Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 334830480
Report Date: 02/02/2016
Date Signed 02/02/2016 12:12:52 PM

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 ST., SUITE 700
RIVERSIDE, CA 92501
FACILITY NAME:CERVANTES FAMILY CHILD CAREFACILITY NUMBER:
334830480
ADMINISTRATOR:CERVANTES, ERIKAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(951) 488-7121
CITY:MORENO VALLEYSTATE: CAZIP CODE:
92557
CAPACITY:14CENSUS: 9DATE:
02/02/2016
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
11:02 AM
MET WITH:Erika CervantesTIME COMPLETED:
12:21 PM
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(3) A Random Annual visit is being conducted as a compliance review. Licensing Program Analyst (LPA) Sharon Sparhawk toured the facility, inside and out, and the following was observed:
· The facility is operating within the licensed capacity and appropriate ratios. The licensee is present with her assistant Magaly Valencia-Ruiz and 9 children. Appropriate supervision provided during visit
· A working telephone is present. Appropriate fire extinguisher was observed, carbon monoxide and smoke detectors present were tested by the licensee on this visit. The fireplace is properly screened
· The facility has adequate heating and ventilation. Stairs are barricaded as observed
· All hazardous items inaccessible. Toxins are locked. No guns or weapons present as stated by the Licensee Ms. Cervantes. Outdoor play area is fenced.
· There is an in-ground pool that has a new mesh, removable fence and gate. The fence is 5 feet tall and the gate opens away from the pool and is self-closing/self-latching. Licensee was reminded that the pool fence and gate must be in place at all times during day care operating hours. LPA Sparhawk took pictures of the new pool fence on this visit. Licensee notified this LPA on 1-29-16 that she had installed a new pool fence and gate.
· Clean, safe and age appropriate toys
· Pediatric CPR and First Aid Card expire on 12-31-17 for the licensee and for Ms. Valencia-Ruiz 11-3-16.
· Licensee has required contact information in case of an emergency. The roster and the files of the children present were reviewed on this visit.
· Resident and/or staff records reviewed on 2-2-16 indicate that all adults who require caregiver background checks have received all required clearances or exemptions.
· The Notice of Site Visit must be posted at the entrance of the facility for a period of 30 days. If
SUPERVISOR'S NAME: Marianne DonleyTELEPHONE: (951) 782-4200
LICENSING EVALUATOR NAME: Sharon SparhawkTELEPHONE: (951) 529-2439
LICENSING EVALUATOR SIGNATURE:

DATE: 02/02/2016
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/02/2016
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 ST., SUITE 700
RIVERSIDE, CA 92501
FACILITY NAME: CERVANTES FAMILY CHILD CARE
FACILITY NUMBER: 334830480
VISIT DATE: 02/02/2016
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As a REMINDER: when your child(ren) turns 18 years of age, you MUST submit an updated LIC 279, LIC 508 and TB screen and have your child get live scanned. This also applies to any adult PRIOR to them moving into the home or who currently lives in the home. Also, PRIOR to employment of ANY adult, you must submit the LIC508, TB screen and get them live scanned and cleared.

You can access our website at: www.ccld.ca.gov to obtain ANY licensing information. Please subscribe to MyCCL on our website. Department updates will be sent directly to your e-mail account once you have set up an account.

There are no Title 22 deficiencies noted during the time of this visit.

An exit interview was conducted and a copy of this report was reviewed and left with the licensee along with the Notice of Site Visit. During this visit, the licensee e-mailed this LPA a revised backyard facility sketch that now includes the storage shed in the backyard. An updated LIC 279 was also received on this visit. A copy of this report has to be made available to the public for 3 years.
SUPERVISOR'S NAME: Marianne DonleyTELEPHONE: (951) 782-4200
LICENSING EVALUATOR NAME: Sharon SparhawkTELEPHONE: (951) 529-2439
LICENSING EVALUATOR SIGNATURE:

DATE: 02/02/2016
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/02/2016
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 ST., SUITE 700
RIVERSIDE, CA 92501
FACILITY NAME: CERVANTES FAMILY CHILD CARE
FACILITY NUMBER: 334830480
VISIT DATE: 02/02/2016
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a serious violation is cited, a copy of the licensing report (LIC809D) must also be posted for 30 days, as well as any documents showing correction of Type A deficiencies. A civil penalty of $100 per violation will be assessed for noncompliance.
· AB 1819 – went into effect January 1, 2015 in accordance with Health and Safety Code Section 1596.795 (a) The smoking of tobacco in a private residence that is licensed as a family day care home shall be prohibited in the home and in those areas of the family day care home where children are present. Nothing in this section shall prohibit a city or county from enacting or enforcing an ordinance relating to smoking in a family day care home if the ordinance is more stringent than this section
· AB 2386 – in accordance with Health and Safety Code Section 1597.543 every family day care home for children shall have one or more carbon monoxide detectors in the facility that meet the standards established in Chapter 8 (commencing with Section 13260) of Part 2 of Division 12. The department shall account for the presence of these detectors during inspections.
· AB 2621 – Health and Safety Code 1596.819. (a) Except as otherwise prohibited by law, the department shall post licensing information on its Internet Web site as follows: Section 1596.750, the information for family child care homes shall include, the licensed capacity of the facility, the status of the license, and the number of site visits, including the number of citations, substantiated and inconclusive complaint inspections, and non-complaint inspections during the preceding five year period. The department shall update the information posted on at least a monthly basis.
· AB 978 – Zero Tolerance Related Regulations went into effect January 18, 2011 – In accordance with California Health and Safety Code Section 1596.99(c)/1597.58(c) – it was explained that an immediate $150 Civil penalty will be assessed for each serious violation and a civil penalty of $150 per day per violation will be assessed until corrected.

During the exit interview, the licensee Ms. Cervantes confirmed that there are no Registered Sex Offenders living in the facility and/or using the facility address for their mailing address.

Licensee stated she has no associations to another community care facility.
SUPERVISOR'S NAME: Marianne DonleyTELEPHONE: (951) 782-4200
LICENSING EVALUATOR NAME: Sharon SparhawkTELEPHONE: (951) 529-2439
LICENSING EVALUATOR SIGNATURE:

DATE: 02/02/2016
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/02/2016
LIC809 (FAS) - (06/04)
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