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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 192000036
Report Date: 11/30/2023
Date Signed: 11/30/2023 04:56:15 PM


Document Has Been Signed on 11/30/2023 04:56 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 CNTR DR. 200-B
MONTEREY PARK, CA 91754



FACILITY NAME:FAJARDO FAMILY CHILD CAREFACILITY NUMBER:
192000036
ADMINISTRATOR:FAJARDO, NAY-YIFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(626) 917-0149
CITY:LA PUENTESTATE: CAZIP CODE:
91744
CAPACITY:14CENSUS: 8DATE:
11/30/2023
TYPE OF VISIT:Required - 3 YearUNANNOUNCEDTIME BEGAN:
01:30 PM
MET WITH:Nay-Yi FajardoTIME COMPLETED:
05:00 PM
NARRATIVE
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Visit conducted in Spanish

On 11/30/2023, Licensing Program Analyst (LPA), Carolyn Tuba conducted an unannounced annual inspection for the above facility. Covid risk assessment was conducted. LPA met with Licensee, Nay-Yi Fajardo and spouse along with 2 adult assistants. LPA observed 8 children in care. A children’s facility roster was available. Per Licensee, operating hours are from Monday - Friday 6:00 am – 10:00 pm and cares for children ages 3 months to 12 years of age. The licensee provides breakfast, lunch, PM snack and dinner to the children in care and licensee is part of a food program.

This is a one-story home which consists of living room, kitchen, formal dining room, family room, garage, front yard, back yard, side yard, 4 bedrooms and 3 bathrooms. There is also a small home located in the back yard. The Adults living in the home have been fingerprint cleared and licensee was given a LIC279B for minors in the home. Areas used by the children are family room, formal dining room, kitchen, side yard, back yard, bedroom #2 and 2 bathrooms. Per Licensee, areas off limits to children and parents include 3 bedrooms, 1-bathroom, front yard, and garage. Facility Sketch was updated and provided to LPA as bathroom and bedroom #2 were added as areas that children may occupy. LPA inspected for safety.

The licensee states that 2 adults currently live in the home. Per Licensee, she has spouse and 2 adults who assist as they operate as a large facility. All adults present in the home have obtained a criminal record clearance or exemption prior to working, residing, or volunteering in the licensed childcare home. 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.
SUPERVISOR'S NAME: Ana ChicoTELEPHONE: (323) 981-3374
LICENSING EVALUATOR NAME: Carolyn TubaTELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:
DATE: 11/21/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/21/2023
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 11/30/2023 04:56 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 CNTR DR. 200-B
MONTEREY PARK, CA 91754


FACILITY NAME: FAJARDO FAMILY CHILD CARE
FACILITY NUMBER: 192000036

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/30/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102425(j)(1)
Infant Safe Sleep
The provider shall supervise infants while they are sleeping and adhere to the following requirements: The provider shall physically check on the infant every 15 minutes.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on interview, the licensee did not comply with the section cited above in not providing proof of documentation, which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 12/06/2023
Plan of Correction
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Licensee will provide proof of daily sleep check to LPA.
Type B
Section Cited
HSC
1596.8662(b)(1)
Administration of Child Day Care Licensing
(1) On or before March 30, 2018, a person who, on January 1, 2018, is a licensed child day care provider, administrator, or employee of a licensed child day care facility shall complete the mandated reporter training provided pursuant to paragraphs (2) and (3) of subdivision (a), 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 is not met as evidenced by:
Deficient Practice Statement
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Based on record review, the licensee did not comply with the section cited above in certificates were expired which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 12/08/2023
Plan of Correction
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Licensee, spouse and 2 assistants will complate training and Licensee will rpovide proof of completed certificates to LPA.
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: Ana ChicoTELEPHONE: (323) 981-3374
LICENSING EVALUATOR NAME: Carolyn TubaTELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:
DATE: 11/30/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/30/2023
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 11/30/2023 04:56 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 CNTR DR. 200-B
MONTEREY PARK, CA 91754


FACILITY NAME: FAJARDO FAMILY CHILD CARE
FACILITY NUMBER: 192000036

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/30/2023

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
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Based on record review, the licensee did not comply with the section cited above in not having proof of immunizations of MMR, Tdap, TB and Flu) which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 12/15/2023
Plan of Correction
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Licensee will be providing proof of immunizations for herself, spouse and both assistants.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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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: Ana ChicoTELEPHONE: (323) 981-3374
LICENSING EVALUATOR NAME: Carolyn TubaTELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:
DATE: 11/30/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/30/2023
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: FAJARDO FAMILY CHILD CARE
FACILITY NUMBER: 192000036
VISIT DATE: 11/30/2023
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The home was inspected for safety, comfort, cleanliness, ventilation, and telephone service.
Fire and safety drills must be performed every 6 months and documented for review by the Department. Licensee conducted an Fire and Earthquake Drill in November 2023. There is no one that smokes in the at family childcare home.

In the absence of the licensee a qualified adult must be present supervising the children; a qualified adult is an individual who has a valid and current Pediatric First Aid and CPR training, Immunization's (TDAP, MMR, TB and Influenza), mandated reporter training and a valid criminal record clearance associated to the facility license.



Detergents, cleaning compounds, medications, and other items, which could pose a danger, were determined to be inaccessible to children in care during this inspection.

LPA observed the required 2:A-10:B-C fire extinguisher and per Licensee it had been serviced on January or February of 2023 and will be servicing in December 2023 and will obtain proof of service. Per State Fire Marshall standards, fire extinguishers shall be service annually. The smoke detector and carbon monoxide detector were tested and operable. Per Licensee, there are no weapons, firearms, or bodies of water on the premises. According to Licensee there are no pets on the premises.

LPA advised the Licensee with regards to safe sleep and that infants under 24 months shall be checked on every 15 minutes and the time of each 15-minute check shall be documented with child’s name, date and initials of the person who checked on the child. LPA provided Licensee a booklet on Safe Sleep in Spanish. The LIC 9227 Individual Infant Sleeping Plan shall be completed for each infant up to 12 months of age and was provided to Licensee. LPA advised Licensee the Provider Information Notice (PIN) 20-24 CCP: Recently Approved Safe Sleep Regulations in Effect and provided a copy. Per Licensee children are checked but is not documenting the 15-minute sleep check. LPA provided a sample sheet and Licensee will be begin checking tomorrow 12/1/2023.

The licensee is observed to be operating within the license capacity limitations. LPA did not observe any children left in parked vehicles. Car seats shall only be used for transportation. LPA did not observe any children sleeping in car seats. The Licensee was reminded to utilize play yards, cribs, and highchairs for what they are intended for and not leave children in them for any other reason.
SUPERVISOR'S NAME: Ana ChicoTELEPHONE: (323) 981-3374
LICENSING EVALUATOR NAME: Carolyn TubaTELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:

DATE: 11/30/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/30/2023
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: FAJARDO FAMILY CHILD CARE
FACILITY NUMBER: 192000036
VISIT DATE: 11/30/2023
NARRATIVE
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The licensee and other personnel have completed training on preventive health practices including Pediatric First Aid and CPR. The licensee, her spouse and assistant currently have Pediatric First Aid and CPR expires on 5/2025, which includes the EMSA sticker. There are first aid supplies available. Licensee, spouse, and 2 assistants have expired mandated reporting training certificate AB 1207, which expired July 2023. Per Licensee they will be taking the trainings which are offered in Spanish. LPA advised that Mandated Reporting training needs to be conducted every 2 years.

Currently, children are using the back yard for outdoor play time. The outdoor play area was observed to be enclosed with a brick wall and fence in the back which meet the height requirements. LPA observed that the outdoor yard has toys, bikes, play structure, sea-saws and other materials for children to play with.



Children and Staff records must be maintained and updated as needed and must be available for review by the Department. If Children and Staff leave the day care all records must be maintained for 3 years after leaving. Licensee did not have proof of immunizations for herself, spouse and assistants and will obtaining the proof.

To improve the quality and value of the new inspection process, a survey may 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 CARE tools, please send email inquiries 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/inspection-process.


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 [or facility representative] 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.

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: https://www.ada.gov/resources/child-care-centers/.
SUPERVISOR'S NAME: Ana ChicoTELEPHONE: (323) 981-3374
LICENSING EVALUATOR NAME: Carolyn TubaTELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:

DATE: 11/30/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/30/2023
LIC809 (FAS) - (06/04)
Page: 5 of 6
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: FAJARDO FAMILY CHILD CARE
FACILITY NUMBER: 192000036
VISIT DATE: 11/30/2023
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Licensee was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain childcare by connecting them to childcare providers and Resource and Referral Agencies (R&Rs) throughout California.

During the exit interview, the Licensee, confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS.

Please see LIC809-D pages for deficiencies cited during today's visit in accordance with the California Code of Regulations Title 22, Division 12, Chapter 1.

A notice of site visit was given and must remain posted for 30 days.

Exit interview conducted and report was reviewed with the Licensee, Nay-Yi Fajardo.
SUPERVISOR'S NAME: Ana ChicoTELEPHONE: (323) 981-3374
LICENSING EVALUATOR NAME: Carolyn TubaTELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:

DATE: 11/30/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/30/2023
LIC809 (FAS) - (06/04)
Page: 6 of 6