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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198020675
Report Date: 10/28/2021
Date Signed: 10/28/2021 11:04:19 AM

Document Has Been Signed on 10/28/2021 11:04 AM - 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, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME:CARRERA FAMILY CHILD CAREFACILITY NUMBER:
198020675
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 6DATE:
10/28/2021
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
08:35 AM
MET WITH:Amber Carrera - LicenseeTIME COMPLETED:
11:15 AM
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Licensing Program Analyst (LPA) Nolan Tcheng conducted an in person Case Management-Licensee Initiated inspection. Upon arrival at 8:35am, LPA was let into residence by licensee Amber Carrera to whom the purpose of the inspection was announced. This inspection is being conducted for a requested capacity increase. The facility is requesting to increase from a small family child care with a capacity of 8, to a large family child care with a capacity of 14.

Licensee’s hours are currently Monday-Friday 7am-6pm. Census: There were 6 children present during the time of inspection. LPA verified all persons who live in residence. Names provided on attached LIC811. This is a one-story home which consists of 3 bedrooms, 2 bathrooms, kitchen, dining area, living room, laundry room, backyard (fenced), and garage. The children use the bathroom in the front of the house next to the front entrance. Per licensee, areas off limits to children and parents include: Master bedroom, Bedroom #2, kitchen, and garage. The licensee provides food for children in care.

Licensee states that she currently has one assistant. All individuals present in the home have obtained a criminal record clearance or exemption prior to working, residing or volunteering. The licensee states that there are no poisons in the home and understands that storage areas for poisons must be locked with a key or combination lock. Per licensee, there are no weapons, firearms or bodies of water on the premises.



PHYSICAL PLANT
At 8:45am, LPA was lead on a tour of the facility by the licensee. Tour started near the front entrance and into the bathroom used by children. LPA observed cupboards and drawers underneath bathroom sink had child locks. Tour continued into Bedroom #3 which is used as as diaper changing room. LPA observed napping equipment in the form of cots. Equipment is stored in hallway closet next to the living room. .The living room was reviewed. There are age appropriate toys present. At 8:50am, LPA observed a fireplace that had a plastic gate standing in front of the opening but was not secured to anything. Per Title 22 regulations, the fireplace must be made inaccessible to children in care. REPORT CONTINUES PAGE 1 of 4
SUPERVISORS NAME: Christina Gabelman
LICENSING EVALUATOR NAME: Nolan Tcheng
LICENSING EVALUATOR SIGNATURE: DATE: 10/28/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/28/2021
This report must be available at Child Care and Group Home facilities for public review for 3 years.

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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: CARRERA FAMILY CHILD CARE
FACILITY NUMBER: 198020675
VISIT DATE: 10/28/2021
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In the living room, Emergency Disaster Plan, Parent’s Rights Poster and the Facility License are observed to be posted. The smoke detector was located in the hallway near the front door, and the carbon monoxide was in the kitchen. Smoke and carbon monoxide detectors were tested and are operable. At 8:55am, LPA observed the fire extinguisher. The valve on the required 2A 10BC fire extinguisher indicates fully charged and was purchased on 07/08/2020, as indicated on receipt. Per State Fire Marshall standards, fire extinguishers shall be serviced annually. There are first aid supplies available. Detergents, cleaning compounds, medications, and other items which could pose a danger are inaccessible to children. The licensee states that a cell phone is used as facility phone and stays at the facility during operating hours. Per licensee, Bedroom #2 will be used as an area for an ill child until an authorized representative comes to pick up child.

At 9:00am, LPAs observed the back yard area. The outdoor play area was observed to be fenced. At this time, children are using the back yard for outdoor play time. Licensee does have a dog at the facility. Per licensee, they check the outdoor area before children come out to ensure there are no animal feces in the outdoor play area. LPA observed a tin trash can with a tight fitted lid that is used to dispose of the animal feces. The licensee is observed to be operating within the license capacity limitations.

FACILITY RECORDS:


The licensee and other personnel have completed training on preventive health practices including Pediatric First Aid and CPR. The licensee's Pediatric First Aid and CPR expires on 09/23/2023. Licensee has completed mandated reporter training that expires on 10/14/2023. The licensee does have proof of immunization against influenza, tuberculosis, pertussis, and measles. Children’s records were reviewed, including but not limited to, a copy of the emergency information card that contains all the information specified by regulation. At 10:05am, LPA observed that Child #3 and #4 do not have their immunization records present at the facility. Per Title 22 regulations, licensee shall document each child's immunizations and maintain while they are enrolled in the facility.

The following was discussed: Individuals who are 18 years of age or older living in the home must be finger print cleared prior to being in the presence of the children in care. Individuals within one month of their 18th birthday must be fingerprinted immediately.
-There is one medium sized dog accessible to children during operation hours.
REPORT CONTINUES PAGE 2 of 4
SUPERVISORS NAME: Christina Gabelman
LICENSING EVALUATOR NAME: Nolan Tcheng
LICENSING EVALUATOR SIGNATURE:

DATE: 10/28/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/28/2021
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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: CARRERA FAMILY CHILD CARE
FACILITY NUMBER: 198020675
VISIT DATE: 10/28/2021
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- Infant Walkers, Johnny Jumpers, Saucer Chairs, Trampolines and/or any other item that falls into these categories are not permitted in a family child care facility.
- Smoking is prohibited in a license family child care home.

Infant Care: Licensee states that they are currently caring for infants. LPA advised the licensee to sleep infants where they can be directly supervised at all times and advised the licensee against sleeping infants in a separate room. Licensee states that infants sleep in the living room. LPA provided the licensee with a copy of the Child Care Provider’s Guide to Safe Sleep, by American Academy of Pediatrics and Helping you to reduce the risk of SIDS. LPA consulted and explained Child Abuse Reporting, Updated Parent’s Rights Poster with Complaint Hotline information, Never Shake a Baby, Sudden Infant Death Syndrome (SIDS), and Safe Sleeping practices. PIN 20-24-CCP was provided and explained during the inspection.

Incidental Medical Services (IMS):
The licensee states that she will provide IMS. Per licensee, there are no children enrolled that require IMS at this time. 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 observed that a COVID-19 Technical Assistance call had been made on 12/03/2020 during prelicensing inspection. LPA observed health and safety practices being conducted at facility.

LPA advised the licensee how to access forms, regulations and quarterly updates on line at: www.ccld.ca.gov. AB1207 Mandated Child Abuse Reporting – Implementation was discussed with Licensee. Website provided: http://mandatedreporterca.com/

At this time, licensee is not in compliance with Title 22 regulations. Upon receipt of corrections, licensee will be granted a provisional license for a Large Family Child Care Home, until 12/08/2021. At that time, she will be granted a license for a Large Family Child Care Home.


REPORT CONTINUES PAGE 3 of 4
SUPERVISORS NAME: Christina Gabelman
LICENSING EVALUATOR NAME: Nolan Tcheng
LICENSING EVALUATOR SIGNATURE:

DATE: 10/28/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/28/2021
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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: CARRERA FAMILY CHILD CARE
FACILITY NUMBER: 198020675
VISIT DATE: 10/28/2021
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Based on the LPA’s observations and records review, the following deficiencies listed on the attached LIC 809 (deficiency page) are being cited in accordance with California Code of Regulations Title 22. Deficiencies that are being cited need to be cleared to protect the children’s health & safety.

The Notice of Site Visit (LIC 9213) – must remain posted for 30 days during the hours of operation after each site visit made by a licensing representative.

Exit interview was conducted with Amber Carrera licensee, and Plan of Corrections were reviewed and developed. A copy of the report was provided.
SUPERVISORS NAME: Christina Gabelman
LICENSING EVALUATOR NAME: Nolan Tcheng
LICENSING EVALUATOR SIGNATURE:

DATE: 10/28/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/28/2021
LIC809 (FAS) - (06/04)
Page: 3 of 6
Document Has Been Signed on 10/28/2021 11:04 AM - It Cannot Be Edited


Created By: Nolan Tcheng On 10/28/2021 at 10:27 AM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME: CARRERA FAMILY CHILD CARE
FACILITY NUMBER: 198020675

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/28/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
11/11/2021
Section Cited
CCR
102418(g)

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Immunizations
The licensee shall document each child's immunizations as required by the California Code of Regulations, Title 17, Section 6070, and shall maintain such documentation for as long as the child is enrolled.

This requirement was not met as evidenced by:
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Per Licensee, they will let parent know to email the copies of immunization records for Child #3 and #4. Licensee will submit to LPA by POC date.
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Based on file review, Licensee did not ensure that 2 of 6 children in care had copies of there immunzation records kept at the facility. THis poses a potential risk to the health, safety, and personal rights of children in care.
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Type B
11/11/2021
Section Cited
CCR102417(g)(1)

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Operation of Family Children Care Home
Fireplaces and open-face heaters shall be screened to prevent access by children.


This requirement was not met as evidenced by:
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Per Licensee, they will strap the gate to the wall. If that does not seem to work, they will get a gate that locks. Licensee will submit proof of fireplace being made inaccessible by POC date.
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Based on observation and interview, the fencing covering the fireplace in the living room is not secured and does not prevent access to children in care. This poses a potential risk to the health, safety, and personal rights of children in care.
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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:Christina Gabelman
LICENSING EVALUATOR NAME:Nolan Tcheng
LICENSING EVALUATOR SIGNATURE:
DATE: 10/28/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/28/2021


LIC809 (FAS) - (06/04)
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Document Has Been Signed on 10/28/2021 11:04 AM - It Cannot Be Edited


Created By: Nolan Tcheng On 10/28/2021 at 10:33 AM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME: CARRERA FAMILY CHILD CARE
FACILITY NUMBER: 198020675

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/28/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
11/11/2021
Section Cited
CCR
102417(g)(1)

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Operation of Family Child Care Home
The home shall contain a fire extinguisher....which meet standards established by the State Fire Marshal.

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Per licensee, they will purchase a new fire extinguisher and send proof of receipt to LPA by POC date
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Based on observation and interview, Licensee did not ensure that the fire extinguisher at the facility has been serviced annually. This poses a potential risk to the health, safety, and personal rights of children in care.
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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:Christina Gabelman
LICENSING EVALUATOR NAME:Nolan Tcheng
LICENSING EVALUATOR SIGNATURE:
DATE: 10/28/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/28/2021


LIC809 (FAS) - (06/04)
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