192007738-6-9-2019-30-CC-SGAN-BCYLNN-20190609085438

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 192007738
Report Date: 05/30/2019
Date Signed: 06/09/2019 08:54:44 AM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245

FACILITY NAME:	SAN GERMAN FAMILY CHILD CARE		FACILITY NUMBER:	192007738
ADMINISTRATOR:	SAN GERMAN, MARIA GERARDO		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(818) 767-0313
CITY:	NORTH HOLLYWOOD	STATE: CA	ZIP CODE:	91605
CAPACITY:	14	CENSUS: 8	DATE:	05/30/2019
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	07:55 AM
MET WITH:	Maria San German/licensee		TIME COMPLETED:	10:15 AM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	Licensing Program Analyst (LPA) Silva Garibyan conducted a site visit for the purpose of an Annual Random visit . LPA met with the licensees and toured the home inside and outside at 08:05 a.m on 05/30/2019. There were four preschoolers and four infants present at the time of the visit. . All areas identified on the facility sketch were inspected. Licensees' home is a single story 3 bedroom, 3 bathroom home with living room, dining area, kitchen, den (used as a bedroom) and a guest room at the rear of the home. Main care is provided in the guest room at the rear of the home. Children have access to the living room, dining area, kitchen, and den/bedroom as well. Off limit areas include the home's 3 bedrooms. The home also has a laundry room and storage room that is accessible from the back yard. There is no pool, spa or other bodies of water on the premises. Family members residing in the home include the licensees, and their two adult children. Children eat and nap in the guest room and den. LPA observed napping equipment, playpens,, cribs, small tables and chairs. Licensees report they have no firearms or weapons in the home. The LPA toured all areas used by children during this inspection. LPA also observed Licensees' current Pediatric CPR (Adult/Infant /Child) and Pediatric First Aid certifications (expire 10/2019). The bathroom in the guest room/play room and the kitchen was observed free of chemicals or toxic items that can pose danger to children in care. Children play outside in the back yard only. The yard is fenced and gated. Vehicles are parked at the rear of the yard, near the gate that leads to the alley. There is a second gate/fence used to separate the parking area from the play area. Licensee has 2 dogs that are kept in the area where the cars are parked. Children do not interact with the pets. Children's outdoor play equipment and toys are age appropriate and in good repair.. LPA observed the yard to be fully fenced. The Fire Extinguisher (2A-10-BC) is mounted on the wall in the kitchen. There is a working smoke/carbon monoxide detectors located in the hall way. The First Aid kit was observed, and complete. Page 1 of 3

SUPERVISOR'S NAME: Mary Ruiz	TELEPHONE: (424) 301-3061
LICENSING EVALUATOR NAME: Silva Garibyan	TELEPHONE: (424) 301-3062
LICENSING EVALUATOR SIGNATURE:	DATE: 05/30/2019

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/30/2019

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, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245

FACILITY NAME: SAN GERMAN FAMILY CHILD CARE	FACILITY NUMBER: 192007738
	VISIT DATE: 05/30/2019

NARRATIVE

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Licensee has the following documents posted in the FCCH; Facility License (LIC 203), Notification of Parents' Rights Poster (PUB 394) , Child Care Facility Roster (LIC9040), Emergency Disaster Plan (LIC610a).
A review of the children's records was conducted and are found to have the following: LIC 282 Affidavit Liability Insurance, LIC 627/Consent for Medical Treatment, LIC 700/ID and Emergency Information, LIC 995A/Parent's Rights, LIC995E/Caregiver Background Check, LIC 9150/Parent Notification, LIC 9212/Parent's Responsibilities, PM 286/Immunization Card.
LPA observed the fire drill log. The fire drills are done every month.

The following was thoroughly discussed with the licensee:

Assembly Bill 633: Upon receipt by the licensee, licensees are to provide to parents/guardians the following: Copies of any licensing reports that document a Type A citation- this includes facility visits and substantiated complaint investigations; copy of licensing documents pertaining to a conference conducted by a local licensing agency management representative and the licensee of this family child care home in which issues of noncompliance are discussed or copies of a summary of an accusation indicating the Department's intent to revoke the facility's license. Copies of any of the above licensing documents the licensee has received in the prior 12 months shall be provided to parents/guardians of newly enrolled child at the facility.

Senate Bill 792: This bill, commencing September 1, 2016, prohibits a person from being employed or volunteering at a child care facility or family day care if he or she has not been immunized against influenza, pertussis and measles. Licensees immunization records are up to date

New Appeal Process: A licensee may file an appeal, in writing 15 business days from the date of receiving the penalty assessment

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SUPERVISOR'S NAME: Mary Ruiz	TELEPHONE: (424) 301-3061
LICENSING EVALUATOR NAME: Silva Garibyan	TELEPHONE: (424) 301-3062
LICENSING EVALUATOR SIGNATURE:	DATE: 05/30/2019

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/30/2019

LIC809 (FAS) - (06/04)

Page: 2 of 3

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245

FACILITY NAME: SAN GERMAN FAMILY CHILD CARE	FACILITY NUMBER: 192007738
	VISIT DATE: 05/30/2019

NARRATIVE

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Update on Incidental Medical Services:

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

Mandated Reporter: Beginning on January 1, 2018, AB 1207, requires all licensed providers, applicants, directors and employees to complete training as specified on their mandated reporter duties and to renew their training every two years. Volunteers are encouraged but not required to take the training. Website: www.mandatedreporterca.com. Licensees completed the training on 02/08/18.

The licensee was informed of The Child Care Advocate Program (CCAP) that is administered from within the Community Care Licensing Division. CCAP participates in many community activities and special projects in order to disseminate information on the State’s licensing role, provide information to the public and parents on child care licensing, and provide many other helpful resources to the licensees and the public. CCAP’s direct contact information is as followed: Phone number: (916) 654-1541
Email Address: childcareadvocatesprogram@dss.ca.gov

The facility is operating in substantial compliance with the Title 22 Regulations at time of visit.
No violations were cited. A copy of this report along with a Notice of Site Visit were issued and explained to licensee.

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SUPERVISOR'S NAME: Mary Ruiz	TELEPHONE: (424) 301-3061
LICENSING EVALUATOR NAME: Silva Garibyan	TELEPHONE: (424) 301-3062
LICENSING EVALUATOR SIGNATURE:	DATE: 05/30/2019

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/30/2019

LIC809 (FAS) - (06/04)

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