Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198018116
Report Date: 11/13/2017
Date Signed 11/13/2017 07:47:40 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:MONTES FAMILY CHILDCAREFACILITY NUMBER:
198018116
ADMINISTRATOR:MONTES, PAULAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(619) 520-2558
CITY:WHITTIERSTATE: CAZIP CODE:
90605
CAPACITY:14CENSUS: 10DATE:
11/13/2017
TYPE OF VISIT:Required - 3 YearUNANNOUNCEDTIME BEGAN:
02:30 PM
MET WITH:Licensee Paula Montes-ZavalzaTIME COMPLETED:
07:45 PM
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An unannounced Required-3 Year inspection was conducted on this date by Licensing Program Analyst (LPA) B. Emiko Bell. Upon arrival, LPA was greeted and let into the facility by Licensee Paula Montes-Zavalza, who was with her assistant, Dora Romero, and ten (10) children. Licensee's eighteen-year-old was also present. (See Advisory Note.) The children were ages 12, 8, 5, 5, 3, 3, 3, 3, 2 and 11 months. At 3:00 P.M., Licensee's 11 year old child arrived. At 4:10 P.M., a 3 year old was picked up. At 4:30 P.M., a 12 and 3 year old were picked up. At 4:40 P.M., a 3 year old was picked up.

Licensee's days and hours of operation are Mon.-Fri., 6:30 A.M.-7:30 P.M. There are thirteen children currently enrolled. The family members residing at the facility are four adults. Licensee guided LPA on a tour of the residence, both inside and outside. This is a single-story home with three bedrooms and two bathrooms. All areas identified on the Facility Sketch were inspected in the following order (inside): the kitchen, each of the three bedrooms, the bathroom used by the daycare children, the living room, the dining room, the den, the bathroom in the den, and outside (the backyard).

The following areas are designated off-limits to the daycare children: bedroom #2 and bedroom #3. All bedrooms are rendered inaccessible through the use of doorknob handle covers. The living room is rendered inaccessible through use of a baby gate.

The home was inspected for safety, comfort, cleanliness, telephone service (Licensee and her assistant have cell phones and Licensee also has a landline), heating and ventilation (Licensee has central heating and air-conditioning, three ceiling fans and an additional fan in the playroom), inaccessibility to poisons, detergents, cleaning compounds, medicines, and hazardous items that can pose a danger to children. Licensee has two dogs, which are kept in the front yard during daycare hours. The front yard is separated from the backyard by a chain-link fence. As Licensee transports school-age daycare children, her SUV was inspected for working seatbelts and car seats. Licensee has two booster seats.
SUPERVISOR'S NAME: Cassandra CooperTELEPHONE: (323) 981-3365
LICENSING EVALUATOR NAME: Betty BellTELEPHONE: (323) 981-3364
LICENSING EVALUATOR SIGNATURE:

DATE: 11/13/2017
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/13/2017
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, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME: MONTES FAMILY CHILDCARE
FACILITY NUMBER: 198018116
VISIT DATE: 11/13/2017
NARRATIVE
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Licensee provides all food. Per Licensee, there are no firearms or weapons on the premises. There were no poisons observed by LPA during the inspection. (Cleaning compounds in the kitchen are rendered inaccessible by a childproof latch on the cabinet underneath the kitchen sink. All toiletries and cleaning compounds in the bathroom used by the daycare children are stored in the cabinet underneath the sink and in the mirrored cabinet above the sink. All knives in the kitchen are stored in a drawer, which is rendered inaccessible by a childproof latch.) The fireplace is blocked to prevent access by children. Licensee has a fire extinguisher, size 3-A:40-B:C, which is mounted on a wall in the kitchen; it was purchased 01/17. There are three electrical smoke detectors, which are mounted in the living room, in the kitchen, and in the den; all were tested and are operable. There is a carbon monoxide detector which is mounted on the wall across from bedroom #2; it was tested and was operable after Licensee replaced the batteries. The home is kept clean and orderly, with heating and ventilation for safety and comfort. There is a small step which leads from the kitchen to the den and there is one large stair which leads from the den to the hallway; there is a baby gate between the kitchen and the den. The one large stair is unable to be fenced because the bathroom is in the hallway. There are age-appropriate toys and napping equipment (two playpens and seven cots) on the premises. The licensee was present and was supervising the children at all times. No children were observed left in parked vehicles. The outdoor play area is fenced, but Licensee also stated that she is always outdoors when the children are outdoors. Capacity and ratio was observed to be in compliance. All individuals present, working, or residing in the home have a criminal record clearance and are associated to the facility (with the exception of Licensee's 18 year old child, as mentioned earlier). Licensee complied with Inspection Authority. The last fire drill was run 10/13/17 at 09:30 A.M. and the last earthquake drill was run on 10/17/17 at 9:00 A.M. Licensee's Pediatric First Aid/CPR, which was issued by the American Heart Association, expires 02/19. Licensee's assistant's Pediatric First Aid/CPR was issued by the American Red Cross and expired 07/09/18. During today's inspection, children and staff files were reviewed for completeness. Licensee's Child Care Facility Roster was observed to be current and complete.

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 Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Section 102417. 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.
SUPERVISOR'S NAME: Cassandra CooperTELEPHONE: (323) 981-3365
LICENSING EVALUATOR NAME: Betty BellTELEPHONE: (323) 981-3364
LICENSING EVALUATOR SIGNATURE:

DATE: 11/13/2017
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/13/2017
LIC809 (FAS) - (06/04)
Page: 2 of 5
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: MONTES FAMILY CHILDCARE
FACILITY NUMBER: 198018116
VISIT DATE: 11/13/2017
NARRATIVE
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*A copy of the LIC 811 Confidential Names list was provided to Licensee during today's visit.*

The following is being cited in accordance to Title 22 of the California Code of Regulations and/or Health and Safety Code. Please refer to 809D for documentation of deficiencies.

Notice of Site Visit posted. The Notice of Site Visit must be posted for thirty (30) days. If it is removed prior to thirty (30) days, a $100 civil penalty will be assessed.

An exit interview has been conducted with, and a copy of this report has been signed by and provided to Licensee Paula Montes-Zavalza. Appeal Rights and procedures were provided and explained to Licensee as well.
SUPERVISOR'S NAME: Cassandra CooperTELEPHONE: (323) 981-3365
LICENSING EVALUATOR NAME: Betty BellTELEPHONE: (323) 981-3364
LICENSING EVALUATOR SIGNATURE:

DATE: 11/13/2017
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/13/2017
LIC809 (FAS) - (06/04)
Page: 3 of 5
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: MONTES FAMILY CHILDCARE
FACILITY NUMBER: 198018116
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/13/2017
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
11/27/2017
Section Cited
CCR
102416.1(a)(11)
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PERSONNEL RECORDS
Personnel records shall contain a signed statement regarding their criminal record history, and shall contain specified information.
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Licensee stated that she will ensure that all three adults complete the LIC 508 Criminal Record Statement by the COB on the POC due date of 11/27/17.
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-Adults #2-4 do not have a signed LIC 508 Criminal Record Statement in their staff files.
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Type B
11/27/2017
Section Cited
CCR
102359(a)(1)
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ADVERTISEMENTS AND LICENSE NUMBER
Advertisements and License Number. Licensees shall reveal each facility license number in all advertisements, publications or announcements with the intent to attract clients. Advertisements subject to Section 102359(a) shall contain specified information.
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Licensee agreed to put her license number on the banner in the front yard by the COB on the POC due date of 11/27/17.
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-Licensee has a banner with her married name and her phone number on it outside of her residence in her front yard.
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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: Cassandra CooperTELEPHONE: (323) 981-3365
LICENSING EVALUATOR NAME: Betty BellTELEPHONE: (323) 981-3364
LICENSING EVALUATOR SIGNATURE:

DATE: 11/13/2017
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/13/2017
LIC809 (FAS) - (06/04)
Page: 4 of 5
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: MONTES FAMILY CHILDCARE
FACILITY NUMBER: 198018116
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/13/2017
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
12/13/2017
Section Cited
HSC
1597.622(a)(1)
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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 vaccination between August 1 and December 1 of each year.
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Licensee stated that she will ensure that Adult #2 obtains a TDAP shot and an MMR shot (or the negative results of a Titers test). Verification will be provided to CCL by the COB on the POC due date of 12/13/17.
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-Licensee could not provide verification that Adult #2 has been immunized against measles and pertussis.
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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: Cassandra CooperTELEPHONE: (323) 981-3365
LICENSING EVALUATOR NAME: Betty BellTELEPHONE: (323) 981-3364
LICENSING EVALUATOR SIGNATURE:

DATE: 11/13/2017
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/13/2017
LIC809 (FAS) - (06/04)
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