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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 336300957
Report Date: 11/28/2023
Date Signed: 11/28/2023 03:46:24 PM

Document Has Been Signed on 11/28/2023 03:46 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
RIVERSIDE SOUTH EAST, 3737 MAIN STREET, STE 700
RIVERSIDE, CA 92501
FACILITY NAME:DOMINGUEZ FAMILY CHILD CAREFACILITY NUMBER:
336300957
ADMINISTRATOR:DOMINGUEZ, SYLVIAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(760) 834-5034
CITY:INDIOSTATE: CAZIP CODE:
92203
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 0DATE:
11/28/2023
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
08:55 AM
MET WITH:Sylvia DominguezTIME COMPLETED:
11:15 AM
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On date at 8:55 AM, Licensing Program Analyst (LPA) Lorena Valenzuela arrived at the facility to conduct a pre-licensing inspection. The licensee was is currently licensed at 83-899 Carolina Ct Indio CA and has applied to relocate the childcare. Present during this inspection were: Sylvia Dominguez and Yolanda Dominguez. The home is a one story with 4 bedrooms, 3 bathrooms, with attached garage. LPA toured the facility, inside and out with Sylvia Dominguez and the following was observed and/or discussed:

· Per Sylvia Dominguez, off-limit areas include: garage, bedroom 1,3,4, the backyard, pantry, laundry room
· Normal hours of operation will be: Monday to Friday, 12 am to 11:59 pm
· Smoke detectors and Carbon Monoxide detectors were tested by Sylvia Dominguez during this inspection and were in working order.
· The fire extinguisher met standards established by the State Fire Marshal.
· All hazardous items were observed to be inaccessible. Storage of poisons and toxins are inaccessible to children and locked in the laundry room. Sharp items including kitchen knives, are inaccessible and stored in the pantry. Medicines are locked and stored in top kitchen cabinet.
· No guns or weapons are stored in the facility as stated by Sylvia Dominguez as of this date. Licensee understands all guns, weapons and ammunition must be key locked separately and made inaccessible per Title 22 Regulations.
· This is a one story home
· The fireplace is properly screened
· Clean, safe and age appropriate toys were observed
· There are no bodies of water observed on 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.
SUPERVISORS NAME: Deborah Mullen
LICENSING EVALUATOR NAME: Lorena Valenzuela
LICENSING EVALUATOR SIGNATURE: DATE: 11/28/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/28/2023
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
RIVERSIDE SOUTH EAST, 3737 MAIN STREET, STE 700
RIVERSIDE, CA 92501
FACILITY NAME: DOMINGUEZ FAMILY CHILD CARE
FACILITY NUMBER: 336300957
VISIT DATE: 11/28/2023
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 The Department must be notified before and after installation of the bodies of water described. In addition, all wading pools or similar product must be emptied immediately after use and stored in an upright position when not in use.
· There were no toxic plants inside or outside the facility observed at this time
· The outside activity area consists of: outdoor area with grass and patio with cement. Per Ms. Dominguez is currently working on the grass area of the backyard and will use the cement patio for now. Ms. Domiguez agrees to contact the Department once is ready to make the grass area accessible to children in care.
· Verification of control of property is maintained by applicant
· Facility Sketch and Emergency Disaster Plan are posted
· Pediatric CPR and First Aid Card - expire 07/2024
· Preventive Health and Safety training, including nutrition and lead components have been completed by Sylvia Dominguez.
· Licensee Sylvia Dominguez, confirmed there are no Registered Sex Offenders living in the facility and/or using the facility address for their mailing address.

During this inspection, LPA reviewed COVID-19 guidance and resources with Sylvia Dominguez and advised to stay up to date with COVID-19 restrictions and guidance by checking the California Department of Public Health website; local health department website Riverside County Public Health Department); and Community Care Licensing Division, Provider Information Notices (PIN).

Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Family Child Care Homes Section 102417. 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

Licensee was reminded all adults 18 and over living or working in the home, 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.
SUPERVISORS NAME: Deborah Mullen
LICENSING EVALUATOR NAME: Lorena Valenzuela
LICENSING EVALUATOR SIGNATURE:

DATE: 11/28/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/28/2023
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
RIVERSIDE SOUTH EAST, 3737 MAIN STREET, STE 700
RIVERSIDE, CA 92501
FACILITY NAME: DOMINGUEZ FAMILY CHILD CARE
FACILITY NUMBER: 336300957
VISIT DATE: 11/28/2023
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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.
LPA reviewed with licensee, the LIC 311d, Records To Be Maintained At The Facility, for child’s records, personnel records, administrative records, and documents to be posted.
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.
The following reminders were reviewed with licensee during inspection:
- Title 22 Reporting Requirements and the Regional Office Unusual Incident Reporting email mailbox: UnusualIncidentReportsDO10@dss.ca.gov
-Fingerprint transfer forms to associate new individuals or to disassociate someone from the facility at: Associations_Disassociations858@dss.ca.gov
- The Duty Officer is available to answer questions Monday – Friday 8:00am to 5:00pm at:
1-844-LET-US-NO (1-844-538-8766) and/or 951-782-4200.
Before licensure, the following needs to be corrected/completed:
1. Will make laundry room inaccessible/locked
2. Will make grass backyard area inaccessible to children in care
3. Parent board with required postings

Once all corrections have been verified, the relocation application for a Large Family Child Care Home will be submitted for approval with a maximum capacity of 12, or 14 with parent notification. Licensee advised that all corrections are due within 30 days or the application may be withdrawn.

Exit interview conducted and report was reviewed with licensee Sylvia Dominguez.
SUPERVISORS NAME: Deborah Mullen
LICENSING EVALUATOR NAME: Lorena Valenzuela
LICENSING EVALUATOR SIGNATURE:

DATE: 11/28/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/28/2023
LIC809 (FAS) - (06/04)
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