<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 192011172
Report Date: 01/24/2020
Date Signed: 01/24/2020 04:27:32 PM

COMPREHENSIVE INSPECTION
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:MADRIGAL FAMILY CHILD CAREFACILITY NUMBER:
192011172
ADMINISTRATOR:MADRIGAL, ROSAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(323) 253-6416
CITY:LOS ANGELESSTATE: CAZIP CODE:
90003
CAPACITY:14CENSUS: 8DATE:
01/24/2020
TYPE OF VISIT:Annual/RequiredUNANNOUNCEDTIME BEGAN:
01:20 PM
MET WITH:Licensee, Rosa MadrigalTIME COMPLETED:
04:40 PM
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 Analysts (LPAs) Katrina Chicote and Timothy Fields conducted an Unannounced Required Annual inspection to the above facility on 1/24/2020 at 1:20pm. Upon arrival, LPAs observed 2 children inside a white van parked out in the driveway. LPAs met with Licensee Rosa who guided the LPAs on a tour of the facility. There were 8 children present during today’s inspection. LPAs observed infant sleeping in a car seat. The children's roster was reviewed and is current. Per licensee, the facility’s hours of operation are 7 days and 23 hours. Emergency Disaster Plan was posted at the time of inspection. Disaster drill log was also available during today’s inspection, last disaster drill conducted on 09/2019.

This is a single-story home which consists of 2 bedrooms, 2 bathrooms, kitchen, living room, play yard area, and day care space located in the rear of the home. Care is mainly provided in the day care space which includes a bathroom. The play yard area on the side and back of the house is used for outdoor activity space. Per Licensee, areas off limits to children and parents include the front house area where there are 2 bedrooms and 1 bathroom, kitchen, and living room. Per licensee, off limit areas are also locked during operating hours, LPAs observed doors to be locked.

All areas identified on the facility sketch as accessible to children were inspected to ensure that they are clean and orderly with ventilation and heating for the safety of the children. There is a working telephone maintained in the home. LPAs observed age appropriate toys, free of loose and sharp parts. Per licensee, there are no pets and LPA did not observe any pets. Detergents, cleaning compounds, and medications 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. Per Licensee, there are no weapons, firearms in the home and there are no bodies of water around the premises. LPAs observation did not see any bodies of water around the premises.
Report continues- Page 1 of 4
SUPERVISOR'S NAME: Trevino CochranTELEPHONE: (323) 981-3385
LICENSING EVALUATOR NAME: Katrina ChicoteTELEPHONE: (323) 629-7658
LICENSING EVALUATOR SIGNATURE:

DATE: 01/24/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/24/2020
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 7
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: MADRIGAL FAMILY CHILD CARE
FACILITY NUMBER: 192011172
VISIT DATE: 01/24/2020
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
26
27
28
29
30
31
32
Per licensee, they provide food for children in care. LPAs observed a knife on dish rack. Per Licensee, it is kept in the drawer which LPAs observed to not have proper child proof lock which would make it accessible to children in care.

LPAs observed play yard has turf grass and adequate perimeter fencing through-out the yard. LPAs advised Licensee that outdoor supervision is required at all times. LPAs observed age appropriate toys free of loose and sharp parts available for the children in the backyard. LPAs observed a rose plant with thorns growing in a pot in the front yard area. Per Licensee, front is not an inaccessible area, so LPAs advised Licensee to move the rose plant in a place that would be inaccessible. Licensee states that she will just dispose of the rose plant.

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. Smoke and carbon monoxide detectors are in operable condition. Per Licensee, First Aid kit is kept in the day care space. LPAs observed First Aid kit and was inventoried for necessary supplies. The Licensee has current Pediatric First Aid and CPR. Proof of immunization against influenza, pertussis, and measles was readily available during today’s inspection. The Licensee has also taken the Mandated Reporter Training
—CPR Card valid until: 07/14/2020
—Fire Extinguisher was last serviced on: 02/19/2019
—Mandated Reporter AB1207 Completed: 04/14/2018
—Child Care Roster, Disaster Plan, and Children's Records were reviewed and discussed.
—Children records and required licensing forms were discussed as well as mandated child abuse reporting and criminal record clearance requirement.

The following were discussed: Individuals who are 18 years of age or older living in the home must obtain a criminal record clearance. Individuals within one month of their 18th birthday must be fingerprinted immediately. Failure to obtain a criminal record background check clearances prior to initial presence in the home will result in an immediate $100.00 dollar or more per day Civil Penalty.
Report continues- Page 2 of 4
SUPERVISOR'S NAME: Trevino CochranTELEPHONE: (323) 981-3385
LICENSING EVALUATOR NAME: Katrina ChicoteTELEPHONE: (323) 629-7658
LICENSING EVALUATOR SIGNATURE:

DATE: 01/24/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/24/2020
LIC809 (FAS) - (06/04)
Page: 2 of 7
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: MADRIGAL FAMILY CHILD CARE
FACILITY NUMBER: 192011172
VISIT DATE: 01/24/2020
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
26
27
28
29
30
31
32
Rooms that are off-limits need to be made inaccessible during operating hours. NO smoking, NO infant walkers, NO Johnny jumpers, NO saucer chairs, NO trampolines and any other item that falls into that category are permitted in the facility. Effective January 1, 2010, licensees of family child care homes are required to ensure that at least one staff member with current training in pediatric first aid and pediatric CPR is on site at all times when children are present.

The Licensee was advised that inaccessibility of hazards must be constantly reassessed depending on the children in care. Sudden Infant Death Syndrome (SIDS) and Never-Shake-a-Baby were discussed. A hard copy of A Child Care Provider’s Guide to Safe Sleep was provided.

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



The following deficients listed below were observed by the LPAs and are being cited in accordance with California Code of Regulations Title 22. Please see attached LIC 809-D. Deficiencies that are being cited need to be cleared to protect the children’s health & safety.
  1. Upon arrival LPAs observed 2 children in van parked on the driveway. Licensee was in the home with the remaining children. There was a large black sheet isolating the visual supervision from the van to where the Licensee was located in the home.
  2. LPAs observed an infant sleeping in a car seat inside the home with the blanket covering the car seat.
  3. Per Licensee, she keeps knives in a drawer that LPAs did not observe to have a child lock.
  4. Upon file review, files were missing for C2, C4, C5, C6, and C7.
Report continues- Page 3 of 4

SUPERVISOR'S NAME: Trevino CochranTELEPHONE: (323) 981-3385
LICENSING EVALUATOR NAME: Katrina ChicoteTELEPHONE: (323) 629-7658
LICENSING EVALUATOR SIGNATURE:

DATE: 01/24/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/24/2020
LIC809 (FAS) - (06/04)
Page: 7 of 7
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: MADRIGAL FAMILY CHILD CARE
FACILITY NUMBER: 192011172
VISIT DATE: 01/24/2020
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
26
27
28
29
30
31
32
Upon receipt of this report, the Licensee shall post the Notice of Site Visit and any Licensing report documenting a type “A” deficiency. The report and the Notice of Site Visit shall be posted for 30 consecutive days. Failure to maintain posting as required, will result in an immediate $100 civil penalty. A copy of this report shall be provided to the parent/guardian of children currently enrolled by the next business day or immediately upon return. A copy of this report shall also be provided to the parent/guardian of any newly enrolled children for the next 12 months (1 year). The Acknowledgement of Receipt (LIC 9224 form must be maintained in each child’s file immediately upon receipt from parent. Licensee was provided with a copy of the Acknowledgement of Receipt of Licensing Reports (LIC 9224) Form during this visit.

Exit interview, copy of report was given. Appeal rights were issued and discussed.


Report ends- Page 4 of 4
SUPERVISOR'S NAME: Trevino CochranTELEPHONE: (323) 981-3385
LICENSING EVALUATOR NAME: Katrina ChicoteTELEPHONE: (323) 629-7658
LICENSING EVALUATOR SIGNATURE:

DATE: 01/24/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/24/2020
LIC809 (FAS) - (06/04)
Page: 3 of 7
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: MADRIGAL FAMILY CHILD CARE
FACILITY NUMBER: 192011172
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/24/2020
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
01/31/2020
Section Cited

1
2
3
4
5
6
7
102423(a)(2) Personal Rights

To receive safe, healthful, and comfortable accommodations, furnishings, and equipment.

This regulation was not met as evidenced by:
8
9
10
11
12
13
14
Based on LPAs observations of a child sleeping in a car seat covered by a blanket. This poses an immediate health, safety, or personal rights risk to children in care.
8
9
10
11
12
13
14
Type A
01/31/2020
Section Cited

1
2
3
4
5
6
7
102417(k)(1) Operation of a Family Child Care

Children shall not be left in parked vehicles.

This regulation was not met as evidenced by:
8
9
10
11
12
13
14
Based on LPAs observations 2 children in van parked on the driveway. Licensee was in the home with the remaining children. There was a large black sheet isolating the visual supervision from the van to where the Licensee was located in the home.This poses an immediate health, safety, or personal rights risk to children in care.
8
9
10
11
12
13
14
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: Trevino CochranTELEPHONE: (323) 981-3385
LICENSING EVALUATOR NAME: Katrina ChicoteTELEPHONE: (323) 629-7658
LICENSING EVALUATOR SIGNATURE:
DATE: 01/24/2020
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/24/2020
LIC809 (FAS) - (06/04)
Page: 4 of 7
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: MADRIGAL FAMILY CHILD CARE
FACILITY NUMBER: 192011172
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/24/2020
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
01/24/2020
Section Cited

1
2
3
4
5
6
7
102417 (g) Operation of a Family Child Care Home

The home shall be free from defects or conditions which might endanger a child.

This regulation was not met by:
8
9
10
11
12
13
14
Based on Licensee statement that she keeps knives in a drawer and LPAs did not observe drawer to have a child lock. This poses a potential health, safety, or personal rights risk to children in care.
8
9
10
11
12
13
14
Type B
01/31/2020
Section Cited

1
2
3
4
5
6
7
102421 (b) Child's Records

The licensee shall maintain, in each child's record, a copy of the emergency information card required in Section 102417(g)(7).

This regulation was not met by:
8
9
10
11
12
13
14
Based on record review by LPAs C4, C5, C6, and C7 did not have their emergency card inofmration. This poses as a potential health, safety, or personal rights risk to children in care.
8
9
10
11
12
13
14
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: Trevino CochranTELEPHONE: (323) 981-3385
LICENSING EVALUATOR NAME: Katrina ChicoteTELEPHONE: (323) 629-7658
LICENSING EVALUATOR SIGNATURE:
DATE: 01/24/2020
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/24/2020
LIC809 (FAS) - (06/04)
Page: 6 of 7
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: MADRIGAL FAMILY CHILD CARE
FACILITY NUMBER: 192011172
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/24/2020
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
01/31/2020
Section Cited

1
2
3
4
5
6
7
102418(a) Immunizations

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. This regulation was not met by:
8
9
10
11
12
13
14
Based on LPAs record review C2, C4, and C5 did not have immunization records in their file. This poses a potential health, safety, or personal rights risk to children in care.
8
9
10
11
12
13
14

1
2
3
4
5
6
7

1
2
3
4
5
6
7
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: Trevino CochranTELEPHONE: (323) 981-3385
LICENSING EVALUATOR NAME: Katrina ChicoteTELEPHONE: (323) 629-7658
LICENSING EVALUATOR SIGNATURE:
DATE: 01/24/2020
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/24/2020
LIC809 (FAS) - (06/04)
Page: 5 of 7