197402255-4-27-2022-12-CC-JDOY-CDVQJ3-20220427121205

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 197402255
Report Date: 04/27/2022
Date Signed: 04/27/2022 12:12:19 PM

Document Has Been Signed on 04/27/2022 12:12 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
CCLD Regional Office, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551

FACILITY NAME:	CHANG FAMILY DAY CARE		FACILITY NUMBER:	197402255
ADMINISTRATOR:	MARIA DE JESUS CHANG		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(747) 253-7308
CITY:	SYLMAR	STATE: CA	ZIP CODE:	91342
CAPACITY:	14	CENSUS: 3	DATE:	04/27/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	10:22 AM
MET WITH:	Maria De Jesus Chang		TIME COMPLETED:	12:26 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 Analyst (LPA) Justin Dorsey met with licensee Maria De Jesus Chang , who allowed analyst on a tour of the facility for the One Year Required Inspection. Staff #1 was present to assist with the inspection. This is a one story, 4 bedroom, 2 bathroom home with kitchen, dining room, and family room (converted main care area). There is no pool on the premises. Upon arrival LPA observed 3 children with the licensee, Staff #1 and Staff #2. Physical Plant: Main care is provided in the converted family room. Children use the bathroom in hallway near the main care area. Children have access to the main care area and on-limits bathroom. Off limit areas include all of the homes bedrooms, 1 bathroom, kitchen and dining room. The home was inspected inside and out for safety, comfort, cleanliness, telephone service, heating and ventilation, inaccessibility to poisons, detergents/cleaning compounds (inaccessible under kitchen and bathroom sink), medicines (inaccessible in top kitchen cabinet) and hazardous items (inaccessibly in kitchen drawer) that can pose a danger to children. Fireplace in the home. The home has safe and age appropriate toys, play equipment and materials. Smoke detector, carbon monoxide detector, and Fire Extinguisher (2A10BC) are in operable condition. Per Licensee no one smokes in the home. Electrical outlets are inaccessible, no baby bouncers saucer chairs, or any recalled and or prohibited toys or sleep/play equipment were observed on the premises. There is a designated area for ill children as necessary in family room. Per Licensee there are no weapon/firearms in the home. Per Staff #1 last fire/earthquake drill was completed 01/22, LPA advised licensee that all disaster drill must be documented. Roster complete and maintained current. Bathroom: Shower/tub are free of hazards (child care bathroom). Toilet and faucet is clean and operable.

SUPERVISOR'S NAME: Claretta Yates	TELEPHONE: (661) 202-3318
LICENSING EVALUATOR NAME: Justin Dorsey	TELEPHONE: (661) 305-3012
LICENSING EVALUATOR SIGNATURE:	DATE: 04/27/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/27/2022

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 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, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551

FACILITY NAME: CHANG FAMILY DAY CARE	FACILITY NUMBER: 197402255
	VISIT DATE: 04/27/2022

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

Kitchen: The kitchen is made inaccessible to children by a locked half door. Sharp utensils are inaccessible. Breakfast, lunch, and dinner are provided, Per Staff #1 children in care are also given snacks when necessary. LPA reminded licensee If food is brought from the children’s home, the container shall be labeled with the child’s name and properly stored or refrigerated. Cleaning supplies are kept under the kitchen sink. No chemicals in the kitchen were observed to be accessible.

Outdoor: The backyard is safe for children. The backyard is completely fenced. The backyard has turf and concrete areas for children to play. LPA observed the toys in the backyard to be in safe condition. Per staff #1 children also use the front yard, LPA observed the front yard to fully fenced and safe for children activities.

Advisory/Other: First Aid kit was readily available. Licensees CPR/First Aid up to date and expires 10/23, Per Staff #1 the training was taken online. LPA advised licensee and staff to retake the training in person. Licensees Mandated Reporter was completed 09/20. LPA Dorsey observed Staff #1 and Staff #2's Mandated Reporter expired 10/2020, Licensee was advised staff must retake the training. Children nap on mats and cribs in the main care area.

Documents discussed: Safe Sleep PIN 20-24-CCP.

Staff #1 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.

LPA discussed the safe sleep regulations with licensee Chang 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 Chang 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.

SUPERVISOR'S NAME: Claretta Yates	TELEPHONE: (661) 202-3318
LICENSING EVALUATOR NAME: Justin Dorsey	TELEPHONE: (661) 305-3012
LICENSING EVALUATOR SIGNATURE:	DATE: 04/27/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/27/2022

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, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551

FACILITY NAME: CHANG FAMILY DAY CARE	FACILITY NUMBER: 197402255
	VISIT DATE: 04/27/2022

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

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

Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

Exit interview conducted and report was reviewed with the licensee Maria De Jesus Chang, with assistance from Staff #1.

SUPERVISOR'S NAME: Claretta Yates	TELEPHONE: (661) 202-3318
LICENSING EVALUATOR NAME: Justin Dorsey	TELEPHONE: (661) 305-3012
LICENSING EVALUATOR SIGNATURE:	DATE: 04/27/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/27/2022

LIC809 (FAS) - (06/04)

Page: 3 of 3