191596214-6-28-2022-54-CC-JESA-CFTUGF-20220628153417

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 191596214
Report Date: 06/28/2022
Date Signed: 06/28/2022 03:34:28 PM

Document Has Been Signed on 06/28/2022 03:34 PM - 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 CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME:	ESCOBEDO FAMILY DAY CARE		FACILITY NUMBER:	191596214
ADMINISTRATOR:	ESCOBEDO, MARIA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(323) 567-5050
CITY:	SOUTH GATE	STATE: CA	ZIP CODE:	90280
CAPACITY:	14	CENSUS: 11	DATE:	06/28/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	01:11 PM
MET WITH:	Licensee Maria Escobedo		TIME COMPLETED:	03:45 PM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	On 6/28/22 Licensing Program Analyst (LPAs) Jeanette Estrada conducted an unannounced required 1 year inspection at the above facility. LPA met with the Licensee Maria Escobedo and informed her of the purpose for the visit. Entrance checklist was provided. Licensee guided LPA on a tour of the facility. There were 12 children present when LPAs arrived. Also present was Licensee's assistant. Criminal record clearance for all adults present was verified. Licensee provides care to children ages birth to 13 years old and operation days/ hours are Monday through Friday 6AM to 6PM. This is a 2 story,4 bedroom 3 bathroom home with a living room, dining room area, kitchen, detached garage, and fenced backyard. Areas on limits to children are the living room, 2 rooms, one bathroom and enclosed patio-The kitchen and the dining room are also on limits but per Licensee, they do not enter these areas. Areas off limits to children are one bedroom downstairs and the bedroom upstairs, two bathrooms and detached garage. All areas identified on the facility sketch that are accessible for children to use were inspected for safety, comfort, and cleanliness. The following was observed and reviewed during this inspection: LPA reviewed required posted documentation for Facility License, Publication (PUB) 394- Notification of Parent Rights and Licensing Form (LIC) 9148- Earthquake Preparedness form. Facility records were reviewed for LIC 9040- Facility Roster, LIC 610- Facility Disaster Plan and Disaster drill log, last drill conducted on 6/6/22. Licensee had a copy of the Roster available during the inspection. There is an operable carbon monoxide detector and a smoke detector in the home. The 2A10BC Fire extinguisher in the kitchen indicated fully charged and was last serviced on 8/2021. The home maintains telephone service (landline and cellphone). Food is provided by Licensees. Licensees were reminded if children bring food from home it must be labeled with the child’s name and properly stored or refrigerated. The home is observed to be clean and orderly. There are toys and other age appropriate materials available for children. Sharp objects, detergents and cleaning compounds are kept inaccessible to children in care. Sharp objects are kept in an upper cabinet in the kitchen inaccessible to children in care. Knives are kept in an upper kitchen cabinet.

SUPERVISOR'S NAME: Valarie Cook	TELEPHONE: (323) 513-3828
LICENSING EVALUATOR NAME: Jeanette Estrada	TELEPHONE: (323) 229-6521
LICENSING EVALUATOR SIGNATURE:	DATE: 06/28/2022

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/28/2022

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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Document Has Been Signed on 06/28/2022 03:34 PM - It Cannot Be Edited

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 CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME: ESCOBEDO FAMILY DAY CARE	FACILITY NUMBER: 191596214
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 06/28/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

HSC

1597.622(a)(1)

General Provisions and Definitions

(1) 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. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on record review the licensee did not comply with the section cited above Assistant did not have proof of measles and pertussis imumunization which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 07/28/2022
	Plan of Correction
1 2 3 4	Licensee will submit proof of immunization by POC due date.

Section Cited


	Deficient Practice Statement
1 2 3 4
	POC Due Date:
	Plan of Correction
1 2 3 4

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: Valarie Cook	TELEPHONE: (323) 513-3828
LICENSING EVALUATOR NAME: Jeanette Estrada	TELEPHONE: (323) 229-6521
LICENSING EVALUATOR SIGNATURE:	DATE: 06/28/2022

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/28/2022

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, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME: ESCOBEDO FAMILY DAY CARE	FACILITY NUMBER: 191596214
	VISIT DATE: 06/28/2022

NARRATIVE

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Cleaning products are kept in the garage. Per Licensee no children currently enrolled require medication. Personal medication is kept in the bedroom on the second floor and in an upper kitchen cabinet. There is an AC/ heating unit in the home. Children use the restroom in the playroom. No hazards were observed in the restroom. Per Licensee, children are supervised while playing outside.
Per Licensee there are no poisons in the home. Licensee understands that all poisons must be locked, not only inaccessible to children. Isolation area for sick children waiting to be picked up is in the living room. Per Licensee, there are no firearms or weapons stored in the home. LPAs did not observe pools or spas, or other bodies of water. There is a pet dog in the home.
Infant Care: Currently licensee cares for 2 infants. LPAs observed two cribs in the playroom room. Napping equipment does not block entrances or exits. Infant mattresses were observed to be firm with tightly fitted sheets. Per licensee wet or soiled sheets are laundered in the facility. Each infant has their own crib and bedding. LPAs and licensee reviewed the new Safe sleep regulations, including LIC 9227 Infant Sleep Plan for infants under 12 months, 15-minute sleep check documentation for infants 0-24 months.
Overnight Care: There is no overnight care provided at the moment. LPA discussed the following: Licensee is aware that they must remain wake while children are awake. If children sleep in separate area from licensee, the door must remain open. If licensee cannot hear children when they wake up, video or audio device can be used.
Children’s records were reviewed for (LIC) 282- Affidavit Regarding Liability Insurance, Immunization Records, LIC 700- Identification and Emergency Information, LIC 627- Consent for Medical Treatment, LIC 995A Notification of Parents’ Rights, LIC 9227- Infant sleep form (0-12 months, and documentation of 15-minute Infant Sleep Check (0-24 months)
Staff records were reviewed for approved Pediatric First Aid and CPR certification, LIC-501: Personnel Record, LIC 508-Criminal Record Statement, LIC 9052- Employee Rights, Proof of immunizations against measles, pertussis and influenza or influenza declination, TB clearance or risk assessment, LIC 9108- Statement of Child and Mandated Reporter Training Certificate. Both the Licensee's and the Assistants CPR/First Aid was completed on 5/29/21. Mandated Reporter training certificates for Licensee and Assistant were completed on 10/19/2. Assistant present was missing proof of immunization for measles and pertussis.

SUPERVISOR'S NAME: Valarie Cook	TELEPHONE: (323) 513-3828
LICENSING EVALUATOR NAME: Jeanette Estrada	TELEPHONE: (323) 229-6521
LICENSING EVALUATOR SIGNATURE:	DATE: 06/28/2022

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/28/2022

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, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME: ESCOBEDO FAMILY DAY CARE	FACILITY NUMBER: 191596214
	VISIT DATE: 06/28/2022

NARRATIVE

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During inspection the children present was observed to be treated with dignity and respect, observed to be receiving safe, healthful and comfortable accommodations, furnishings and equipment, and free from corporal and/or unusual punishment.
Incidental Medical Services (IMS): 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 Center and the ADA, available at: http://www.ada.gov/childqanda.htm
Licensee was reminded that all adults 18 and over living or working in the home, 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. LPA discussed the safe sleep regulations with Licensee 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 licensee of the importance of checking for recalled infant devices on 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.
To improve the quality and value of the new inspection process, a survey will be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or tools, please send them by email to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/process.
The following deficiency is being cited on LIC 809-D. Exit interview conducted and report was reviewed with the Licensee Maria Escobedo. A notice of site visit was given and must remain posted for 30 days. Appeal rights were given to the licensee.

SUPERVISOR'S NAME: Valarie Cook	TELEPHONE: (323) 513-3828
LICENSING EVALUATOR NAME: Jeanette Estrada	TELEPHONE: (323) 229-6521
LICENSING EVALUATOR SIGNATURE:	DATE: 06/28/2022

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/28/2022

LIC809 (FAS) - (06/04)

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