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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 192000344
Report Date: 05/28/2024
Date Signed: 05/28/2024 03:57:52 PM


Document Has Been Signed on 05/28/2024 03:57 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
MONTEREY PARK SW RO, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754



FACILITY NAME:MERA FAMILY CHILD CAREFACILITY NUMBER:
192000344
ADMINISTRATOR:MERA, OLGAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(323) 231-6447
CITY:LOS ANGELESSTATE: CAZIP CODE:
90011
CAPACITY:14CENSUS: DATE:
05/28/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
12:45 PM
MET WITH:Olga MeraTIME COMPLETED:
04:00 PM
NARRATIVE
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On 5/28/2024 at 12:45 PM, Licensing Program Analysts (LPAs) Claudia Kam and Katrina Chicote conducted an unannounced case management visit on 05/28/24. LPA was met by Olga Mera provided entry and guided analysts on a tour of the family child care. LPA observed 2 total adults caring for 4 children, 1 granddaughter and 2 nieces and 1 niece, infant daughter of her daughters paternal cousin. The physical plant was observed to be clean and free of defects.

The purpose of this visit is to obtain signatures on the LIC 9111 - Non Compliance Summary held on 05/22/24, and to review the procedures of LIC 9224 - Acknowledgement of Receipt of Licensing Reports. LPA advised Licensee that a Technical Support Program referral will be sent, and a representative will reach out to the facility. The following subjects noted on 05/22/24 were reviewed with the licensee in regards to bringing the facility into compliance:

-Licensee will be inactive effective 5/23/2024 and will not care for children with the exception of 2 family members her niece and granddaughter, until the uncleared adults have moved out or are approved in Guardian to be in the home.
-Licensee will submit a request for inactive status
-Licensee will notify the department once the residents have moved out and has agreed to a visit to confirm the departure of the uncleared adults
-Licensee will submit a new application to update the adults in the home due 6/22/2024
-Licensee will submit a new facility sketch to identify all areas in the home including additions to the home that were constructed without a permit and are in the process of being made off limits and basement area due 6/22/2024
-Licensee will submit verification of TB for all adults residing in the home by 6/22/24
-Licensee will participate in increased monitoring for 18 months
SUPERVISOR'S NAME: Denise GibbsTELEPHONE: (323) 981-3385
LICENSING EVALUATOR NAME: Claudia KamTELEPHONE: (626) 602-6842
LICENSING EVALUATOR SIGNATURE:
DATE: 05/28/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/28/2024
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 07/09/2024 09:30 AM - It Cannot Be Edited

Document is an Amendment of Original Document on 07/03/2024 10:11 AM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MONTEREY PARK SW RO, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754


FACILITY NAME: MERA FAMILY CHILD CARE
FACILITY NUMBER: 192000344

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/28/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
05/28/2024
Section Cited
CCR
102416.1(a)(1)

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(a) Personnel records shall be maintained on each employee and shall contain the following information: This requirement is not met as evidenced by:
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Licensee will provide the employee documents and have the employee complete and place in file by 6/22/24
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Based on observation and file review licensee did not an a complete employee file which poses a potential health and safety risk or personal rights risk to children in care
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Type B
05/28/2024
Section Cited
CCR102416.1(a)(10)

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(a) Personnel records shall be maintained on each employee and shall contain the following information: (10) A signed and dated copy of the Notice of Employee Rights [LIC 9052, (Rev. 03/03)] as required by Section 102416(a) and Section 102417.
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Licensee has been provided list of forms needed and will provide them to the employee for completion by 6/22/24
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Based on observation and file review licensee did have all required forms which poses a potential health and safety risk or personal rights risk to 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: Denise GibbsTELEPHONE: (323) 981-3385
LICENSING EVALUATOR NAME: Claudia KamTELEPHONE: (626) 602-6842
LICENSING EVALUATOR SIGNATURE:
DATE: 05/28/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/28/2024
LIC809 (FAS) - (06/04)
Page: 2 of 6


Document Has Been Signed on 07/03/2024 12:17 PM - It Cannot Be Edited

Document is an Amendment of Original Document on 07/03/2024 10:12 AM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MONTEREY PARK SW RO, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754


FACILITY NAME: MERA FAMILY CHILD CARE
FACILITY NUMBER: 192000344

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/28/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
05/28/2024
Section Cited
CCR
102418(a)

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(a) 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.
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Licensee will request immuniztion orecords for children in care and place in each childs file and correct by 6/22/24
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This requirement is not met as evidenced by:
Based on observation, licensee interview that residents have not been tested for TB which poses a potential health and safety risk or personal rights risk to children in care.

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Type B
05/28/2024
Section Cited
CCR102416.3(a)(6)

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(a) Prior to making alterations or additions to a family child care home or grounds, the licensee shall notify the Department of the proposed changed, including, but not limited to, the following: (6) Any change from an area of the family child care home previously identified as "off limits" to an area where care and supervision will be provided to children in care.
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The licensee will create a new facility sketch for the home and submit by 6/22/24
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This requirement is not met as evidenced by:
Based on observation, interview and file review licensee there is no facility sketch which poses a potential health and safety risk or personal rights risk to 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: Denise GibbsTELEPHONE: (323) 981-3385
LICENSING EVALUATOR NAME: Claudia KamTELEPHONE: (626) 602-6842
LICENSING EVALUATOR SIGNATURE:
DATE: 05/28/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/28/2024
LIC809 (FAS) - (06/04)
Page: 3 of 6


Document Has Been Signed on 07/03/2024 12:17 PM - It Cannot Be Edited

Document is an Amendment of Original Document on 05/30/2024 04:20 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MONTEREY PARK SW RO, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754


FACILITY NAME: MERA FAMILY CHILD CARE
FACILITY NUMBER: 192000344

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/28/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
05/28/2024
Section Cited
CCR
102425(c)

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An Individual Infant Sleeping Plan [LIC 9227 (3/20)] shall be completed for each infant up to 12 months of age the provider has in care and included in the infant's file at the facility.
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Licensee will provide parent with the sleep plan for all children in care 12 months and under and have completed by 7/5/24
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This requirement is not met as evidenced by:
Based on observation, interview and file review licensee has no sleep plan available for review, which poses a potential health and safety risk or personal rights risk to 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: Sharon GreeneTELEPHONE: (323) 981-3385
LICENSING EVALUATOR NAME: Denise GibbsTELEPHONE: (626) 602-6842
LICENSING EVALUATOR SIGNATURE:
DATE: 05/28/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/28/2024
LIC809 (FAS) - (06/04)
Page: 4 of 6


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MONTEREY PARK SW RO, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME: MERA FAMILY CHILD CARE
FACILITY NUMBER: 192000344
VISIT DATE: 05/28/2024
NARRATIVE
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In addition during this inspection Technical Violations were reviewed for confirmation of completion. It was found that none of the technical violations given on 5/17/24 were corrected. LPAs have provided the licensee with a packet for infant sleep plan and template for safe sleep observation, packet listing all documents needed for an employee file and the forms, a facility file packet with all forms needed in the facilty and forms to be posted. Licensee has been provided a facility sketch form for completion via email and form provided at todays visit. Licensee has been advised that a Type A notice to parents is to be in all files for children for up to 12 months and LIC 9224 provided for reference for parents to sign acknowledging notification.

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

Based on this information the following deficiencies on the LIC 809 D are being cited today 05/28/24.

LPA Claudia Kam informed licensee Olga Mera that this report dated 05/28/24 documents 6 Type B citations which shall be posted for 30 consecutive days as there is an immediate risk to the health, safety, or personal rights of children in care.



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

Exit interview conducted and report was reviewed with the licensee Olga Mera.
SUPERVISOR'S NAME: Denise GibbsTELEPHONE: (323) 981-3385
LICENSING EVALUATOR NAME: Claudia KamTELEPHONE: (626) 602-6842
LICENSING EVALUATOR SIGNATURE:

DATE: 05/28/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/28/2024
LIC809 (FAS) - (06/04)
Page: 6 of 6
Document Has Been Signed on 07/03/2024 12:18 PM - It Cannot Be Edited

Document is an Amendment of Original Document on 07/03/2024 10:26 AM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MONTEREY PARK SW RO, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754


FACILITY NAME: MERA FAMILY CHILD CARE
FACILITY NUMBER: 192000344

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/28/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
05/28/2024
Section Cited
HSC
1596.8595(c)(1)

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(c)(1) A licensed child day care facility shall provide to the parents or guardians of each child receiving services in the facility copies of any licensing report that documents any Type A citation that represents an immediate risk to the health, safety, or personal rights of children in care as set forth in paragraph (1) of subdivision (a) of Section 1596.893b.
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Licensee will provide notification of Type A and post on the wall by 6/22/24
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This requirement is not met as evidenced by:
Based on observation, and licensee interview that the Type A violation is not posted and parents did not sign a notice of Type A violation, which poses a potential health and safety risk or personal rights risk to 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: Denise GibbsTELEPHONE: (323) 981-3385
LICENSING EVALUATOR NAME: Claudia KamTELEPHONE: (626) 602-6842
LICENSING EVALUATOR SIGNATURE:
DATE: 05/28/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/28/2024
LIC809 (FAS) - (06/04)
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