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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 192004922
Report Date: 11/10/2022
Date Signed: 11/10/2022 12:18:27 PM

Document Has Been Signed on 11/10/2022 12:18 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:GARCIA FAMILY CHILD CAREFACILITY NUMBER:
192004922
ADMINISTRATOR:GARCIA, EVELIAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(562) 215-3559
CITY:HAWAIIAN GARDENSSTATE: CAZIP CODE:
90716
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 0DATE:
11/10/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:15 AM
MET WITH:Daisy Garcia, AssistantTIME COMPLETED:
12:30 PM
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Licensing Program Analyst (LPA) Alicia Mooberry conducted a Required Annual Inspection on this date. LPA met with Daisy Garcia, Assistant, and provided the inspection Entrance Checklist, LIC 126. Assistant provided tour of facility. LPA inspected rooms/areas on the facility sketch in which child-care services are provided and to which children have access. There were no children present during inspection. Per Assistant the hours of operation are Monday-Friday 6:00am-5:00pm. Individuals residing in the home were discussed and noted. LPA verified there is a working telephone maintained in the home.

This is a one story home which consists of two (2) bedrooms and one (1) bathroom, kitchen with laundry area, storage shed in teh backyard and a detached unit used as day-care activity room. There is a below ground swimming pool in the back yard.

Areas used by the children include the living room, dining area, one bedroom, bathroom, detached unit, and backyard. The children pass through the kitchen to get to the backyard.


Per Assistant, areas off limits to children and parents include: One bedroom, swimming pool, storage shed and front yard area .

Areas accessible to children were inspected to ensure that they are clean and orderly with ventilation and heating for the safety of the children. Detergents, cleaning compounds, medications, and other items which can pose a danger to children are inaccessible in the overhead cabinets in the kitchen.

LPA observed an in ground pool in the backyard with a padlock on the door making it inaccessible to children in care. The pool is surrounded by metal fence that does not obscure the pool from view. The fenced is in good repair and designed so children could not remove any portion of it. The fence is taller than five feet. No window or door provides direct access to the pool. Gate swings away from the pool, and it is self closing and self latching. There are no openings that exceed four inches. Bottom of the fence is less than four inches from the cement ground. -------------Page 1 Report Continues

SUPERVISORS NAME: Valarie Cook
LICENSING EVALUATOR NAME: Alicia Mooberry
LICENSING EVALUATOR SIGNATURE: DATE: 11/10/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/10/2022
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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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: GARCIA FAMILY CHILD CARE
FACILITY NUMBER: 192004922
VISIT DATE: 11/10/2022
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The home is observed to be clean and orderly. There are toys and other age appropriate material available for children. LPA observed that detergents, cleaning compounds are in the kitchen inaccessible to children. Licensee understands that all poisons must be lock, not only inaccessible to children. Isolation area for sick children waiting to be picked up is in living room, away from the other children. Per Licensee there are no firearms or weapons stored in the home. Child care children use the bathroom located in the hallway next to the dining room and was observed to be clean without visible hazards.

The valve on the required 2A 10BC fire extinguisher indicates fully charged with attached purchase receipt dated 1/21/22. Facility representative was reminded to service the fire extinguisher yearly as required by the Fire Marshall

LPA provided updated Publication (PUB) 394- Notification of Parent Rights and Licensing in Spanish and English and a copy of Form (LIC) 9148- Earthquake Preparedness form. LPA observed facility records including; LIC 9040- Facility Roster and LIC 610- Facility Disaster Plan.

Children’s records were reviewed for (LIC) 282- Affidavit Regarding Liability Insurance, Immunization's Records, LIC 700- Identification and Emergency Information, LIC 627- Consent for Medical Treatment, LIC 995A Notification of Parents’ Rights, and documentation of 15-minute Infant Sleep Check (0-24 months). LPA observed signed copies of the LIC 9227 and Infant Sleep Plan (LIC 9224) for infant in care

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 Acknowledging Requirement to Report Child Abuse and current Mandated Reporter Training Certificate.

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.

Facility staff was reminded to report any unusual incidents to the department within 24 hours.

LPA observed 3 small dogs in the backyard, per staff, the dogs are kept in the storage shed during daycare hours. ------------------Page 2 – Report Continues

SUPERVISORS NAME: Valarie Cook
LICENSING EVALUATOR NAME: Alicia Mooberry
LICENSING EVALUATOR SIGNATURE:

DATE: 11/10/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/10/2022
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: GARCIA FAMILY CHILD CARE
FACILITY NUMBER: 192004922
VISIT DATE: 11/10/2022
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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

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/inspection-process.

Based on the LPA's observations and records review the following deficiencies will be cited today in accordance with California Title 22 Regulations.

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

Exit interview conducted and report was reviewed with the Daisy Garcia, Assistant

SUPERVISORS NAME: Valarie Cook
LICENSING EVALUATOR NAME: Alicia Mooberry
LICENSING EVALUATOR SIGNATURE:

DATE: 11/10/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/10/2022
LIC809 (FAS) - (06/04)
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