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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376620696
Report Date: 08/03/2022
Date Signed: 08/03/2022 03:01:03 PM

Document Has Been Signed on 08/03/2022 03:01 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, 7575 METROPOLITAN DR., STE 110
SAN DIEGO, CA 92108
FACILITY NAME:PEREZ, ELENA FAMILY CHILD CAREFACILITY NUMBER:
376620696
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 1DATE:
08/03/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:54 PM
MET WITH:Elena Perez TIME COMPLETED:
03:15 PM
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On 08/03/22 at 1:54 p.m., Licensing Program Analyst (LPA), Rajani Goudreau conducted an unannounced Annual Inspection and met with the Licensee, Elena Perez. LPA disclosed the purpose of the inspection and was granted entry into the facility by the Licensee. There was one infant child present during this inspection. This facility is a one story, three-bedroom and 2 ½ bathroom home. The following areas are used for childcare: living room, kitchen, daycare room (located near kitchen), restroom located in daycare room, covered patio, and partial of backyard. The following off-limit areas are made securely inaccessible: front yard, left side of backyard, master bedroom, master bathroom, two bedrooms, restroom located in hallway of home and garage. Operation hours are Monday through Friday from 6:00 a.m. to 4:00 p.m.

The fire extinguisher, smoke detector, and carbon monoxide detector met requirements, per LPA observation. LPA observed hazardous items inaccessible to children in care. LPA informed licensee poisons shall be placed in a storage area and locked. LPA observed toys, play equipment and materials available for the children’s use. Children utilize the back yard for outdoor activities. LPA informed licensee children shall be supervised during outdoor activities. There is a tall water birdbath located in the off-limit area of the backyard, made inaccessible by the use of a fence. A review of staff records on this date indicates that all facility staff or other individuals who require caregiver background checks have received criminal record and child abuse clearances or exemptions. 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. Licensee’s First Aid and CPR certifications are valid and expire in 10/2023. Licensees completed the Mandated Reporter Training in 03/2022. Facility roster and children records are maintained and complete, per file review.
SUPERVISORS NAME: Tulam Vu
LICENSING EVALUATOR NAME: Rajani Goudreau
LICENSING EVALUATOR SIGNATURE: DATE: 08/03/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/03/2022
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, 7575 METROPOLITAN DR., STE 110
SAN DIEGO, CA 92108
FACILITY NAME: PEREZ, ELENA FAMILY CHILD CARE
FACILITY NUMBER: 376620696
VISIT DATE: 08/03/2022
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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.

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 discussed California Megan's Law and LPA provided: www.meganslaw.ca.gov. LPA discussed and provided Licensee with the following: child care advocates email address: childcareadvocatesprogram@dss.ca.gov . LPA informed licensee in order to sign up for Quarterly Updates and PINs through our website. Please go to www.cdss.ca.gov and on the right side of your screen click on “Receive Important Updates”, put your email address in and choose which program(s) you would like to subscribe to and click “subscribe. In addition, for general questions or questions regarding licensing requirements contact the Child Care Licensing Duty Line at (619) 767-2248.

To improve the quality and value of the new inspection process, a survey will be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or tools, please send them by email to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/process.

No deficiencies issued during today’s inspection. Exit interview conducted and report reviewed with Licensee, Elena Perez. A notice of site visit was given and must remain posted for 30 days.
SUPERVISORS NAME: Tulam Vu
LICENSING EVALUATOR NAME: Rajani Goudreau
LICENSING EVALUATOR SIGNATURE:

DATE: 08/03/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/03/2022
LIC809 (FAS) - (06/04)
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