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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 364843526
Report Date: 08/01/2024
Date Signed: 08/01/2024 03:56:13 PM

Document Has Been Signed on 08/01/2024 03:56 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:DE ALBA FAMILY CHILD CAREFACILITY NUMBER:
364843526
ADMINISTRATOR/
DIRECTOR:		AMARUCHY D.FACILITY TYPE:
810
ADDRESS:TELEPHONE:
(909) 258-2290
CITY:RIALTOSTATE: CAZIP CODE:
92376
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 3DATE:
08/01/2024
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:00 PM
MET WITH:Amaruchy De La Paz De AlbaTIME VISIT/
INSPECTION COMPLETED:
04:15 PM
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On 08/01/2024 at 12:00 PM, Licensing Program Analyst (LPA) Tiffanie Diep arrived at the facility to conduct an annual inspection. LPA toured inside and outside of the home, reviewed records, and observed and/or discussed the following:
  • Licensee Amaruchy De La Paz De Alba’s preferred language is Spanish. Licensee was able to speak and understand English.
  • LPA was greeted by Licensee’s in-laws (S2 and S3) upon arrival as Licensee was not home at the time. At approximately 12:45 PM, Licensee returned to the facility with three day care children. Licensee’s two minor children (C1 and C2) were also present during the inspection.
  • Normal days and hours of operation are Monday through Friday from 4:00 AM to 6:00 PM.
  • Off-limits areas include: all four bedrooms, kitchen, garage, and backyard.
  • The facility was operating within the licensed capacity and appropriate ratios.
  • Appropriate supervision was provided during the inspection.
  • A working telephone was present with current number on file.
  • An appropriate fire extinguisher was present. A functioning smoke detector and carbon monoxide detector were present and tested by Licensee during the inspection.
  • Fireplace was properly screened to prevent access by children in care.
  • All hazardous items were stored inaccessible to children.
  • There are no weapons present in the home per Licensee. Licensee understands all firearms, weapons, and ammunition must be locked separately and made inaccessible to children in care according to Title 22 Regulations.
  • Facility is a one-story home.
  • Verification of control of property on file (Deed).

Continues on LIC 809-C
SUPERVISORS NAME: Ana Noble
LICENSING EVALUATOR NAME: Tiffanie Diep
LICENSING EVALUATOR SIGNATURE: DATE: 08/01/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/01/2024
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 6
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: DE ALBA FAMILY CHILD CARE
FACILITY NUMBER: 364843526
VISIT DATE: 08/01/2024
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Continued from LIC 809 (Page 2)
  • Facility sketches, Emergency Disaster Plan (LIC 610A), and Notification of Parents' Rights poster (PUB 394) were posted.
  • Preventive health and safety training was completed on 10/27/2012.
  • Pediatric CPR and first aid certification expires on 06/28/2025.
  • Mandated Reporter Training certificate expires on 06/15/2025.
  • The backyard has an in-ground pool area that is fenced according to Title 22 Regulations, and LPA observed the gate to self-close. LPA observed the gate did not self-latch due to the rusted material. Licensee understands all bodies of water, including in-ground and above-ground pools, hot tubs, spas, and ponds, must be inaccessible to children in care and be properly covered or fenced according to Title 22 Regulations. The Department must be notified prior to installation of these and similar bodies of water.
  • Clean, safe, and age-appropriate toys were present.
  • A current roster of children was on file.
  • Documentation of fire and disaster drills was on file; last drill was conducted on 04/17/2024.
  • Children’s records were complete.
  • Staff records were not complete. LPA did not observe all required immunizations for S2 and S3. S2 and S3 were not present with day care children at the time of inspection. LPA reminded Licensee to maintain documentation of the required immunizations for all employees and volunteers.
  • Licensee was informed of their reporting requirements and was provided with the Regional Office’s Unusual Incident Reporting e-mail at UnusualIncidentReportsDO09@dss.ca.gov.
  • Licensee can submit transfer forms to associate new individuals or to disassociate someone from their facility via e-mail to Associations_Disassociations862@dss.ca.gov.
  • The Duty Officer is available to answer questions Monday through Friday from 8:00 AM to 5:00 PM at (951) 782-4200.
  • Resident and/or staff records reviewed during today’s inspection indicate that all adults who require caregiver background checks have received all required clearances or exemptions.
SUPERVISORS NAME: Ana Noble
LICENSING EVALUATOR NAME: Tiffanie Diep
LICENSING EVALUATOR SIGNATURE:

DATE: 08/01/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/01/2024
LIC809 (FAS) - (06/04)
Page: 2 of 6
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: DE ALBA FAMILY CHILD CARE
FACILITY NUMBER: 364843526
VISIT DATE: 08/01/2024
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Continued from LIC 809-C (Page 3)

Licensee was reminded that all adults 18 and over living or working in the home, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, 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 for a maximum of five days or, if the penalty is for a repeat violation, for a maximum of 30 days per person will be assessed if this regulation is violated.

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.

This facility provides Incidental Medical Services - IMS. LPA reviewed storage of medication and equipment/supplies, and reviewed children’s, personnel, and administrative records. For IMS information, see PIN 22-02-CCP. The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice) or (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA, available at https://www.ada.gov/resources/child-care-centers/.
SUPERVISORS NAME: Ana Noble
LICENSING EVALUATOR NAME: Tiffanie Diep
LICENSING EVALUATOR SIGNATURE:

DATE: 08/01/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/01/2024
LIC809 (FAS) - (06/04)
Page: 3 of 6
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: DE ALBA FAMILY CHILD CARE
FACILITY NUMBER: 364843526
VISIT DATE: 08/01/2024
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Continued from LIC 809-C (Page 4)

To improve the quality and value of the new inspection process, a survey may be sent to the e-mail address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or CARE Tool, please send e-mail inquiries to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at https://www.cdss.ca.gov/inforesources/community-care-licensing/inspection-process. Licensee was informed of the MyChildCarePlan.org site, a consumer education website that helps families obtain child care by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.

There were no deficiencies cited at this time. See attached LIC 9102 for advisory notes. An exit interview was conducted and report was reviewed with the licensee, Amaruchy De La Paz De Alba. During the exit interview, Licensee confirmed that there are no registered sex offenders (RSO) living in the facility and LPA completed the RSO profile in the Field Automation System. A notice of site visit was given to Licensee and must remain posted on, or immediately adjacent to, the interior side of the main door for 30 days. A copy of Appeal Rights (LIC 9058) in Spanish was provided to Licensee.
SUPERVISORS NAME: Ana Noble
LICENSING EVALUATOR NAME: Tiffanie Diep
LICENSING EVALUATOR SIGNATURE:

DATE: 08/01/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/01/2024
LIC809 (FAS) - (06/04)
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