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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 364816117
Report Date: 05/24/2024
Date Signed: 05/24/2024 02:27:56 PM

Document Has Been Signed on 05/24/2024 02:27 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 CC RO, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501
FACILITY NAME:CHAVEZ FAMILY CHILD CAREFACILITY NUMBER:
364816117
ADMINISTRATOR/
DIRECTOR:		FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 3DATE:
05/24/2024
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:15 PM
MET WITH:Dolores ChavezTIME VISIT/
INSPECTION COMPLETED:
02:40 PM
NARRATIVE
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On date and time listed, Licensing Program Analyst (LPA) Aman Lama arrived at the facility to conduct a Case Management Licensee Initiated inspection. The licensee has applied for a capacity increase from a Small Family Child Care Home (FCCH) capacity of 8 to a Large FCCH capacity of 14. A Fire Clearance was granted on 02/22/2024. LPA toured the facility, inside and out.
Records were reviewed, and the following was observed and/or discussed:

Normal days and hours of operation are: Monday – Friday 6AM – 6PM.

OFF-LIMIT AREAS INCLUDE: All bedrooms, the garage and outdoor side yard.

· The facility is operating within the licensed capacity and appropriate ratios.



· A working telephone is present and current number is on file

· Fire extinguisher, smoke detector & carbon monoxide detector were present during this inspection.

· All toxins and hazardous items are locked and inaccessible to children.

· No Weapons present in the home. Licensee understands all guns, weapons and ammunition must be key locked separately and made inaccessible per Title 22 Regulations.

·Verification of control of property is on file.

· Postings were observed in the home: Facility Sketch, Emergency Disaster Plan & Notification of Parent’s Rights poster were posted in the home.

· Appropriate Mandated Reporter Training for licensee has been updated and expires 11/15/2024.

· Pediatric CPR and First Aid Card for licensee was on file and expires 12/2025.

SUPERVISORS NAME: Ana Noble
LICENSING EVALUATOR NAME: Aman Lama
LICENSING EVALUATOR SIGNATURE: DATE: 05/24/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/24/2024
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 CC RO, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501
FACILITY NAME: CHAVEZ FAMILY CHILD CARE
FACILITY NUMBER: 364816117
VISIT DATE: 05/24/2024
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·Health & Safety Certificate has been completed on 02/28/2004.

· Bodies of water were not observed on property at this time. Licensee understands all bodies of water including ponds, above ground pools & spas, in-ground pools & 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.

· Clean, safe and age appropriate toys were available to the daycare children.

· A complete and updated roster was made available during today’s inspection.

· Documentation of fire and disaster drills are on file – Last drill was conducted on: 03/2024

· The Licensee was informed of their reporting requirements and is provided with the Regional Office’s Unusual Incident Reporting email: UnusualIncidentReportsDO09@dss.ca.gov

· Resident and/or staff records reviewed indicate that all adults who require caregiver background checks have received all required clearances or exemptions.

· The Licensee can submit transfer forms to associate new individuals or to disassociate someone from the facility at: Associations_Disassociations862@dss.ca.gov

-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 that 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: Ana Noble
LICENSING EVALUATOR NAME: Aman Lama
LICENSING EVALUATOR SIGNATURE:

DATE: 05/24/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/24/2024
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
RIVERSIDE CC RO, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501
FACILITY NAME: CHAVEZ FAMILY CHILD CARE
FACILITY NUMBER: 364816117
VISIT DATE: 05/24/2024
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- The Duty Officer is available to answer questions Monday – Friday, 8am to 5pm at: 951-782-4200
-Complaint hotline is also available Monday-Friday, 8am-5pm

The Licensee, Dolores Chavez confirmed that there are no Registered Sex Offenders living in the facility and/or using the facility address for their mailing address.

The capacity for a Large Family Child Care Home (FCCH) will be submitted for licensee to care for 12 children, up to 14 children with parent notification.

Exit interview conducted and report was reviewed with the licensee, Dolores Chavez.

A notice of site visit was given and must remain posted for 30 days.

SUPERVISORS NAME: Ana Noble
LICENSING EVALUATOR NAME: Aman Lama
LICENSING EVALUATOR SIGNATURE:

DATE: 05/24/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/24/2024
LIC809 (FAS) - (06/04)
Page: 3 of 3