Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198016602
Report Date: 09/14/2016
Date Signed 09/14/2016 02:18:54 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME:GUERRERO FAMILY CHILD CAREFACILITY NUMBER:
198016602
ADMINISTRATOR:GUERRERO, ESTELAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(626) 966-4760
CITY:COVINASTATE: CAZIP CODE:
91722
CAPACITY:14CENSUS: 5DATE:
09/14/2016
TYPE OF VISIT:Annual/RequiredUNANNOUNCEDTIME BEGAN:
12:35 PM
MET WITH:Estela Guerrero, LicenseeTIME COMPLETED:
02:45 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
Visit Conducted in Spanish
An unannounced Annual Required Visit was conducted by Licensing Program Analyst (LPA) Armando J. Lucero. Analyst met with licensee Estela Guerrero who guided LPA on a tour of the facility. This is a single story, four bedroom, two bathroom home. Currently residing in the home are five adults (Licensee, husband Jose Guerrero, adult son Jose Guerrero Jr., adult daughter Lissette Guerrero, and adult niece Karen Sanchez) and one child.

Areas accessible to children were inspected as follows: Living room, kitchen, one bathroom, and back yard.

Areas off limits include: Four bedrooms, one bathroom, hallway, front yard, and the side of the house where dog is kept.

There are no weapons, firearms, swimming pools or spas on the premises. The backyard is adequately fenced. There are age appropriate toys and equipment on the premises. The smoke detectors, fire extinguisher, and carbon monoxide detector are in operable condition. During discussion with Licensee, LPA determined that Licensee and assistant do no have proof of vaccination according to Health and Safety Code 1597.622.

Report Continues on 809-C
SUPERVISOR'S NAME: Claudia GuangorenaTELEPHONE: (323) 981-3417
LICENSING EVALUATOR NAME: Armando J LuceroTELEPHONE: (323) 981-3435
LICENSING EVALUATOR SIGNATURE:

DATE: 09/14/2016
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/14/2016
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 4


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME: GUERRERO FAMILY CHILD CARE
FACILITY NUMBER: 198016602
VISIT DATE: 09/14/2016
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
26
27
28
29
30
31
32
—CPR and First Aid expire: 11/21/2017 for Licensee Estela Guerrero
—Child Care Roster was not up to date during records review, Disaster Plan, and Children's Records were reviewed and discussed.
—Children records and required licensing forms were discussed as well as mandated child abuse reporting and criminal record clearance (finger print and child abuse clearance) requirement.

The following was discussed with the licensee:

Rooms that are off-limits need to be made inaccessible during operating hours. Smoking is prohibited. No infant walkers, no Johnny Jumpers, no excersaucers or any other item that falls into that category are allowed in facility. The Licensee was advised that inaccessibility of hazards must be constantly reassessed depending on the children in care. Sudden Infant Death Syndrome (SIDS) and Never-Shake-a-Baby were discussed.

Mandatory Forms for the children’s files and staff files, requirements for fire drills, earthquake drills and documentation for both were reviewed. Role and responsibilities of being a Mandated Reporter were reviewed. The Licensee was advised how to access forms and Regulations online at www.ccld.ca.gov. Licensee was made aware that it is his/her responsibility to know the regulations as well as anyone who assists in providing care. The Licensee was advised that inaccessibility of hazards must be constantly reassessed depending on the children in care.

LPA informed Licensee to log onto web site www.ccld.ca.gov to obtain forms and LIVE SCAN application. Records for all children and staff must be maintained for three (3) years after separation from the facility.
Report Continues on 809-C
SUPERVISOR'S NAME: Claudia GuangorenaTELEPHONE: (323) 981-3417
LICENSING EVALUATOR NAME: Armando J LuceroTELEPHONE: (323) 981-3435
LICENSING EVALUATOR SIGNATURE:

DATE: 09/14/2016
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/14/2016
LIC809 (FAS) - (06/04)
Page: 2 of 4


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME: GUERRERO FAMILY CHILD CARE
FACILITY NUMBER: 198016602
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/14/2016
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
10/10/2016
Section Cited
§1597.622
1
2
3
4
5
6
7
Employees or volunteers at family day care home; immunization requirements; records; exemptions

Commencing September 1, 2016, a person shall not be employed or volunteer at a family day care home if he or she has not been immunized against influenza, pertussis, and measles. Each employee and volunteer shall receive an influenza between
1
2
3
4
5
6
7
Licensee stated that she and assistants will make appointments with their doctors to get proof of vaccinations. Licensee stated that she will provide proof of vaccinations for herself and assistants to LPA by POC date by email.

8
9
10
11
12
13
14
August 1 and December 1 of each year.

During records review and discussion with Licensee, LPA determined that Licensee and assistants could not provide proof of vaccination. This is a health and safety risk to children in care.
8
9
10
11
12
13
14
Type B
09/19/2016
Section Cited
102417(g)(8)
1
2
3
4
5
6
7
Operation of a Family Child Care Home

All homes shall have a current roster of the children.

During records review, LPA determined that the roster provided by Licensee was not up to date.
1
2
3
4
5
6
7
Licensee stated that she will provide a current roster of currently enrolled children to LPA by POC date. Licensee stated that she will submit proof to LPA by email.

1
2
3
4
5
6
7
1
2
3
4
5
6
7
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Claudia GuangorenaTELEPHONE: (323) 981-3417
LICENSING EVALUATOR NAME: Armando J LuceroTELEPHONE: (323) 981-3435
LICENSING EVALUATOR SIGNATURE:

DATE: 09/14/2016
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/14/2016
LIC809 (FAS) - (06/04)
Page: 4 of 4


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME: GUERRERO FAMILY CHILD CARE
FACILITY NUMBER: 198016602
VISIT DATE: 09/14/2016
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
26
27
28
29
30
31
32
The Licensee was also advised of the requirement to report Unusual Incidents and/or injuries to the parent/guardian and to CCL within the time frame specified by the regulation. Licensee advised to visit www.shotsforschool.org for immunization information.

· Dog(s) and/or pets should be isolated from children in care.
· It is recommended that First-Aid kits be available on premises.
· Outdoor supervision required at all times. If outdoor area not adequately fenced, provider must be with children at all times when outdoors.

These forms may also be downloaded from our website: www.ccld.ca.gov

See page 809-D for deficiencies cited during today's visit in accordance to the California Code of Regulations Title 22, Division 12, Chapter 1

Upon receipt of this report, the Licensee shall post the Notice of Site Visit and any Licensing report documenting a type “A” deficiency. The report and the Notice of Site Visit shall be posted for 30 consecutive days. Failure to maintain posting as required, will result in an immediate $100 civil penalty.

Exit interview, copy of report was given. Appeal rights were issued and discussed.
SUPERVISOR'S NAME: Claudia GuangorenaTELEPHONE: (323) 981-3417
LICENSING EVALUATOR NAME: Armando J LuceroTELEPHONE: (323) 981-3435
LICENSING EVALUATOR SIGNATURE:

DATE: 09/14/2016
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/14/2016
LIC809 (FAS) - (06/04)
Page: 3 of 4