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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376629365
Report Date: 06/01/2022
Date Signed: 06/01/2022 10:38:35 AM

Document Has Been Signed on 06/01/2022 10:38 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, 7575 METROPOLITAN DR., STE 110
SAN DIEGO, CA 92108
FACILITY NAME:ANDRAL, EDNER FAMILY CHILD CAREFACILITY NUMBER:
376629365
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 0DATE:
06/01/2022
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
07:50 AM
MET WITH:Edner AndralTIME COMPLETED:
09:00 AM
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On June 1st, 2022 at 07:50 AM, Licensing Program Analyst (LPA) Jo Ann Legaspi conducted a pre-licensing relocation inspection with Applicant Edner Andral. The inspection’s purpose is to ensure that the home follows standards established in CCR, Title 22, Division 12, Chapter 3, for Family Child Care Homes. Present in the home was only the Applicant. This four (4), three (3) bathroom house was toured and inspected. The daycare operational schedule will be everyday 5 AM to 11:55 PM.

The Applicant acknowledges that he will need to notify the Department of any changes to the childcare areas and obtain departmental approval before use of any new childcare areas not previously licensed. Applicant will use the following areas for childcare: the living room, one (1) bathroom and one (1) bedroom. The off limits areas include the remaining bedrooms, remaining bathrooms and the kitchen. The kitchen is made inaccessible via use of child safety gates. The remaining bedrooms and bathrooms have door locks. No bodies of water were observed during time of visit. The fire extinguisher is rated 2A 10B: C. and is located in the kitchen. The smoke/carbon monoxide detector meets requirements and is operational. Poisons, detergents, cleaning compounds and medications are secured inaccessible to children in care by placement in a hallway cabinet which has a sliding cabinet lock. Children’s toys and play equipment are available. The Applicant has a working telephone/cell phone. The Applicant agreed to notify licensing should his telephone number or email address ever change. The Applicant indicated there are no firearms or other weapons in the home.

Outdoor activities will be done in the fenced and shaded side front yard. The Applicant acknowledges continuous, visual supervision shall be given whenever children are engaged in outdoor activities. The Applicant intends to occasionally transport the children in their own vehicle. The Applicant shall transport children in rear seats in appropriate child passenger restraint systems which meet applicable federal motor vehicle safety standards. The Applicant acknowledges children shall never be left unattended in the daycare vehicle. The Applicant further confirms maintenance of the daycare vehicle shall be upheld to ensure safety.
SUPERVISORS NAME: Tulam Vu
LICENSING EVALUATOR NAME: JoAnn R Legaspi
LICENSING EVALUATOR SIGNATURE: DATE: 06/01/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/01/2022
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, 7575 METROPOLITAN DR., STE 110
SAN DIEGO, CA 92108
FACILITY NAME: ANDRAL, EDNER FAMILY CHILD CARE
FACILITY NUMBER: 376629365
VISIT DATE: 06/01/2022
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Applicant maintains documentation of proof of control of property for review by the Department. Applicant has completed the preventative health and lead poisoning prevention courses. The Mandated Reporter training was completed on 06/20/2020. Pediatric CPR and First Aid certifications expire in August 2022. The Applicant and adult residents in the home have criminal record clearances and/or exemptions on file. Applicant was reminded that all adults 18 and over living in the home, persons who provide care and supervision to children, and staff who have contact with children, including employees and volunteers, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a licensed Family Child Care Home. A civil penalty of $100.00 minimum/day up to $500.00 maximum per day/per person will be assessed if this regulation is violated.


The Applicant was advised that any new/additional adults must be cleared prior to working or residing in home. Any minor upon their 18th birthday must be fingerprinted within 30 days. Immunization records per SB792 were reviewed and comply. Applicant reported only he will care for daycare children. LPA advised that prior to making alterations or additions to the home or grounds, the applicant shall notify the Department of the proposed change. The Applicant states they are financially secure to operate a family childcare home for children and will comply with all regulations and laws governing family childcare homes.

Applicant acknowledges that failure to pay all accrued fees and/or civil penalties, including the annual licensing fees, shall constitute grounds for forfeiture of the license. Applicant acknowledges that an agent of the licensing Department, upon presentation of proper identification, may enter and inspect any place providing personal care, supervision, and services at any time, with or without advance notice. The Applicant shall permit the Department to inspect the family childcare home, and to privately interview children or staff, to determine compliance with or to prevent violations of family childcare laws or regulations. Applicant was advised that the department shall assess an immediate civil penalty of five hundred dollars ($500) per violation and one hundred dollars ($100) for each day the violation continues after citation, if the Applicant refuses an agent of the licensing Department entry into the daycare or any part of the daycare.

LPA discussed the safe sleep regulations with the Applicant and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPA also informed applicant of the importance of checking for recalled infant devices on

SUPERVISORS NAME: Tulam Vu
LICENSING EVALUATOR NAME: JoAnn R Legaspi
LICENSING EVALUATOR SIGNATURE:

DATE: 06/01/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/01/2022
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, 7575 METROPOLITAN DR., STE 110
SAN DIEGO, CA 92108
FACILITY NAME: ANDRAL, EDNER FAMILY CHILD CARE
FACILITY NUMBER: 376629365
VISIT DATE: 06/01/2022
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the United States Consumer Product Safety Commission (CPSC) website at https://www.cpsc.gov/ and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment.

Incidental Medical Services (IMS) policy was discussed. For IMS information , see PIN 22-02-CCP. 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 reviewed with Applicant the LIC 311D, Forms/Records to Keep in Your Family Child Care Homes, children’s forms/records, facility forms/records, and information to be posted. Entrance Checklist was provided to the applicant. The Applicant was also informed the following items are prohibited during day care operating hours: walkers, exersaucers, jumpers, inclined sleepers and bouncy seats. Corporal punishment and smoking are not allowed in the day care.


LPA discussed the maximum capacity for a small family child care home: four infants only (infants mean any children under 24 months); or six children with no more than three infants; or, with landlord consent, eight children with no more than two infants, one child in kindergarten or elementary school and one child at least age six, including children under age 10 who live in the home. Landlord consent is on file.

The Applicant agrees to comply with all regulations and laws governing family childcare homes. Community Care Licensing Division (CCLD) regularly sends information to licensed facilities, providers, and stakeholders by way of Provider Information Notices (PIN), Program Quarterly Update Newsletters and other important information communication platform. To receive important licensed-related information to licensed facilities, visit the CCLD Important Information website at https://www.cdss.ca.gov/inforesources/community-care-licensing/subscribe and select the Child Care option to receive email communication. Applicant is already enrolled in this email network notification system.

No corrections are needed. A small license is issued effective today 06/01/2022. The new license will be mailed to the Applicant. Exit interview conducted and report was reviewed with the Applicant Edner Andral.

SUPERVISORS NAME: Tulam Vu
LICENSING EVALUATOR NAME: JoAnn R Legaspi
LICENSING EVALUATOR SIGNATURE:

DATE: 06/01/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/01/2022
LIC809 (FAS) - (06/04)
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