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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197401376
Report Date: 02/16/2024
Date Signed: 02/16/2024 12:03:59 PM


Document Has Been Signed on 02/16/2024 12:03 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
L.A. DAYCARE-NO.WEST, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245



FACILITY NAME:ROSA FAMILY DAY CAREFACILITY NUMBER:
197401376
ADMINISTRATOR:ROSA, RUTHFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(310) 832-2750
CITY:SAN PEDROSTATE: CAZIP CODE:
90731
CAPACITY:12CENSUS: 4DATE:
02/16/2024
TYPE OF VISIT:Required - 3 YearUNANNOUNCEDTIME BEGAN:
09:19 AM
MET WITH:Licensee, Ruth RosaTIME COMPLETED:
12:10 PM
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On 02/16/2024, Licensing Program Analyst (LPA), Sarah Garcia conducted an unannounced Required Inspection at the above-mentioned facility. LPA was greeted by licensee, Ruth Rosa. During the initial inspection, LPA observed 4 children in care. 1 of the 4 children was the licensee's granddaughter. Present during today's inspection is licensee's spouse. All adults are fingerprint cleared. Facility operates Monday through Friday from 8:00 a.m. to 4:30 p.m. Currently licensee is available to care for children 0 to 12 years old. Facility is Large Family Child Care Home with a max capacity of 12. Licensee does not provide transportation to children.

LPA toured the home inside and outside. The home is a single family home with 2 bedrooms and 2 bathrooms, living room, dining room, kitchen area, detached unit (play room) in the back of the home, detached garage, and outdoor area. Licensee confirmed the following areas are designated for day care only: Dining room, kitchen, bathroom #1, detached unit in the back of the home, and outdoor area. LPA inspected the dining room and observed the space to be clean and orderly. LPA observed play yards and mats to utilize for sleeping children. LPA observed age-appropriate toys, materials, children's tables and books. LPA inspected the kitchen and observed the knives and sharp objects to be out of reach to the children. LPA observed a safety latch under the kitchen sink cabinet to ensure all poisons, detergents, cleaning compounds, medications and other items which can pose a risk to children in care made inaccessible. The bathroom that children use is located inside the hallway near the living room. LPA inspected the bathroom and did not observe any medications, toxins or cleaning compounds accessible to the children in care. LPA advised licensee that shampoos shall be stored out of reach to ensure inaccessible to children in care.

The following areas are OFF LIMITS to the children in care: 2 Bedroom, living room, 1 bathroom and garage.

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SUPERVISOR'S NAME: Maureen NealTELEPHONE: (424) 301-3042
LICENSING EVALUATOR NAME: Sarah GarciaTELEPHONE: (424) 301-3066
LICENSING EVALUATOR SIGNATURE:
DATE: 02/16/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/16/2024
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
L.A. DAYCARE-NO.WEST, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME: ROSA FAMILY DAY CARE
FACILITY NUMBER: 197401376
VISIT DATE: 02/16/2024
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LPA inspected the detached unit in the back of the home. LPA observed play equipment, children's tables and chairs. LPA observed the licensee test the smoke detector in the detached unit. Per licensee, the back detached unit is utilized as a play room and children do not sleep or eat there. LPA inspected the outdoor area and observed safe toys, play equipment, and a sandbox. LPA observed a detached garage that is locked and off-limits to the children in care. LPA observed two safety gates on the two sides of the home to ensure inaccessible to children. The outdoor area is properly fenced and supervised at all times.


All electrical outlets were observed to be covered. LPA reminded licensee to ensure all areas that have been designated as OFF LIMITS need to have doors closed, locked, and made inaccessible when children are present.

LPA observed licensee test the carbon monoxide detector in the home. LPA observed the licensee test the carbon monoxide detector in the home. One working fire extinguisher 3A40BC was observed. LPA observed first aid kit with thermometer and Band-Aids. Licensee provides meals and snacks. LPA discussed the importance of maintaining a system where allergies and food restrictions are noted. When a child is ill licensee will isolate them in the living room.

No swimming pools or bodies of water were observed in the space. There are no firearms or ammunition on the premises.

Licensee currently does not administer medication. Adequate ventilation for safety and comfort were observed in the space. The home has working telephone service and LPA confirmed the phone number (310) 832-2750.

Licensee ensures that children in care are supervised at all times and is aware children shall not be left in parked vehicles. Car seats are used for transportation purposes only and are not used for sleeping children.

Capacity as specified on the license is being maintained during today’s inspection.

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SUPERVISOR'S NAME: Maureen NealTELEPHONE: (424) 301-3042
LICENSING EVALUATOR NAME: Sarah GarciaTELEPHONE: (424) 301-3066
LICENSING EVALUATOR SIGNATURE:

DATE: 02/16/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/16/2024
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
L.A. DAYCARE-NO.WEST, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME: ROSA FAMILY DAY CARE
FACILITY NUMBER: 197401376
VISIT DATE: 02/16/2024
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LPA reviewed 3 children’s files and observed files to be incomplete. LPA discussed missing documents and developed plan of correction. LPA did not observe a fire drill log on file. LPA provided a drill log sample to licensee. LPA advised licensee that drills shall be conducted at least every six months. LPA discussed all necessary forms needed in each children’s file and provided licensee with the LIC 311D- Records to be maintain in the facility and provided licensee with a current copy to use as a reference when auditing files.

LPA reviewed licensee's Pediatric CPR and first aid certification and observed a certification with an expiration date of 01/2024. LPA instructed licensee to enroll in a Emergency Medical Services Authority (EMSA) approved Pediatric CPR and first aid course and send receipt to LPA via email and provided Website: www.emsa.ca.gov. Licensee’s Mandated Reporter training was not available for review. LPA developed a POC with licensee and provided the Website: www.mandatedreporterca.com. Licensee was reminded of their responsibility to report suspected child abuse.

Licensee was reminded that all adults 18 and over living or working in the home, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, 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 for a maximum of 5 days or, if the penalty is for a repeat violation, for a maximum of 30 days per person will be assessed if this regulation is violated.



LPA discussed the safe sleep regulations with licensee and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPA also informed licensee of the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at https://www.cpsc.gov/ and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment.

Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02-CCP. 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: https://www.ada.gov/resources/child-care-centers/.


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SUPERVISOR'S NAME: Maureen NealTELEPHONE: (424) 301-3042
LICENSING EVALUATOR NAME: Sarah GarciaTELEPHONE: (424) 301-3066
LICENSING EVALUATOR SIGNATURE:

DATE: 02/16/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/16/2024
LIC809 (FAS) - (06/04)
Page: 3 of 8
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
L.A. DAYCARE-NO.WEST, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME: ROSA FAMILY DAY CARE
FACILITY NUMBER: 197401376
VISIT DATE: 02/16/2024
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Licensee was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain child care by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.

During the exit interview, the LICENSEE Ruth Rosa, confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS.

Per Title 22, Division 12, Chapter 3, of the California Code of Regulations, the following deficiencies are being cited: (see next page, 809D) Licensee was provided with a copy of appeal rights.

A notice of site visit was given and must remain posted for 30 days.

Exit interview conducted and report along with appeal rights was reviewed with the licensee, Ruth Rosa.

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.

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SUPERVISOR'S NAME: Maureen NealTELEPHONE: (424) 301-3042
LICENSING EVALUATOR NAME: Sarah GarciaTELEPHONE: (424) 301-3066
LICENSING EVALUATOR SIGNATURE:

DATE: 02/16/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/16/2024
LIC809 (FAS) - (06/04)
Page: 4 of 8
Document Has Been Signed on 02/16/2024 12:03 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
L.A. DAYCARE-NO.WEST, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245


FACILITY NAME: ROSA FAMILY DAY CARE
FACILITY NUMBER: 197401376

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/16/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102416(c)
Personnel Requirements
(c) The licensee and other personnel as specified shall complete training on preventive health practices, including pediatric cardiopulmonary resuscitation and pediatric first aid, pursuant to Health and Safety Code Section 1596.866.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, interview, record review, the licensee did not comply with the section cited above in, licensee does not have current Pediatric CPR and first aid certification. LPA observed CPR and first aid certification with an expiration date of 01/2024 which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 02/23/2024
Plan of Correction
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Licenseee will enroll in an EMSA approved Pediatric CPR and first aid course. Licensee will send Pediatric and First Aid certificate via email to LPA sarah.garcia@dss.ca.gov by 5pm on 02/23/2204. Website: www.emsa.ca.gov.
Type B
Section Cited
HSC
1597.622(c)
(c) The family day care home shall maintain documentation of the required immunizations or exemptions from immunization, as set forth in this section, in the person's personnel record that is maintained in the family day care home.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, interview, record review, the licensee did not comply with the section cited above in, licensee does not have immunizations (measles and pertussis) on file which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 02/23/2024
Plan of Correction
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Licensee will obtain immunizations (measles and pertussis) and send copy of immunization record to LPA via email at sarah.garcia@dss.ca.gov by 5pm on 02/23/2024.
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: Maureen NealTELEPHONE: (424) 301-3042
LICENSING EVALUATOR NAME: Sarah GarciaTELEPHONE: (424) 301-3066
LICENSING EVALUATOR SIGNATURE:
DATE: 02/16/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/16/2024
LIC809 (FAS) - (06/04)
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