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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 336300613
Report Date: 03/09/2023
Date Signed: 03/09/2023 11:16:12 AM

Document Has Been Signed on 03/09/2023 11:16 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, 3737 MAIN STREET, STE 700
RIVERSIDE, CA 92501
FACILITY NAME:DIAZ FAMILY CHILD CAREFACILITY NUMBER:
336300613
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 0CENSUS: 2DATE:
03/09/2023
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Kaillie DiazTIME COMPLETED:
11:30 AM
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On date and time listed, Licensing Program Analyst (LPA) Sumayya Habeebulla arrived at the facility to conduct a pre-licensing inspection. Present during this inspection were: Applicant Kailie Diaz and her 2 children. LPA toured the facility, inside and out and the following was observed and/or discussed:

· Normal days and hours of operation are: Mon – Fri, 8 AM to 4 PM


· OFF-LIMIT AREAS INCLUDE: Kitchen, Formal Living Room, Dining Area, Master Bedroom, 2 Additional Bedrooms (children), Garage, and Laundry Room.
· Appropriate fire extinguisher - 2A:10BC was not present. Applicant will be obtaining one. Smoke detector and carbon monoxide detector are present and were tested by the applicant during this inspection. Smoke detector and carbon monoxide detector are in working order.
· All hazardous items inaccessible
· Toxins locked.
· Weapons are present as of this date. Applicant understands all guns, weapons and ammunition must be key locked separately and made inaccessible per Title 22 Regulations. Ammunition is not key locked. Applicant will be locking it and sending pictures of correction within 30 days of this visit.
· Stairs are not applicable this is a single-story home
· The fireplace is properly screened.
· Storage of poisons is inaccessible to children and locked.
· Verification of control of property on file – viewed Property Tax Bill
SUPERVISORS NAME: Carlos Martinez
LICENSING EVALUATOR NAME: Sumayya Habeebulla
LICENSING EVALUATOR SIGNATURE: DATE: 03/09/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/09/2023
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, 3737 MAIN STREET, STE 700
RIVERSIDE, CA 92501
FACILITY NAME: DIAZ FAMILY CHILD CARE
FACILITY NUMBER: 336300613
VISIT DATE: 03/09/2023
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· Facility Sketch and Emergency Disaster Plan are posted
· Pediatric CPR and First Aid Card - expire 08/18/25
· Mandated Reporter completed on 08/14/21
· Health & Safety Certificate - completed on 08/21/21
· There are no bodies of water as of this date. Applicant understands all bodies of water including ponds, above ground pools and spas, in-ground pools and spas, and some fountains must be properly covered or fenced per title 22 regulations. The Department must be notified before and after installation of the above types of bodies of water. In addition, all wading pools or similar product must be emptied immediately after use and stored in an upright position when not in use.
· Clean, safe and age-appropriate toys
· There are no toxic plants observed at this time
· 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.

· 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
SUPERVISORS NAME: Carlos Martinez
LICENSING EVALUATOR NAME: Sumayya Habeebulla
LICENSING EVALUATOR SIGNATURE:

DATE: 03/09/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/09/2023
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, 3737 MAIN STREET, STE 700
RIVERSIDE, CA 92501
FACILITY NAME: DIAZ FAMILY CHILD CARE
FACILITY NUMBER: 336300613
VISIT DATE: 03/09/2023
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· Applicant, was reminded that all adults 18 and over living in the home, persons who provide care and supervision to children, and staff who have contact with children, including employees and volunteers, 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 up to $500.00 maximum per day/per person will be assessed if this regulation is violated.

· The Licensee can submit transfer forms to associate new individuals or to disassociate someone from your facility at: Associations_Disassociations858@dss.ca.gov

· There is a trampoline on the premises and the applicant states that it will be used by children in care. The trampoline and its surrounding cover appear to be in good repair with no tears or exposed springs. The manufacturer of the trampoline is Sky Walker Trampolines and the licensee has the manufacturer’s instructions and guidelines. The licensee agrees to only use the trampoline in accordance with the manufacturer’s guidelines and will provide adequate supervision to all children in care. Applicant provided a written letter stating that Parental Permission would be obtained before child care children can use it. ______________________
SUPERVISORS NAME: Carlos Martinez
LICENSING EVALUATOR NAME: Sumayya Habeebulla
LICENSING EVALUATOR SIGNATURE:

DATE: 03/09/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/09/2023
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, 3737 MAIN STREET, STE 700
RIVERSIDE, CA 92501
FACILITY NAME: DIAZ FAMILY CHILD CARE
FACILITY NUMBER: 336300613
VISIT DATE: 03/09/2023
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The following was discussed with the applicant(s):

- Pre-Licensing Visit Packet provided (children’s/staff records & posting requirements included)

- Failure to meet the posting requirements shall result in an immediate $100 civil penalty.

- Documentation of fire & earthquake drills to be conducted every six months

- Responsibilities of being a mandated reporter – Training needs to be renewed every two years.

- Access to forms & Regulations for Family Child Care online at www.ccld.ca.gov

- Responsibility to know the regulations for anyone providing care

- Inaccessibility of hazards must be constantly reassessed depending on the children in care

- Current facility’s phone numbers must be on file with the licensing office at all times

- Baby walkers, bouncy seats, exer-saucers and other similar items are prohibited

- The applicant is urged to visit the U.S. Consumer Product Safety Commission webpage at www.cpsc.gov to ensure that equipment purchased for the day care has not been recalled

- Once licensed, the Notice of Site Visit must be posted at the entrance of the facility for a period of 30 days. If a serious violation is cited, a copy of the licensing report (LIC809/LIC9099) must also be posted for 30 days. A civil penalty of $100 per violation will be assessed for noncompliance.

- Effective January 1, 2017 – Children under 2 years of age shall ride in a rear-facing car seat unless the child weighs 40 or more pounds OR is 40 or more inches tall. For additional information regarding car seat laws see www.chp.ca.gov

SUPERVISORS NAME: Carlos Martinez
LICENSING EVALUATOR NAME: Sumayya Habeebulla
LICENSING EVALUATOR SIGNATURE:

DATE: 03/09/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/09/2023
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, 3737 MAIN STREET, STE 700
RIVERSIDE, CA 92501
FACILITY NAME: DIAZ FAMILY CHILD CARE
FACILITY NUMBER: 336300613
VISIT DATE: 03/09/2023
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- The Duty Officer is available to answer questions Monday – Friday at 1-844-LET-US-NO (1-844-538-8766).

- The Licensee was informed of their reporting requirements and is provided with the Regional Office’s Unusual Incident Reporting email mailbox: UnusualIncidentReportsDO10@dss.ca.gov

Before licensure, the following needs to be corrected/completed:

1. Applicant will obtain a Fire Extinguisher – 2A10BC and send pictures to the department within 30 days of this visit.


2. Set up the Nap room for childcare and send pictures to the Department
3. Lock cabinets in the hall way and send pictures to the department
4. Store the water Hose in the backyard to prevent tripping hazard
5. Flu decline for Applicant and spouse
6. Mandated Reporter Certificate - General
7. LIC 9108 - for Spouse

Once all corrections have been verified, the application for a Small Family Child Care Home will be submitted for approval with a maximum capacity of 6, or 8 with parent notification. Applicant advised that all corrections are due within 30 days or the application may be withdrawn. An exit interview was conducted, and a copy of this report was provided to the applicant on this date.



During the exit interview, the Applicant Kailie Diaz, confirmed that there are no Registered Sex Offenders living in the facility and/or using the facility address for their mailing address.

LPA reviewed with applicant, 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

SUPERVISORS NAME: Carlos Martinez
LICENSING EVALUATOR NAME: Sumayya Habeebulla
LICENSING EVALUATOR SIGNATURE:

DATE: 03/09/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/09/2023
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, 3737 MAIN STREET, STE 700
RIVERSIDE, CA 92501
FACILITY NAME: DIAZ FAMILY CHILD CARE
FACILITY NUMBER: 336300613
VISIT DATE: 03/09/2023
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Entrance Checklist was provided to the applicant.

Subscribe to CCLD important information

Community Care Licensing Division (CCLD) regularly sends information to licensed facilities, providers, and stakeholders by way of Provider Information Notices (PIN), Program Quarterly Update Newsletters and other important information communication platform.

To receive important licensed-related information to licensed facilities, visit the CCLD Important Information website at https://www.cdss.ca.gov/inforesources/community-care-licensing/subscribe and select the Child Care option to receive email communication.

Exit interview conducted and report was reviewed with the applicant, Kailie Diaz.

A copy of this report was left with the Applicant and a copy must be made available upon request, to the public for 3 years.

SUPERVISORS NAME: Carlos Martinez
LICENSING EVALUATOR NAME: Sumayya Habeebulla
LICENSING EVALUATOR SIGNATURE:

DATE: 03/09/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/09/2023
LIC809 (FAS) - (06/04)
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