197412464-10-15-2019-30-CC-SPOL-BGYRMS-20191015130913

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 197412464
Report Date: 10/15/2019
Date Signed: 10/15/2019 01:09:35 PM

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:	BERMUDEZ FAMILY CHILD CARE		FACILITY NUMBER:	197412464
ADMINISTRATOR:	BERMUDEZ, TRACY		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(661) 886-0417
CITY:	HAWTHORNE	STATE: CA	ZIP CODE:	90250
CAPACITY:	14	CENSUS: 5	DATE:	10/15/2019
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	09:30 AM
MET WITH:	Tracy Bermudez, Licensee		TIME COMPLETED:	01:07 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 Analysts (LPA) Shandra Powell conducted an unannounced annual random inspection to the above facility. Upon arrival, Licensee was not present. Licensee's assistant was alone with 3 preschoolers/toddlers and 1 infant. Licensee and one more assistant arrived during inspection. (approximately 20 minuets into inspection). Upon LPA arrival, Assistant was out in back yard with 4 toddlers. One infant was alone in bedroom #1 with bedroom door closed. LPA advised assistant to leave door open while infant was napping. Assistant stated that a additional assistant was here with her and had to run out for a few minutes. LPA asked that assistant bring other children closer to the indoors of the home so that the infant would be supervised as well. Assistant agreed and brought children to a small play area next to back sliding glass door of the home. When Licensee arrived LPA also advised on Safe Sleep Practices for infants and the importance of the infant to always be supervised during nap time as well. Licensee gave LPA a tour of the home. Per Licensee, there are 16 children enrolled, LPA observed completed roster. This is a single dwelling home consists of 2 bedrooms, 2 bathroom, living room, kitchen/dinning room, den and a detach garage. Child care conducted in den, living room and kitchen. Children do have access to one bathroom. The rest of the areas in the home are off-limits to children. Licensee acknowledged that children may never enter these off-limit areas. Per licensee, children play in the backyard only. LPA observed to be fenced in, safe and clean with appropriate outdoor materials. LPA did not observed any bodies of water at the home. The licensee provides food for children in care. Children also bring their own food and snacks. LPA observed child's name on each child's lunch bag and or food item. ---------------Page 1 of 4

SUPERVISOR'S NAME: Mary Ruiz	TELEPHONE: (424) 301-3061
LICENSING EVALUATOR NAME: Shandra Powell	TELEPHONE: (323) 981-3383
LICENSING EVALUATOR SIGNATURE:	DATE: 10/15/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/15/2019

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 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, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245

FACILITY NAME: BERMUDEZ FAMILY CHILD CARE	FACILITY NUMBER: 197412464
	VISIT DATE: 10/15/2019

NARRATIVE

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The licensee states that no other adults or children currently live in the home. Per Licensee, she currently has two assistants. All adults residing in the home have obtained a criminal record clearance or exemption. Licensee states that there are no firearms stored in the home.

All areas identified on the facility sketch that are accessible for children to use were inspected for safety, comfort, and cleanliness. There is telephone service via a cellphone at the facility. LPA advised licensee to make sure all assistants have working cell phones. If Licensee has to run errands away from the home she will call assistants cell phones to make sure they are operable if not licensee will leave her cell phone at the home to be available for assistants. There is ventilation (air conditioners) and heating (central). The following was observed and reviewed during this inspection.

LPA observed detergent cleaning compounds inaccessible to children. Licensee stores items above refrigerator in cabinet. Per Licensee, there are no poisons stored at the facility. The restroom that children use was observed to be safe and sanitary.

The valve on the required 2A 10BC fire extinguisher did indicate fully charged the receipt showed the year of 2013. This poses a potential health and safety risk to children in care. Smoke and carbon monoxide detectors were tested and are operable.

The home is observed to be clean and orderly. There are toys available for children. Appropriate sleeping arrangements were observed.

Children are using the back yard for outdoor play time. The outdoor play area was observed to be fenced. LPA observed that the outdoor yard has toys and other materials for children to play with. The outdoor yard is divided into three sections and the Licensee is able to separate or close off areas as needed.

The licensee and two assistants do have proof of Pediatric First Aid and CPR . Licensee expires 10/09/21. LPA advised licensee that all assistants will need to always have a valid Pediatric First Aid and CPR card. There are first aid supplies available.
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SUPERVISOR'S NAME: Mary Ruiz	TELEPHONE: (424) 301-3061
LICENSING EVALUATOR NAME: Shandra Powell	TELEPHONE: (323) 981-3383
LICENSING EVALUATOR SIGNATURE:	DATE: 10/15/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/15/2019

LIC809 (FAS) - (06/04)

Page: 2 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, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245

FACILITY NAME: BERMUDEZ FAMILY CHILD CARE	FACILITY NUMBER: 197412464
	VISIT DATE: 10/15/2019

NARRATIVE

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Licensee does not have proof of immunization record.

All homes shall conduct fire and disaster drills at least once every six months, and document the date and time of each drill. Per Licensee she has not conducted any fire/disaster drills this year. This poses a potential health and safety risk to children in care.

Emergency Disaster Plan, Parent’s Rights Poster and the Facility License were observed to be on a clipboard/wall. LPA advised the Licensee that the required forms to be posted need to be visible at all times.

LPs did not observe the following items during the inspection: Infant Walkers, Johnny Jumpers, Saucer Chairs, Trampolines and/or any other item that fall into these categories are not permitted in a family child care facility.

Smoking is prohibited in a licensed Family Child Care Home. Per Licensee, no one smokes in the home.

LPA provided the licensee with a copy of the Child Care Provider’s Guide to Safe Sleep, by American Academy of Pediatrics and the New Proposed Safe Sleep Regulations and Best Practices, Helping you to reduce the risk of SIDS. LPA also consulted and explained Child Abuse Reporting, Updated Parent’s Rights Poster with Complaint Hotline information.

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SUPERVISOR'S NAME: Mary Ruiz	TELEPHONE: (424) 301-3061
LICENSING EVALUATOR NAME: Shandra Powell	TELEPHONE: (323) 981-3383
LICENSING EVALUATOR SIGNATURE:	DATE: 10/15/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/15/2019

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, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245

FACILITY NAME: BERMUDEZ FAMILY CHILD CARE	FACILITY NUMBER: 197412464
	VISIT DATE: 10/15/2019

NARRATIVE

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Incidental Medical Services (IMS):
The licensee states that does not provide IMS. Per licensee, there are no children enrolled that require IMS at this time. 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 available at: http://www.ada.gov/childqanda.htm.

INFORMATION TO BE POSTED IN YOU FAMILY CHILD CARE HOME – You are required by Law to post the following:
Facility License (LIC 203), Emergency Disaster Plan (LIC 610A), Earthquake Preparedness Checklist (LIC 9148), Notification of Parent’s Rights (PUB 394). A Notice of Site Visit (LIC 9213): Must be posted for 30 days after each site inspection by a Licensing Representative. Any Licensing Report documenting a Type “A” deficiency must be posted for 30 days during the hours that children are in care. Any Licensing Report or other document verifying compliance or non-compliance with the Department’s order to correct a Type “A” deficiency must be posted for 30 days during the hours that children are in care.

LPA advised the licensee to access forms, regulations and quarterly updates on line at: www.ccld.ca.gov.

Based on the LPA observations and records review, the following deficiencies listed on the attached LIC 809D deficiency page are being cited in accordance with California Code of Regulations Title 22. Deficiencies that are being cited need to be cleared to protect the children’s health & safety.

The Notice of Site Visit (LIC 9213) – must remain posted for 30 days during the hours of operation after each site visit made by a licensing representative. Failure to maintain posting as required will result in a civil penalty of $100.00.

Exit interview was conducted with Tracy Bermudez, Licensee, including, but not limited to Appeal Procedures, Site Visit and Initial Appeal Rights. --------------Page 4 of 4

SUPERVISOR'S NAME: Mary Ruiz	TELEPHONE: (424) 301-3061
LICENSING EVALUATOR NAME: Shandra Powell	TELEPHONE: (323) 981-3383
LICENSING EVALUATOR SIGNATURE:	DATE: 10/15/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/15/2019

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, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245

FACILITY NAME: BERMUDEZ FAMILY CHILD CARE	FACILITY NUMBER: 197412464
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 10/15/2019

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 10/18/2019 Section Cited	1 2 3 4 5 6 7	Operation of a Family Child Care Home The licensee shall document the drills, including the date and time of each drill. This documentation shall be kept at the family child care home. This requirement is not met as evidenced by
	8 9 10 11 12 13 14	LPA observing that the Licensee did not have a drill conducted within the last 6 months. Licensee admitted. This poses a potential health and safety risk to children in care.	8 9 10 11 12 13 14
Type B 10/18/2019 Section Cited	1 2 3 4 5 6 7	Operation of a Family Child Care Home Fireplaces and open-face heaters shall be screened to prevent access by children. The home shall contain a fire extinguisher and smoke detector device which meet standards established by the State Fire Marshal.
	8 9 10 11 12 13 14	This requiremnet is not met as evidenced by LPA observing that the fire extinguisher was purchased in 2013. This poses a potential health and safety risk to children in care.	8 9 10 11 12 13 14

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: Mary Ruiz	TELEPHONE: (424) 301-3061
LICENSING EVALUATOR NAME: Shandra Powell	TELEPHONE: (323) 981-3383
LICENSING EVALUATOR SIGNATURE:	DATE: 10/15/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/15/2019

LIC809 (FAS) - (06/04)

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