192011172-8-5-2021-54-CC-KCHE-C5LNZH-20210805105421

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 192011172
Report Date: 08/05/2021
Date Signed: 08/05/2021 10:54:38 AM

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 CARE		FACILITY NUMBER:	192011172
ADMINISTRATOR:	MADRIGAL, ROSA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(323) 253-6416
CITY:	LOS ANGELES	STATE: CA	ZIP CODE:	90003
CAPACITY:	14	CENSUS: 1	DATE:	08/05/2021
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	09:30 AM
MET WITH:	Licensee, Rosa Madrigal		TIME COMPLETED:	11:00 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)Katrina Chicote conducted an Unannounced Required Annual inspection to the above facility on 08/05/2021 at 9:30 AM. LPA conducted a COVID-19 screening call prior to entering home. Upon arrival, LPA disclosed the purpose of the inspection and met with Licensee, Rosa Madrigal who guided the LPA on a tour of the facility. There was one day care child present during today’s inspection. Licensee states that there are currently eleven children enrolled. The children's roster was reviewed and is current. Per licensee, the facility’s hours of operation are currently from 6am to 6pm, seven days a week. Licensee discussed providing overnight care to children in the future, which LPA discussed supervision and sleeping arrangements requirements with Licensee. Emergency Disaster Plan, License, and Parents’ Rights were posted at the time of inspection. Disaster drill log was also available during today’s inspection, last disaster drill conducted on April 1st, 2021. This is a single story home which consists of two bedrooms and two bathrooms, kitchen, living room, backyard and back house. Home is separated into three living spaces, with Licensee using the front area of home and a back house is currently unoccupied. Areas used by the children is the middle house, which consists of a bathroom, kitchen, and main care area. Per Licensee, areas off limits to children and parents include front of the home and back house. At 9:35 AM, LPA observed that there is a door with large couch blocking door to front area of the home, making it inaccessible to children in care. Per licensee, off limit areas are also locked during operating hours, LPA 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. Entrance to facility is through the right side of the home. Kitchen is located to the right upon entry of Main Care Area. At 9:37 AM, LPA observed knives to be kept in a high cabinet area making it inaccessible to children in care. LPA observed contents of cabinets in Kitchen area to contain food and plastic cups, plates, and Report continues- Page 1 of 4

SUPERVISOR'S NAME: Trevino Cochran	TELEPHONE: (323) 981-3385
LICENSING EVALUATOR NAME: Katrina Chicote	TELEPHONE: (323) 629-7658
LICENSING EVALUATOR SIGNATURE:	DATE: 08/05/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/05/2021

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 4

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: 08/05/2021

NARRATIVE

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utensils. LPA observed COVID-19 safety and handwashing posters posted by Kitchen sink and refrigerator. Per Licensee, she takes the children to wash her hands at Kitchen sink upon arrival and immediately after using restroom. LPA observed large couch, child size tables and chairs, cubbies for children's belongings, puzzles, play mats, dinosaur toys, and other age appropriate toys, free of loose and sharp parts. Licensee states she sanitizes toys after each use using a mild bleach solution. LPA observed small mattresses (3) and a Cosco pack-n-play in Main Care Area to be used for sleeping and possible overnight care. Per Licensee, she and the children will be in Main Care Area if overnight care is provided. Restroom used by the children is located to the left of Main Care Area. At 9:42 AM, LPA observed restroom to be clean and free of hazards, and to have step stool for children to reach sink and have adequate handwashing supplies, and handwashing poster near sink. Per licensee, there are no pets and LPA did not observe any pets. 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 and understands that poison must be locked with a key or combination lock.

Per licensee, the children will have access to backyard area which is accessible through sliding glass door in rear of Main Care Area. At 9:42 AM, LPA observed backyard has turf grass through out and adequate perimeter fencing through-out the yard. LPA observed plastic ride along toys, large plastic legos, plastic play structures, puzzles, and other age appropriate toys free of loose and sharp parts available for the children in the backyard and all trees, shrubs, and plants are maintained.

Per Licensee, there are no weapons, firearms in the home and there are no bodies of water around the premises. LPA observation did not see any bodies of water around the premises. Per licensee, they provide food for children in care.

The valve on the required 2A 10BC fire extinguisher indicates fully charged. At 10:19 AM, LPA tested Smoke and carbon monoxide detectors to be in operable condition at time of inspection. LPA observed First Aid kit which is kept in Main Care Area on top of cubbies. The Licensee has current Pediatric First Aid and CPR. The Licensee has also taken the Mandated Reporter Training
—CPR Card valid until: 02/01/2022
—Fire Extinguisher was last serviced on: 02/24/2021
—Mandated Reporter AB1207 Completed: 02/01/2020

Report continues- Page 2 of 4

SUPERVISOR'S NAME: Trevino Cochran	TELEPHONE: (323) 981-3385
LICENSING EVALUATOR NAME: Katrina Chicote	TELEPHONE: (323) 629-7658
LICENSING EVALUATOR SIGNATURE:	DATE: 08/05/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/05/2021

LIC809 (FAS) - (06/04)

Page: 2 of 4

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: 08/05/2021

NARRATIVE

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The following were discussed:
Incidental Medical Services (IMS)
This facility provides Incidental Medical Services – IMS. LPA reviewed storage of medication and equipment/supplies, and reviewed children’s, personnel, and administrative records. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Section 102417. 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

Licensee (or facility representative) 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.

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 incline sleepers 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, and Lead Hand out.

The Licensee was advised how to access forms and Regulations online at www.ccld.ca.gov. Licensee was made aware that it is his/her responsibility to know the regulations as well as anyone who assists in providing care.

Report Continues - Page 3 of 4

SUPERVISOR'S NAME: Trevino Cochran	TELEPHONE: (323) 981-3385
LICENSING EVALUATOR NAME: Katrina Chicote	TELEPHONE: (323) 629-7658
LICENSING EVALUATOR SIGNATURE:	DATE: 08/05/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/05/2021

LIC809 (FAS) - (06/04)

Page: 3 of 4

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: 08/05/2021

NARRATIVE

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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. LPA discussed the influenza waiver during the visit.

The facility was found in compliance per Title 22 regulations, there will be no deficiencies cited today 08/05/2021.

The Notice of Site Visit (LIC 9213) – must remain posted for 30 days during the hours of operation after each site inspection by a licensing representative. Failure to maintain posting as required will result in a civil penalty of $100.00.

Exit interview was conducted and report was reviewed with the Licensee, Rosa Madrigal.

SUPERVISOR'S NAME: Trevino Cochran	TELEPHONE: (323) 981-3385
LICENSING EVALUATOR NAME: Katrina Chicote	TELEPHONE: (323) 629-7658
LICENSING EVALUATOR SIGNATURE:	DATE: 08/05/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/05/2021

LIC809 (FAS) - (06/04)

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