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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 192006918
Report Date: 08/01/2022
Date Signed: 08/01/2022 03:26:37 PM


Document Has Been Signed on 08/01/2022 03:26 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:DIAS FAMILY CHILD CAREFACILITY NUMBER:
192006918
ADMINISTRATOR:DIAS, ETELBINAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(626) 797-8637
CITY:PASADENASTATE: CAZIP CODE:
91103
CAPACITY:14CENSUS: 2DATE:
08/01/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
02:15 PM
MET WITH:Etelbina DiasTIME COMPLETED:
03:40 PM
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Licensing Program Analyst (LPA) Crystal Green conducted an unannounced annual inspection. LPA met with licensee, Etelbina Dias, who guided analyst on a tour of the facility. There were 2 children present during this inspection. Licensee states that there are currently 2 children enrolled.

This is a two story home which consists of 3 bedrooms, 2 bathrooms, kitchen, dining room, living room, front and backyard (fenced). This is a duplex property. The children use the bathroom on the first floor, kitchen, living room, one bedroom and dining room. Per licensee, areas off limits to children and parents include: 2nd floor, there is a kiddie gate blocking access to the stairwell. LPA observed a fireplace located in the living room that was made inaccessible via a shelf barricade and gate. The LPA toured all areas used by children during this visit.

Family members residing in the home are 3 adults (criminal record clearances on file). 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.

Areas accessible to children were inspected to ensure that they are clean and orderly with ventilation and heating or safety and comfort. There were safe toys, play equipment and materials observed for children. 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. 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.

Report Continues Page 2 of 2.
SUPERVISOR'S NAME: Christina GabelmanTELEPHONE: (323) 981-3380
LICENSING EVALUATOR NAME: Crystal GreenTELEPHONE: (323) 980-4930
LICENSING EVALUATOR SIGNATURE:
DATE: 08/01/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/01/2022
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 2


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: DIAS FAMILY CHILD CARE
FACILITY NUMBER: 192006918
VISIT DATE: 08/01/2022
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Per licensee, there are no weapons, firearms or bodies of water on the premises. 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 02/10/2022. At 2:25pm, LPA tested the smoke detector located in the dining area and carbon monoxide detector located in the living room, which was observed to be in operable condition. The licensee has current Pediatric First Aid and CPR, which will expire 04/2023.

LPA did not observe any sleeping equipment for infants during this inspection. Per licensee, there no infants currently enrolled at this time. LPA advised licensee to review the safe sleep regulation and the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep prior to caring for infants.

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

At this time, the licensee is in compliance with California Title 22 Regulations. Therefore, there are no citations being issued today.

Exit interview conducted and report was reviewed with the licensee Etelbina Dias. 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.

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.
Report Ends Page 2 of 2.
SUPERVISOR'S NAME: Christina GabelmanTELEPHONE: (323) 981-3380
LICENSING EVALUATOR NAME: Crystal GreenTELEPHONE: (323) 980-4930
LICENSING EVALUATOR SIGNATURE:

DATE: 08/01/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/01/2022
LIC809 (FAS) - (06/04)
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