197412416-10-25-2019-12-CC-JSIS-BHAUHE-20191025153548

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 197412416
Report Date: 10/25/2019
Date Signed: 10/25/2019 03:36:03 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1605 EAST PALMDALE BLV, STE A
PALMDALE, CA 93550

FACILITY NAME:	LEDEZMA FAMILY CHILD CARE		FACILITY NUMBER:	197412416
ADMINISTRATOR:	LEDEZMA, MARTHA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(818) 893-8691
CITY:	MISSION HILLS	STATE: CA	ZIP CODE:	91345
CAPACITY:	14	CENSUS: 10	DATE:	10/25/2019
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	12:15 PM
MET WITH:	Martha Ledesma		TIME COMPLETED:	03:45 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) Jesse Sims conducted an annual random inspection at the above facility. Upon arrival LPA was greeted by licensee, Martha Ledesma. LPA observed 4 school age, 3 preschool children, and 3 infants. The licensee's assistant was also present. Per Licensing Information System (LIS) all adults residing and working in the home have obtained background clearances. The facility annual fees were current per LIS. The licensee is operating within proper capacity and ratios. LPA observed licensee to be present at the home and providing adequate supervision to children in care along with her assistant. The home is clean, orderly, comfortable and well ventilated. LPA observed a working smoke detector and Carbon Monoxide detector, 2 fully charged fire extinguishers and a working telephone. There are several age appropriate toys and a first aid kit on the premises. The day care children use the family room/ day care room where there is a designated restroom for day care children only and a designated day care play, rest, and eating area. The rest of the home is off limits and gated off. The backyard is completely fenced in. There is a swing set in the back which was securely anchored to the ground and some bikes and scooters for children. The ground where children's swing set is, is padded. The licensee has no pets. There are no bodies of water in the FCCH. Per the licensee, there are no firearms on the premises. CPR and first aid are current and expire 5/2020.

SUPERVISOR'S NAME: Claretta Yates	TELEPHONE: (661) 789-6944
LICENSING EVALUATOR NAME: Jesse Sims	TELEPHONE: (661) 789-6944
LICENSING EVALUATOR SIGNATURE:	DATE: 10/25/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/25/2019

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, 1605 EAST PALMDALE BLV, STE A
PALMDALE, CA 93550

FACILITY NAME: LEDEZMA FAMILY CHILD CARE	FACILITY NUMBER: 197412416
	VISIT DATE: 10/25/2019

NARRATIVE

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The licensee and her assistants have completed their mandated reporter training which was taken 10-11-18 and 6-15-19 respectively.

The licensee has her required immunization. Her assistant's file did not have a record of the required immunization's. This will be a type B violation cited today.

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

The licensee was informed of the responsibility to report suspected Child Abuse by calling the Child Abuse Hot-line at 1-800-540-4000. Also call the CCL office and follow up with a written Unusual Incident/Injury Report (LIC 624B).

The licensee was informed that the presence of adults in the home without Criminal Record Clearance or Exemption will be cited and civil penalty assessed for $100 per day. The licensee may find additional information and forms on the DSS website at www.ccld.ca.gov including information on the Live Scan application (LIC 9163). Appointments can be made for Live Scan at 1-800-315-4507

SUPERVISOR'S NAME: Claretta Yates	TELEPHONE: (661) 789-6944
LICENSING EVALUATOR NAME: Jesse Sims	TELEPHONE: (661) 789-6944
LICENSING EVALUATOR SIGNATURE:	DATE: 10/25/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/25/2019

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, 1605 EAST PALMDALE BLV, STE A
PALMDALE, CA 93550

FACILITY NAME: LEDEZMA FAMILY CHILD CARE	FACILITY NUMBER: 197412416
	VISIT DATE: 10/25/2019

NARRATIVE

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Our Quarterly updates come out every 3 months they are also now in Spanish please log in to the CCLD website or you can email our advocates to have the quarterly updates send directly to your email.

LPA observed a current child roster. Per the licensee, fire and disaster drills are conducted every month.

Licensee has the required documents posted in the FCCH; Facility License (LIC 203), Emergency Disaster Plan (LIC610a), Notification of Parents' Rights Poster (PUB 394).

The following was discussed with the licensee;

No smoking, no infant walkers, Johnny jumpers, and any other item that falls into that category, earthquake safety and necessity of drills (every 6 months), required forms for children’s files, facility files, posting requirements, penalty, fingerprint clearance, and the transfer process and penalty.
For additional information and forms visit our website at: www.ccld.ca.gov
A copy of this report must be made available to the public for 3 years.

For updates on Community Care Licensing please visit the following website at: Childcareadvocatesprogram@dss.ca.gov
https://ccld.childcarevideos.org/

SUPERVISOR'S NAME: Claretta Yates	TELEPHONE: (661) 789-6944
LICENSING EVALUATOR NAME: Jesse Sims	TELEPHONE: (661) 789-6944
LICENSING EVALUATOR SIGNATURE:	DATE: 10/25/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/25/2019

LIC809 (FAS) - (06/04)

Page: 3 of 5

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1605 EAST PALMDALE BLV, STE A
PALMDALE, CA 93550

FACILITY NAME: LEDEZMA FAMILY CHILD CARE	FACILITY NUMBER: 197412416
	VISIT DATE: 10/25/2019

NARRATIVE

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Please be mindful of the following safe sleep best practices:

• Always place infants on their backs for sleeping

• Use only a tight-fitting sheet on the crib or play yard mattress

• Do not hang any items from the crib or above the crib

• Keep all items, including blankets, out of the crib or play yard

• Pacifiers may be used as long as they do not have items attached to them

• Infants should not be swaddled or have any items covering them while sleeping

• The temperature of the room should be comfortable enough for an adult to wear a t-shirt and not be too hot or too cold

Note: the above guidelines are recommendations for best practices only, until regulations are approved and adopted.

Thank you for all that you do to help keep our children safe.

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

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

The facility was not in compliance per Title 22 regulations, a Type B deficiency will be cited today 10/25/2019. An exit Interview was conducted, a copy of this Report, appeal rights, and a Notice of Site visit was provided to the licensee on this date.

SUPERVISOR'S NAME: Claretta Yates	TELEPHONE: (661) 789-6944
LICENSING EVALUATOR NAME: Jesse Sims	TELEPHONE: (661) 789-6944
LICENSING EVALUATOR SIGNATURE:	DATE: 10/25/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/25/2019

LIC809 (FAS) - (06/04)

Page: 4 of 5

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1605 EAST PALMDALE BLV, STE A
PALMDALE, CA 93550

FACILITY NAME: LEDEZMA FAMILY CHILD CARE	FACILITY NUMBER: 197412416
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 10/25/2019

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 11/22/2019 Section Cited	1 2 3 4 5 6 7	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.
	8 9 10 11 12 13 14	This requirement was not met as evidenced by LPA observed that the facility did not have documentation verifying that the assistant has the required immunizations nor TB test documentation. This poses a potential risk to the health and safety of children	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: Claretta Yates	TELEPHONE: (661) 789-6944
LICENSING EVALUATOR NAME: Jesse Sims	TELEPHONE: (661) 789-6944
LICENSING EVALUATOR SIGNATURE:	DATE: 10/25/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/25/2019

LIC809 (FAS) - (06/04)

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