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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197408172
Report Date: 07/19/2019
Date Signed: 07/19/2019 11:59:50 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:PEREZ FAMILY CHILD CAREFACILITY NUMBER:
197408172
ADMINISTRATOR:ANA & MARIANO PEREZFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(310) 278-7681
CITY:LOS ANGELESSTATE: CAZIP CODE:
90035
CAPACITY:14CENSUS: 5DATE:
07/19/2019
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
09:22 AM
MET WITH:Ana & Mariano PerezTIME COMPLETED:
11:40 AM
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Licensing Program Analyst (LPA) Christopher Garlington conducted an unannounced Annual Random Inspection at the facility to ensure that health and safety standards will be met as required by regulations, statutes, and requirements governing California family child care homes. Upon arrival, LPA Garlington met with Licensees Ana & Mariano Perez and explained the purpose of the inspection. LPA was guided on a tour of the home indoors and outdoors.

The following was observed and discussed with the Licensee during the inspection
Home is a 1 story dwelling that includes the following:
· 3 bedrooms (off limits).
· 1 bathroom (1 on limits).
· 1 kitchen (on limits)
· 1 dining room, (on limits).
· 1 living-room (on limits),
· 1 front yard (off limits).
· 1 backyard (on limits).

The following was also observed by LPA during the inspection
1. All adults living in the home have submitted fingerprints and child abuse index check forms to Department of Justice.
2. Home is neat and clean.
3. Heat vents inaccessible (on ceiling).
SUPERVISOR'S NAME: Sharalyn Jenkins-SweetenTELEPHONE: (424) 301-3054
LICENSING EVALUATOR NAME: Christopher GarlingtonTELEPHONE: (424) 301-3056
LICENSING EVALUATOR SIGNATURE:

DATE: 07/19/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/19/2019
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: PEREZ FAMILY CHILD CARE
FACILITY NUMBER: 197408172
VISIT DATE: 07/19/2019
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Licensee was reminded of their responsibility to report suspected child abuse. Mandatory Forms for the children’s files and provider’s files were discussed. Licensee was referred to LIC 311D: Records To Be Maintained At The Facility - Family Child Care Home. Licensee was advised that regulation prohibits the smoking of tobacco in a private residence licensed as a family child care home during the hours of operation. Licensee was made aware that state law prohibits baby walkers, bouncy seats, exersaucers and any other items that fall into that category. Licensee was reminded that all infants must be placed on their backs when sleeping to prevent S.I.D.S. (Sudden Infant Death Syndrome), and that the Provider is required to wash hands after every diaper change and to never shake a baby to prevent the Shaken Baby Syndrome. Licensee was also reminded that only children eating may be in high chairs and that car seats are utilized only for transportation.

The licensee was advised the Notice of Site Visit must be posted at the entrance of the facility for a period of 30 days. If a serious violation is cited, (Type A violation), a copy of the licensing report (LIC809 or LIC9099) must also be posted for 30 days. If these requirements are not met, civil penalties in the amount of $100 per violation will be assessed. The applicant was made aware that a licensee may file an appeal, in writing 15 business days from the date of receiving the penalty assessment.

Licensee was made reminded that it is the licensee’s, as well as anyone who assists in providing care responsibility to know the regulations. Licensee was advised on how to access quarterly reports, forms, and regulations for Child Care online at www.ccld.ca.gov. Licensee was also encouraged to read the Child Care quarterly updates every season as they come out to stay informed of any changes or updates to statutes and regulations.


Safe to Sleep Campaign: https://safetosleep.nichd.nih.gov/materials

19-02 CCP Safe Sleep Awareness Campaign

(Continued)

SUPERVISOR'S NAME: Sharalyn Jenkins-SweetenTELEPHONE: (424) 301-3054
LICENSING EVALUATOR NAME: Christopher GarlingtonTELEPHONE: (424) 301-3056
LICENSING EVALUATOR SIGNATURE:

DATE: 07/19/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/19/2019
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, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME: PEREZ FAMILY CHILD CARE
FACILITY NUMBER: 197408172
VISIT DATE: 07/19/2019
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AAP: https://www.healthychildren.org/English/ages-stages/baby/sleep/Pages/A-Parents-Guide-to-Safe-Sleep.aspx

NIH: https://safetosleep.nichd.nih.gov/safesleepbasics/environment/room/text_alternative

Licensee was made aware of The Child Care Advocate Program (CCAP) that is administered from within the Community Care Licensing Division. CCAP participates in many community activities and special projects in order to disseminate information on the State’s licensing role, provide information to the public and parents on child care licensing, and provide many other helpful resources to the licensees and the public. CCAP’s direct contact information is as followed: Phone number: (916) 654-1541


Email Address: childcareadvocatesprogram@dss.ca.gov

Commencing September 1, 2016, SB 792, 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 inspection.

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

The facility is operating in compliance with Title 22 Regulations at time of visit. No violations were cited. Copy of this report and the Notice of Site Visit were provided to the facility. Exit interview was conducted with Licensee.
SUPERVISOR'S NAME: Sharalyn Jenkins-SweetenTELEPHONE: (424) 301-3054
LICENSING EVALUATOR NAME: Christopher GarlingtonTELEPHONE: (424) 301-3056
LICENSING EVALUATOR SIGNATURE:

DATE: 07/19/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/19/2019
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: PEREZ FAMILY CHILD CARE
FACILITY NUMBER: 197408172
VISIT DATE: 07/19/2019
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4. Home is equipped with a fully charged fire extinguisher which is at least a 2A:10BC.
5. Home is equipped with a working smoke alarm and a carbon monoxide detector.
6. Home has a working telephone.
7. All poisons are locked.
8. Hazardous materials are kept out of the reach of children (inaccessible):
9. According to the licensee, there are no weapons or firearms at the home. None were observed by LPA.
10. Outdoor play area is free from defects or dangerous conditions.
11. Outdoor play area is fenced in.
12. No bodies of water were observed during the inspection.
13. Toys and playthings are safe, clean, and appropriate for the age of the children.
14. Licensee agrees that no babywalkers, bouncers, jumpers, and similar items will be used for children in care and are kept inaccessible.
15. LPA observed preventative health and safety training certificate(s). LPA also observed 1st Aid and CPR card(s) that expires on 10/2019 (Ana) and 03//2021 (Mariano).
16. The home is equipped with a first aid kit.

At this time, the facility does not provide Incidental Medical Services - IMS.

The following was thoroughly discussed with the licensee
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 Incidental Medical Services Include: Blood-Glucose Monitoring for Diabetic Children, Administering Inhaled Medication, Administering EpiPen Jr. and EpiPen or other Epinephrine Auto-Injectors, Glucagon Administration, Gastrostomy Tube Care (G-tube care), Insulin Injections Administration, Anti-Seizure Administration, and Carrying out medical orders when the child’s physician has determined that a layperson can be trained and safely carry out the orders.
SUPERVISOR'S NAME: Sharalyn Jenkins-SweetenTELEPHONE: (424) 301-3054
LICENSING EVALUATOR NAME: Christopher GarlingtonTELEPHONE: (424) 301-3056
LICENSING EVALUATOR SIGNATURE:

DATE: 07/19/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/19/2019
LIC809 (FAS) - (06/04)
Page: 2 of 4