192009572-3-2-2020-30-CC-SGAN-BMBQ3V-20200302104923

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 192009572
Report Date: 02/27/2020
Date Signed: 03/02/2020 10:49:37 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:	MENENDEZ FAMILY CHILD CARE		FACILITY NUMBER:	192009572
ADMINISTRATOR:	MENENDEZ, ISABEL		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(818) 982-9116
CITY:	NORTH HOLLYWOOD	STATE: CA	ZIP CODE:	91605
CAPACITY:	14	CENSUS: 9	DATE:	02/27/2020
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	09:00 AM
MET WITH:	Isabel Menendez/Licensee		TIME COMPLETED:	11:30 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 licensee, Isabel Menendez, and toured the home inside and outside at 9:10 a.m on 02/27/2020. The licensee was present with 9 children ( including two infants) and two assistants/licensee's sons. All areas identified on the facility sketch were inspected. Licensee's home is a single story 3 bedroom, 2 bathroom home with living room, dining room, kitchen, attached garage and den. There is no pool, spa or other bodies of water on the premises. Family members residing in the home include 3 adults (licensee and 2 adult sons) and no children. All adults have clearances and are associated to the facility. Main care is provided in the den at the rear of the home and in the dining room. Children eat and have table activities in the dining area. Children use the bathroom located near the front door. Off limit areas include the home's 3 bedrooms and 1 remaining bathroom in the master bedroom. LPA observed napping equipment, small tables and chairs.The LPA toured all areas used by children during this inspection. Licensee reports she has no firearms or weapons in the home. LPA also observed Licensee's and assistants' current Pediatric CPR (Adult/Infant /Child) and Pediatric First Aid certifications (expire 08/2021). The bathroom and the kitchen was observed free of chemicals or toxic items that can pose danger to children in care. Children play in the yard at the rear of the home. LPA observed the yard to be clean and free of debris. There is a brick area for bicycle play and a grass area. There are gates on both sides of the yard and a dog run on the left side of the home for the licensee's 2 dogs. All areas identified on the facility sketch that children use, were inspected for safety, comfort, cleanliness, telephone service, ventilation and heating (central). The required fire extinguisher (2A 10BC) and smoke/carbon monoxide detectors are in operable condition. 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: 02/27/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/27/2020

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: MENENDEZ FAMILY CHILD CARE	FACILITY NUMBER: 192009572
	VISIT DATE: 02/27/2020

NARRATIVE

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The First Aid kit was observed, and complete. LPA observed the fire drill log. The fire drills are done every month.

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.
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. Licensee's and assistants' immunization 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: 02/27/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/27/2020

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: MENENDEZ FAMILY CHILD CARE	FACILITY NUMBER: 192009572
	VISIT DATE: 02/27/2020

NARRATIVE

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New Immunization Requirement: Law enacted by SB 277, beginning January 1, 2016, personal beliefs exemptions will no longer be an option for the vaccines that are currently required for entry into child care or school in California. Personal beliefs exemptions already on file will remain valid until the child reaches the next immunization checkpoint.
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. Licensee and assistants have completed the required training.
Licensee was provided the following forms/brochures:
PIN 19-02-CCP: Safe Sleep Awareness Campaign, SafeBaby2indd- Safe Sleep
NIH Pub. No. 18-HD-5759: What Does A Safe Sleep Environment Look Like?
A Child Care Provider's Guide to Safe Sleep, Safe Sleep in Child Care
PUB 271: Preventing Shaken Baby Syndrome/Abusive Head Trauma
PIN 19-10-CCP U.S. Consumer Product Safety... Fisher-Price Infant Equipment Accessory Recall
PIN 19-12-CCP U.S. Cosumer Product Safety... Infant Sleeper Recall
Effects of Lead Exposure
PIN 19-09-CCLD Division Mailchimp Account Information... Subscribe For Updates

The facility was operating in substantial compliance during this inspection. No Title 22 violations were cited.

Exit interview was conducted and a copy of the report was provided.

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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: 02/27/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/27/2020

LIC809 (FAS) - (06/04)

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