal rights were presented to the Licensee.

Fire clearance has received on 7/25/2022. A license with the change in capacity for 14 children (Large Family Child care home) will be issued after final review and management approval.

SUPERVISORS NAME: Rina Lopez
LICENSING EVALUATOR NAME: Mahnaz Malek
LICENSING EVALUATOR SIGNATURE:	DATE: 10/03/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/03/2022

LIC809 (FAS) - (06/04)

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