197410496-7-15-2021-30-CC-LRIS-C4XPLZ-20210715112535

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 197410496
Report Date: 07/15/2021
Date Signed: 07/15/2021 11:25:45 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:	VALENZUELA FAMILY CHILD CARE		FACILITY NUMBER:	197410496
ADMINISTRATOR:	VALENZUELA, M. & J.		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(818) 831-4426
CITY:	GRANADA HILLS	STATE: CA	ZIP CODE:	91344
CAPACITY:	14	CENSUS: 12	DATE:	07/15/2021
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	10:00 AM
MET WITH:	Ana Alvillo and Jesus Valenzuela		TIME COMPLETED:	11:45 AM

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On 7/15/21 Licensing Program Analyst (LPA), conducted an unannounced Annual Required Inspection and was met by the licensee's Assistant, Ana Alvillo. The licensee is out of the country and expected to return on 7/18/21. Also present were Staff #1 Herlinda Colin (S1) and licensee's spouse Jesus Valenzuela. Days and hours of operation are Monday-Friday 7:00am-6:00pm.

LPA toured the home inside and outside and a census was taken. Current facility sketch reviewed, and Licensee's assistant confirmed that the kitchen, bathroom, playroom and back yard are used for providing care and are accessible to children. All other rooms are off-limits and made inaccessible by use of mounted gates. There is no swimming pool or other bodies of water on the premises. There are no firearms or ammunition on the premises. All poisons are kept in a locked storage area. Detergents, cleaning compounds, medication and other hazardous items are made inaccessible. There is no fireplace located in the home. There is a working fire extinguisher serviced on 2/13/2020, smoke detector, carbon monoxide detector and adequate heating and ventilation for safety and comfort. There are no stairs in this home. Safe toys and play equipment are observed. The home has working telephone service and LPA confirmed the phone number is 818-831-4426.

There are currently 2 infants in care. LPA discussed New Infant Regulations and left a copy with the licensee's assistant who 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. The outdoor play area in the backyard is fenced and there are no hazards to children present. Capacity as specified on the license is being maintained.

SUPERVISOR'S NAME: Peter Flores	TELEPHONE: (424) 301-3077
LICENSING EVALUATOR NAME: Lisa Rios	TELEPHONE: (424) 301-3072
LICENSING EVALUATOR SIGNATURE:	DATE: 07/15/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/15/2021

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: VALENZUELA FAMILY CHILD CARE	FACILITY NUMBER: 197410496
	VISIT DATE: 07/15/2021

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LPA reviewed a sample of children’s files and observed files and only one was missing for a child that started on 7/14/21. Licensee’s Mandated Reporter Training was missing for both staff present. Licensee’s pediatric CPR/First Aid expires on 2/13/2023. A review of records indicates that all employees and/or volunteers have immunization records on file for influenza, pertussis and measles. All adults who reside or work in the home have a criminal record clearance or exemption. There are no excluded individuals present at this home.

Incidental Medical Services (IMS) are not currently being provided. Licensee is aware that an IMS plan is required to be submitted to the licensing office if they provide any of these services. Information regarding Americans with Disability Act (ADA) can be obtained by contacting US Department of Justice toll free ADA Information line at (800) 514-0301(voice), (800) 514-0383 (TDD) and website link https://www.ada.gov/childqanda.htm.

LPA and Licensee discussed the Community Care Licensing website www.ccld.ca.gov which will provide access to Provider Information Notices (PINs), Quarterly Updates, COVID-19 Information and Resources, Mandated Reporter Training, Safe Sleep in Child Care, Lead Poisoning Facts, Forms and Regulations.

Per Title 22, Division 12, Chapter 3, of the California Code of Regulations and 1 type B deficiency is cited.

This report shall be made available to the public upon request. LIC 9213 Notice of Site Visit is provided and required to be posted for 30 days.

SUPERVISOR'S NAME: Peter Flores	TELEPHONE: (424) 301-3077
LICENSING EVALUATOR NAME: Lisa Rios	TELEPHONE: (424) 301-3072
LICENSING EVALUATOR SIGNATURE:	DATE: 07/15/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/15/2021

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: VALENZUELA FAMILY CHILD CARE	FACILITY NUMBER: 197410496
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 07/15/2021

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 07/15/2021 Section Cited	1 2 3 4 5 6 7	(a) (1) Commencing September 1, 2016, a person shall not be employed or volunteer at a family day care home if he or she has not been immunized against influenza, pertussis, and measles. Each employee and volunteer shall receive an influenza vaccination between August 1 and December 1 of each year.This requirement is not met as evidenced by:
	8 9 10 11 12 13 14	One of the staff in the day care does not have immunization records on file.	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: Peter Flores	TELEPHONE: (424) 301-3077
LICENSING EVALUATOR NAME: Lisa Rios	TELEPHONE: (424) 301-3072
LICENSING EVALUATOR SIGNATURE:	DATE: 07/15/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/15/2021

LIC809 (FAS) - (06/04)

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