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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 191811185
Report Date: 09/24/2019
Date Signed: 09/24/2019 11:21:19 AM

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:ANA MENDEZ, NORMA ARCA AND CAMILO ARCAFACILITY NUMBER:
191811185
ADMINISTRATOR:MENDEZ, ANA M.FACILITY TYPE:
810
ADDRESS:TELEPHONE:
(213) 484-9487
CITY:LOS ANGELESSTATE: CAZIP CODE:
90026
CAPACITY:14CENSUS: 8DATE:
09/24/2019
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
08:33 AM
MET WITH:Norma ArcaTIME COMPLETED:
11:35 AM
NARRATIVE
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Licensing Program Analysts (LPAs) Lissete Gonzalez and Bardo Baluyot conducted an unannounced annual random site inspection to ensure the health & safety standards as required by regulations governing family child care homes. Upon arrival, LPA met with Licensees, Norma Arca who provided LPA a tour of the facility indoors and outdoors. Licensee, Ana Mendez was also present. There were 8 children present including 5 infants; Licensees are operating out of staffing ratio and capacity limitations. Licensee states there are 12 children enrolled. The children’s roster was reviewed and is current. Licensee’s operating hours are from 7:00 a.m. to 5:00 p.m. from Monday through Friday.

This is a one story home which consists of 3 bedrooms, 1 bathroom, kitchen, living room, dining room, front and backyard (fenced). Per Licensee she lives in the guest house that is located behind the yard, which Licensee states has the same address. The children have access to the day care room one bathroom and backyard for play. Per licensee, areas off limits to children and parents include: kitchen, 3 bedrooms, living and dining rooms. LPAs toured all areas used by children during this visit.

LPAs inspected the day care room used by the children. There are adequate age appropriate toys, books, and games. No hazards or violations were observed. There is proper ventilation through the home. There is a door that leads from the day care room into the kitchen that is maintained closed to prevent access. Knives and sharp objects are stored the kitchen and are inaccessible to the children. The bathroom was inspected for safety and cleanliness. No hazards or violations were observed. LPA There are electrical outlet covers throughout and a First Aid Kit is available. Cleaning compounds and detergents are stored outside and are inaccessible to the children.

The backyard is fenced and there is shade available. There are age appropriate toys and equipment on the premises.
REPORT CONTINUES ON NEXT PAGE: 1 OF 3
SUPERVISOR'S NAME: Adriana HernandezTELEPHONE: (323) 981-3362
LICENSING EVALUATOR NAME: Lissete GonzalezTELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:

DATE: 09/24/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/24/2019
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC809 (FAS) - (06/04)
Page: 1 of 5
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: ANA MENDEZ, NORMA ARCA AND CAMILO ARCA
FACILITY NUMBER: 191811185
VISIT DATE: 09/24/2019
NARRATIVE
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LPA advised the licensee how to access forms, regulations and quarterly updates on the Child Care Licensing website at: www.ccld.ca.gov

Based on this information, the following deficiencies listed on the attached LIC 809d 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.

Upon receipt, the Licensee shall post the Notice of Site Visit and the Licensing report. This report and the Notice of Site Visit shall be posted for 30 consecutive days. Failure to maintain posting as required will result in a $100 civil penalty. A copy of this report shall be provided to the parents/guardians of the children currently enrolled by the next business day or immediately upon return. A copy of this report shall also be provided to the parents/guardians of any children newly enrolled at the facility for the next 12 months. The LIC 9224 Acknowledgement of Receipt of Licensing Reports must be maintained in each child's file immediately upon receipt from the parent. LPA provided Licensee with a blank copy of the LIC 9224 Acknowledgement of Receipt of Licensing Report.

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

END OF REPORT: PAGE 3 OF 3
SUPERVISOR'S NAME: Adriana HernandezTELEPHONE: (323) 981-3362
LICENSING EVALUATOR NAME: Lissete GonzalezTELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:

DATE: 09/24/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/24/2019
LIC809 (FAS) - (06/04)
Page: 3 of 5
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: ANA MENDEZ, NORMA ARCA AND CAMILO ARCA
FACILITY NUMBER: 191811185
VISIT DATE: 09/24/2019
NARRATIVE
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Licensee has the Parent’s Rights poster and other appropriate forms posted on a board in the day care room. Licensee, Norma Arca’s First Aid/Infant CPR certificates are valid through 06/06/2020. Licensee, Norma Arca completed the Mandated Reporter on 1/26/2018. Licensee, Camilo Arca’s First Aid/Infant CPR certificates are valid through 06/06/2020. Licensee, Camilo Arca completed the Mandated Reporter on 3/07/2018. Licensee's disaster drill log notes last drill conducted on 09/03/19. Licensee has a working telephone.

LPA observed the 2A10BC fire extinguisher located in the kitchen was serviced on 09/12/2019 and is fully charged. There is an operational smoke detector and an operational carbon monoxide detector in the home. There are no firearms or poisons present on the premises as stated by Licensee. Currently there is one dog that is kept in a kennel during hours of operation.

Staff files were reviewed and found to be complete. Children’s files were reviewed for proper documentation. Child # 1 and Child #8 did not have an immunization record on file.

The following were 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. No smoking, No infant walkers, No baby bouncers, No Johnny jumpers, No exersaucers and any other item that falls into that category. LPA discussed disaster drills, posting requirements, children records requirements, mandated child abuse and injury/death reporting. LPA reviewed LIC 311D with licensee, reminding her of required forms. LPA reviewed SIDs, Never Shake A Baby, and safe sleeping practices. Infants should sleep mouth up, on their backs, free of clutter surrounding their sleeping space.

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. A qualified Assistant must be present and actively involved in caring for children whenever nine (9) or more children are present at the facility in a large family child care home.
REPORT CONTINUES ON NEXT PAGE: 2 OF 3
SUPERVISOR'S NAME: Adriana HernandezTELEPHONE: (323) 981-3362
LICENSING EVALUATOR NAME: Lissete GonzalezTELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:

DATE: 09/24/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/24/2019
LIC809 (FAS) - (06/04)
Page: 2 of 5
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: ANA MENDEZ, NORMA ARCA AND CAMILO ARCA
FACILITY NUMBER: 191811185
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/24/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
09/24/2019
Section Cited

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Staffing Ratio and Capacity
For a Large Family Child Care Home, the maximum number of children for whom care may be provided at any one time when there is an assistant provider in the home, including children under age 10 who reside at the licensee's home and the assistant provider's children under age 10, shall be either:
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 Twelve children, no more than four of whom may be infants. This requirement was not met as evidenced by: There were 8 children present including 5 infants. This poses an immediate threat to the health and safety of children inc are.
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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: Adriana HernandezTELEPHONE: (323) 981-3362
LICENSING EVALUATOR NAME: Lissete GonzalezTELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:
DATE: 09/24/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/24/2019
LIC809 (FAS) - (06/04)
Page: 4 of 5
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: ANA MENDEZ, NORMA ARCA AND CAMILO ARCA
FACILITY NUMBER: 191811185
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/24/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
10/18/2019
Section Cited

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Immunizations
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 was not met as evidenced by: Child #1 and Child #8 did not have proof of immunizations. This poses
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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: Adriana HernandezTELEPHONE: (323) 981-3362
LICENSING EVALUATOR NAME: Lissete GonzalezTELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:
DATE: 09/24/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/24/2019
LIC809 (FAS) - (06/04)
Page: 5 of 5