376300611-4-20-2023-10-CC-CHAN-CR3T27-20230420142017

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 376300611
Report Date: 04/20/2023
Date Signed: 04/20/2023 02:20:26 PM

Document Has Been Signed on 04/20/2023 02:20 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
CCLD Regional Office, 3737 MAIN STREET, STE 700
RIVERSIDE, CA 92501

FACILITY NAME:	SERVIN FAMILY CHILD CARE		FACILITY NUMBER:	376300611
ADMINISTRATOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY: 8	TOTAL ENROLLED CHILDREN: 4	CENSUS: 2	DATE:	04/20/2023
TYPE OF VISIT:	Case Management - Licensee Initiated	UNANNOUNCED	TIME BEGAN:	01:10 PM
MET WITH:	Maria Estefani Servin		TIME COMPLETED:	02:30 PM

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	On April 20, 2023 at 1:15 PM, Licensing Program Analyst (LPA) Cindy Hamilton arrived at the facility to conduct a pre-licensing inspection. The licensee is currently licensed at 13646 Gray Hawk Wy, Valley Center, CA 92082 and has applied to increase capacity to a large family childcare home. Present during this inspection were: Maria Servin, Denis Soriano and two infants. The home is two-story with four bedrooms, three bathrooms, with attached garage. LPA toured the facility, inside and out with licensee and the following was observed and/or discussed: · Per licensee, off-limit areas include: upstairs, garage, downstairs bedroom and kitchen · Normal hours of operation will be: Monday-Friday, 6:00 am to 6:00 pm · Smoke detectors and Carbon Monoxide detectors were tested by licensee during this inspection and were in working order. · The fire distinguisher 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 under kitchen sink and laundry room. Sharp items including kitchen knives, are inaccessible and stored in kitchen cabinet. Medicines are locked and stored in upstairs bathroom. · No guns or weapons are stored in the facility as stated by licensee as of this date. Licensee understands all guns, weapons and ammunition must be key locked separately and made inaccessible per Title 22 Regulations. · Stairs are barricaded · 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. 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.

SUPERVISORS NAME: Carlos Martinez
LICENSING EVALUATOR NAME: Cindy Hamilton
LICENSING EVALUATOR SIGNATURE:	DATE: 04/20/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/20/2023

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: SERVIN FAMILY CHILD CARE	FACILITY NUMBER: 376300611
	VISIT DATE: 04/20/2023

NARRATIVE

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· There were no toxic plants inside or outside the facility observed at this time
· The outside activity area consists of age and size appropriate toys and equipment
· Verification of control of property is maintained by applicant
· Facility Sketch and Emergency Disaster Plan are posted
· Pediatric CPR and First Aid Card - expire March 2025
· Preventive Health and Safety training, including nutrition and lead components have been completed by licensee.
· Licensee Maria Servin confirmed there are no Registered Sex Offenders living in the facility and/or using the facility address for their mailing address.

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.

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 311A, Records To Be Maintained At The Facility, for child’s records, personnel records, administrative records, and documents to be posted.

SUPERVISORS NAME: Carlos Martinez
LICENSING EVALUATOR NAME: Cindy Hamilton
LICENSING EVALUATOR SIGNATURE:	DATE: 04/20/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/20/2023

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: SERVIN FAMILY CHILD CARE	FACILITY NUMBER: 376300611
	VISIT DATE: 04/20/2023

NARRATIVE

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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.

The increase for a Large Family Child Care Home will be submitted for approval with a maximum capacity of 12, or 14 with parent notification.

Exit interview conducted and report was reviewed with licensee Maria Servin.

SUPERVISORS NAME: Carlos Martinez
LICENSING EVALUATOR NAME: Cindy Hamilton
LICENSING EVALUATOR SIGNATURE:	DATE: 04/20/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/20/2023

LIC809 (FAS) - (06/04)

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