102418(a) · 102418(a) Immunization - Prior to admission to a family day care home, children shall be immunized against diseases as required by the California Code of Regulations, Title 17, beginning with Section 6000. This requirement has not been met as evidenced by Licensee to collect immunization records and provided photographic proof to LPAs by the POC due date. C1, C2 & C3 did not have immunization records present. This poses a potential risk to the health and safety of children in care. Licensee to provide LPAs with photographic proof of infant sleep logs completed for the two infants in care starting 07/09/2025 until 08/01/2025 showing sleep checks have been completed every 15 minutes while infants are in care. Licensee to develop a written plan how she will continue to keep up with

Open Not marked corrected in the state record

Category: health medication. Open / not marked corrected.

102425(j)(2) · (A-C) 102425 Infant Safe Sleep - (j) The provider shall supervise infants while they are sleeping and adhere to the following requirements: ...(2) (2) The provider shall check and document the following (A) Labored breathing. (B) Signs of distress which includes but is not limited to flushed skin color, increase in body temperature and restlessness. (C) Infants up to 12 month of age who are sleeping in a position other than on their back. sleep checks in the future to ensure compliance. This requirement has not been met as evidenced by: Licensee does not have infant sleep logs for infants in care. Gladys Kuizon NAME OF LICENSING PROGRAM MANAGER Jennifer Beehler NAME OF LICENSING PROGRAM ANALYST LICENSING PROGRAM ANALYST SIGNATURE DATE 07/09/2025 I acknowledge receipt of this form and understand my appeal rights as explained and received.

Open Not marked corrected in the state record

Category: supervision. Open / not marked corrected.

102417(g) · 102417 Operation of a Family Child Care Home (g) The home shall be free from defects or conditions which might endanger a child. Safety precautions shall include but not be limited to:... This requirement has not been met as evidenced by Licensee provided proof of deck issue being addressed with landlord during today's inspection. Licensee will complete a thorough vacuuming of the play room and provide LPAs with photographic proof at the end of care today, 07/09/2025. Licensee to provide photographic proof of cleaning of the carpet Wood decking on the back of the home has worn and splintered wooden planks and carpet in the playroom has debris and stains. These conditions pose a potential risk to the health and safety of children in care. by the POC due date. Licensee to email a timeline and next steps as determined by the landlord by the POC due date.

Open Not marked corrected in the state record

Category: ratio. Open / not marked corrected.

102419(d)(1) · Admission Procedures and Parental and Authorized Representative's Rights (d) At the time of acceptance of each child into care, the licensee shall provide the child's parent or authorized representative with a copy of the notice Family Child Care Home Notification of Parents’ Rights, LIC 995A (8/06), the Caregiver Background Check Process Process, LIC 995E (6/05), and the Family Child Care Consumer Awareness Information, LIC 9212 (10/05). (1) The licensee shall request the child's parent or authorized representative to sign and date the bottom portion of the notice form LIC 995A (8/06), which acknowledges that the parent or authorized representative has received and read the LIC 995A. The bottom portion of this form must be kept in the child’s file as proof that the parent or authorized representative has been notified of his or her rights and received a copy of the Caregiver Background Check Process, LIC 995E (6/05), and the Family Child Care Consumer Awareness Information, LIC 9212 (10/05). Licensee to provide parent's rights and have parent's sign the receipt and place it in children's files. Licensee to provide photographic proof to LPAs by POC due date. This requirement has not been met as evidenced by 3 children in care did not have LIC995A signed by parents and available in the children's files. This poses a potential risk to the health, safety and personal rights of children in care. Gladys Kuizon NAME OF LICENSING PROGRAM MANAGER Jennifer Beehler NAME OF LICENSING PROGRAM ANALYST LICENSING PROGRAM ANALYST SIGNATURE DATE 07/09/2025 I acknowledge receipt of this form and understand my appeal rights as explained and received.

Open Not marked corrected in the state record

Category: health medication. Open / not marked corrected.

102416(c) · Personnel Records(c) The licensee and other personnel as specified shall complete training on preventive health practices, including pediatric cardiopulmonary resuscitation and pediatric first aid, pursuant to Health and Safety Code Section 1596.866. This requirement has not been met as evidenced by Licensee to provide photographic proof of CPR certificate to LPAs by POC due date. Licensee to post CPR cards on posting board for future review. Licensee and Helper could not produce their CPR training certificate. This poses a potential risk to the health and safety of children in care. Gladys Kuizon NAME OF LICENSING PROGRAM MANAGER Jennifer Beehler NAME OF LICENSING PROGRAM ANALYST LICENSING PROGRAM ANALYST SIGNATURE DATE 07/09/2025 I acknowledge receipt of this form and understand my appeal rights as explained and received.

Open Not marked corrected in the state record

Category: health medication. Open / not marked corrected.

102417(g)(7) · An emergency information card shall be maintained for each child and shall include the child's full name, telephone number and location of a parent or other responsible adult to be contacted in an emergency, the name and telephone number of the child's physician and the parent's authorization for the licensee or registrant to consent to emergency medical care. Licensee will submit a file for child 10 to CCLD by POC date.

Child 10 did not have a file. This poses a potential risk Health, Safety Personal Rights risk to children in care

Open Not marked corrected in the state record

Category: health medication. Open / not marked corrected.

102419(d)(1) · The licensee shall request the child's parent or authorized representative to sign and date the bottom portion of the notice form LIC 995A (8/06), which acknowledges that the parent or authorized representative has received and read the LIC 995A. The bottom portion of this form must be kept in the child’s file as proof that the parent or authorized representative has been notified of his or her rights and received a copy of the Caregiver Background Check Process, LIC 995E (6/05), and the Family Child Care Consumer Awareness Information, LIC 9212 (10/05). Licensee will submit a file for child 10 to CCLD by POC date.

Child 10 did not have a file. This poses a potential risk Health, Safety Personal Rights risk to children in care SUPERVISOR'S NAME: Susy Cervantes

Open Not marked corrected in the state record

Category: supervision. Open / not marked corrected.

102418(a) · Prior to admission to a family day care home, children shall be immunized against diseases as required by the California Code of Regulations, Title 17, beginning with Section 6000. Licensee will submit a file for child 10 to CCLD by POC date.

Child 10 did not have a file.This poses a potential risk Health, Safety Personal Rights risk to children in care

Open Not marked corrected in the state record

Category: health medication. Open / not marked corrected.

102417(g)(8) · Each family child care home shall have a current roster of children as specified in Health and Safety Code Section 1596.841.

Child 6 and 7 were not listed on the children's roster Licensee updated roster during visit. Deficiency cleared today. This poses a potential risk Health, Safety Personal Rights risk to children in care. SUPERVISOR'S NAME: Susy Cervantes

Open Not marked corrected in the state record

Category: supervision. Open / not marked corrected.

102425(b) · Cribs or play yards shall be free from all loose articles and objects.

LPA observed an infant asleep in a room with a blankets over and under the infant Licensee and her assistant will read Safe Sleep regulations and submit a statement stating they understand the cited regulation to CCLD by POC date. This poses an immediate risk to the Health, Safety or Personal Rights to children in care. SUPERVISOR'S NAME: Susy Cervantes

Open Not marked corrected in the state record

Category: supervision. Open / not marked corrected.

102425(j)(5) · If the infant is sleeping in a separate room from where the provider is stationed, the door to the room the infant is sleeping in shall remain open at all times. Licensee and her assistant will read Safe Sleep regulations and submit a statement stating they understand the cited regulation to CCLD by POC date.

The door to the room was closed with no visible view of the child. This poses a potential risk Health, Safety Personal Rights risk to children in care SUPERVISOR'S NAME: Gladys Kuizon

Open Not marked corrected in the state record

Category: supervision. Open / not marked corrected.

102416.5(e) · Staffing Ratio and Capacity: (e) If no assistant provider is present at a Large Family Child Care Home, then the licensee shall comply with the capacity requirements for a Small Family Child Care Home as specified in subsections (b) and (c). Licensee will submit a statement stating how she will remain in ratio to CCLD by POC date.

LPA observed licensee was out of ratio and caring for four preschool children and three infants alone. This poses an immediate risk to the health, safety, and personal rights of children in care SUPERVISOR'S NAME: Susy Cervantes

Open Not marked corrected in the state record

Category: supervision. Open / not marked corrected.

102416.5(e) · 102416.5 (e) Staffing ratio and Capacity: (e) If no assistant provider is present at a Large Family Child Care Home, then the licensee shall comply with the capacity requirements for a Small Family Child Care Home...

Licensee will submit a written plan of action to CCL by POC due date by 5PM. Based on interview with Licensee, the licensee did not comply with the section cited above by having seven (7) children in care with no assistant, which poses a immediate health, safety or personal rights risk to persons in care. Upon receipt, licensee shall post and provide copies of this licensing report to parents/guardians of children in care at the facility and to parents/guardians of children newly enrolled at the facility during the next 12 months.

Open Not marked corrected in the state record

Category: ratio. Open / not marked corrected.

102416.5(e) · Staffing Ratio and Capacity: (e) If no assistant provider is present at a Large Family Child Care Home, then the licensee shall comply with the capacity requirements for a Small Family Child Care Home as specified in subsections (b) and (c). Licensee, Kimberly Thunderbull will submit a written plan to remain in Ratio at all times by 04/18/24. This case will be referred to Community Care Licensing Management for further review.

Based on LPAs observation and Licensee's statement, S1 was left alone supervising seven children: four infants and three preschool aged children. This poses an immediate risk to the health, safety, and personal rights of children in care. Upon receipt, licensee shall post and provide copies of this licensing report to parents/guardians of children in care at the facility and to parents/guardians of children newly enrolled at the facility during the next 12 months. SUPERVISOR'S NAME: Gladys Kuizon

Open Not marked corrected in the state record

Category: supervision. Open / not marked corrected.

102425(j)(2) · Infant Safe Sleep - The provider shall supervise infants while they are sleeping and adhere to the following requirements: The provider shall check and document the following

By 04/22/24, Licensee agreed to submit documentation that infants are checked every 15 minutes when napping. LPAs observed that licensee does not have documentation of 15 minutes sleep check for infants (C1, C2, C4, & C12). This poses a potential risk to the health, safety, or personal rights to children in care. An immediate civil penalty of $250 was assessed for repeating the same violation within 12 months.

Open Not marked corrected in the state record

Category: supervision. Open / not marked corrected.

102421(a) · Child's Records - (a) The licensee shall maintain, in each child's record, the signed and dated notice form required in Section 102419(d).

By 04/22/24, Licensee agreed to submit missing Licensing documents for the children. LPAs provided Licensee a copy of LIC 811 showing the list of missing documents. Based on LPAs observation and review of records, all of the children in care have incomplete files. An immediate civil penalty of $250 was assessed for repeating the same violation within 12 months.

Open Not marked corrected in the state record

Category: recordkeeping. Open / not marked corrected.

102425(c) · Infant Safe Sleep - An Individual Infant Sleeping Plan [LIC 9227 (3/20)] shall be completed for each infant up to 12 months of age the provider has in care and included in the infant's file at the facility.

By 04/22/4, Licensee agreed to submit a completed and signed LIC 9227 for C4 & C12. Based on LPAs observation and review of records, C4 & C12 are missing the Individual Sleeping Plan (LIC 9227) on file. An immediate civil penalty of $250 was assessed for repeating the same violation within 12 months. SUPERVISOR'S NAME: Gladys Kuizon

Open Not marked corrected in the state record

Category: supervision. Open / not marked corrected.

102417(g)(9)(A) · 1 Operation of A Family Child Care Home (g) The home shall be free from defects or conditions which might endanger a child. Safety precautions shall include but not limited to: (9) Each family child care home shall have a written disaster plan of action prepared on a form approved by the Department. All children, age and ability permitting, and the provider, the assistant provider, and other members of the household, shall be instructed in their duties under the disaster plan. As their age and ability permit, newly enrolled children shall be informed promptly of their duties as required in the plan. (A) Each family child care home shall conduct fire drills and disaster drills at least once every six months. 1. The licensee shall document the drills, including the date and time of each drill. This documentation shall kept at the family child care home.

Deficient Practice Statement Based on interview, the licensee did not comply with the section cited above. Licensee stated she conducted her last drill approximately three months, however, does not have documentation, which poses/posed a potential health, safety or personal rights risk to persons in care. POC Due Date: 04/11/2024

Open Not marked corrected in the state record

Category: ratio. Open / not marked corrected.

102425(j)(2) · Infant Safe Sleep The provider shall supervise infants while they are sleeping and adhere to the following requirements: The provider shall check and document the following

Deficient Practice Statement Based on interview, the licensee did not comply with the section cited above. Licensee stated that she has not documented the 15 minute checks for infants(C1, C2 and C4),which poses/posed a potential health, safety or personal rights risk to persons in care. POC Due Date: 04/11/2024

Open Not marked corrected in the state record

Category: supervision. Open / not marked corrected.

102416(c) · Personnel Requirements (c) The licensee and other personnel as specified shall complete training on preventive health practices, including pediatric cardiopulmonary resuscitation and pediatric first aid, pursuant to Health and Safety Code Section 1596.866.

Deficient Practice Statement Based on interview, the licensee did not comply with the section cited above. Licensee and S1 do not have current Pediatric CPR/FIRST Aid, which poses/posed a potential health, safety or personal rights risk to persons in care. POC Due Date: 04/15/2024

Open Not marked corrected in the state record

Category: health medication. Open / not marked corrected.

102421(a) · Child's Records (a) The licensee shall maintain, in each child's record, the signed and dated notice form required in Section 102419(d).

Deficient Practice Statement Based on observation, the licensee did not comply with the section cited above. LPA's were unable to review six children's files, which poses/posed a potential health, safety or personal rights risk to persons in care. POC Due Date: 04/11/2024

Open Not marked corrected in the state record

Category: health medication. Open / not marked corrected.

102425(c) · Infant Safe Sleep An Individual Infant Sleeping Plan [LIC 9227 (3/20)] shall be completed for each infant up to 12 months of age the provider has in care and included in the infant's file at the facility.

Deficient Practice Statement Based on record review the licensee did not comply with the section cited above. Licensee did not complete a LIC9227 for C4, which poses/posed a potential health, safety or personal rights risk to persons in care. POC Due Date: 04/11/2024

Open Not marked corrected in the state record

Category: health medication. Open / not marked corrected.

102391(a) · 102391- Inspection Authority of the Department. (a) Any duly authorized officer, employee, or agent of the Department shall, upon presentation of proper identification, enter and inspect any place providing personal care, supervision, and services at any time...

Licensee will submit a written plan to CCL by POC due date. Based on interview, the licensee did not comply with the section cited above by not granting LPA entrance into the home to conduct a 3 year required annual inspection, which poses a potential health, safety or personal rights risk to persons in care. SUPERVISOR'S NAME: Gladys Kuizon

Open Not marked corrected in the state record

Category: supervision. Open / not marked corrected.