191806306-9-4-2019-33-CC-JMOA-BFPR4C-20190904124120

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 191806306
Report Date: 09/04/2019
Date Signed: 09/04/2019 12:41:40 PM

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:	ANKA FAMILY CHILD CARE		FACILITY NUMBER:	191806306
ADMINISTRATOR:	ANKA, PHYLLIS		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(323) 663-7619
CITY:	LOS ANGELES	STATE: CA	ZIP CODE:	90039
CAPACITY:	14	CENSUS: 10	DATE:	09/04/2019
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	11:30 AM
MET WITH:	Phyllis Anka		TIME COMPLETED:	12:55 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	Licensing Program Analyst (LPA) Judy Mora conducted an unannounced Annual random inspection. LPA met with licensee, Phyllis Anka, who guided analyst on a tour of the facility. The licensee's assistant's, Delmy Chavez and Sophia Situ, were also present. There were 10 children present, 2 being infants. Licensee states that there are currently 14 children enrolled, children's roster was reviewed and is current. Disaster drill log was available, last drill documented was 07/08/19. This is a three story home which consists of 4 bedrooms, 4 bathrooms, kitchen, dining room, living room and day care room. Children are cared for on the first level. The upper floors are off limits via iron gate installed at the stairwell. Per licensee, there is (1) adult residing in the home. There is also one large dog which is kept in a gated area during the hours of operation. The back yard is fully fenced. Areas accessible to children were inspected to ensure that they are clean and orderly with ventilation and heating for safety and comfort (central air). There is a working telephone service maintained in the home. Detergents, cleaning compounds, medications, and other items which can pose a danger to children are inaccessible in all areas of the home. The licensee states that there are no poisons in the home. The licensee does understand that poison must be locked with a key or combination lock. Per licensee, there are no weapons, firearms or bodies of water on the premises. There were safe toys, play equipment and materials observed for children. Emergency Disaster Plan was posted at the time of visit. Children’s records were reviewed to ensure that each child has an Identification and Emergency form. The valve on the required 2A 10BC fire extinguisher indicates fully charged (serviced 01/30/19). Smoke detector and carbon monoxide detector in the dining room were tested, and are in operable condition. The licensee has current Pediatric First Aid and CPR, which will expire 04/2021. *REPORT CONTINUES ON THE NEXT PAGE

SUPERVISOR'S NAME: Claudia Guangorena	TELEPHONE: (323) 981-3417
LICENSING EVALUATOR NAME: Judy Mora	TELEPHONE: (323) 981-3371
LICENSING EVALUATOR SIGNATURE:	DATE: 09/04/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/04/2019

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, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME: ANKA FAMILY CHILD CARE	FACILITY NUMBER: 191806306
	VISIT DATE: 09/04/2019

NARRATIVE

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LPA reviewed and issued the LIC 311 - Forms/Records to Keep in Your Family Child Care Home.
CHILDREN’S FORMS/RECORDS, FACILITY FORMS/RECORDS and INFORMATION TO BE POSTED, Disaster drills, posting requirements, children records requirements, mandated child abuse and injury/ death reporting, criminal record transfer requirements, criminal record and child abuse clearances were also discussed during this visit.

The licensee’s email address was obtained during this visit. The licensee was advised that email is public information.

LPA advised the licensee how to access forms, regulations and quarterly updates on the Child Care Licensing website at: www.ccld.ca.gov

LPA provided email address in order to be placed on quarterly update subscription: ChildCareAdvocatesProgram@dss.ca.gov

The Notice of Site Visit (LIC 9213) – must remain posted for 30 days during the hours of operation after each site visit by a licensing representative. Failure to maintain posting as required will result in a civil penalty of $100.00.

The deficiencies listed on the following pages were observed by the LPA and are being cited in accordance with California Code of Regulations Title 22 and/or the Health and Safety Code. Please see attached LIC 809d. Deficiencies that are being cited need to be cleared to protect the children’s health & safety.

Exit interview was conducted with Licensee. The Licensee was provided a copy of their appeal rights (LIC 9058) and their signature on this form acknowledges receipt of these forms.

*END OF REPORT

SUPERVISOR'S NAME: Claudia Guangorena	TELEPHONE: (323) 981-3417
LICENSING EVALUATOR NAME: Judy Mora	TELEPHONE: (323) 981-3371
LICENSING EVALUATOR SIGNATURE:	DATE: 09/04/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/04/2019

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 CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME: ANKA FAMILY CHILD CARE	FACILITY NUMBER: 191806306
	VISIT DATE: 09/04/2019

NARRATIVE

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Incidental Medical Services (IMS) policy was discussed. Per Licensee, there are no children on medication. 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

SB792 (Immunization Requirements for Staff and Employees) was discussed with the Licensee. The Licensee does not currently have immunization documentation. This is a potential risk to the health and safety of children in care. Licensee's assistants do have immunization documentation on file.

AB1207 Mandated Child Abuse Reporting – Implementation was discussed with Licensee. Website provided: https://www.mandatedreporterca.com/training/child-care-providers. The Licensee and her assistants have not taken the training. This is a potential risk to the health and safety of children in care.

The Licensee was advised that inaccessibility of hazards must be constantly reassessed depending on the children in care. Sudden Infant Death Syndrome (SIDS) and Never-Shake-a-Baby were discussed. Safe Sleep concepts was distributed.

The following was discussed: Individuals who are 18 years of age or older living in the home must obtain a criminal record clearance. Individuals within one month of their 18th birthday must be fingerprinted immediately. Failure to obtain a criminal record background check clearances prior to initial presence in the home will result in an immediate $100.00 dollar or more per day Civil Penalty.

No smoking, No infant walkers, No Johnny jumpers, No saucer chairs, No trampolines and any other item that falls into that category are not permitted in the facility. Effective January 1, 2010, licensees of family child care homes are required to ensure that at least one staff member with current training in pediatric first aid and pediatric CPR is on site at all times when children are present.

*REPORT CONTINUES ON NEXT PAGE

SUPERVISOR'S NAME: Claudia Guangorena	TELEPHONE: (323) 981-3417
LICENSING EVALUATOR NAME: Judy Mora	TELEPHONE: (323) 981-3371
LICENSING EVALUATOR SIGNATURE:	DATE: 09/04/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/04/2019

LIC809 (FAS) - (06/04)

Page: 2 of 4

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: ANKA FAMILY CHILD CARE	FACILITY NUMBER: 191806306
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 09/04/2019

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 10/04/2019 Section Cited	1 2 3 4 5 6 7	Availability of information regarding detecting and reporting child abuse and neglect; training for mandated reporter who is licensed day care provider, administrator, or employee of a licensed child day care facility; proof of completion On and after January 1, 2018, a person who becomes an administrator or
	8 9 10 11 12 13 14	employee of a licensed child day care facility shall complete the mandated reporter training within the first 90 days that he or she is employed at the facility and shall complete renewal mandated reporter training every two years following the date on which he or she completed the initial mandated reporter training. This requirement was not met as evidenced by staff file review. Staff have not completed the training.	8 9 10 11 12 13 14
Type B 10/04/2019 Section Cited	1 2 3 4 5 6 7	Employees or volunteers at family day care home; immunization requirements; records; exemptions 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 was not met as evicdenced by staff file review. Licensee does not have documentation. This is a potential risk to the health and safety 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: Claudia Guangorena	TELEPHONE: (323) 981-3417
LICENSING EVALUATOR NAME: Judy Mora	TELEPHONE: (323) 981-3371
LICENSING EVALUATOR SIGNATURE:	DATE: 09/04/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/04/2019

LIC809 (FAS) - (06/04)

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