197412962-8-12-2021-30-CC-LRIS-C5TT8D-20210812143010

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 197412962
Report Date: 08/12/2021
Date Signed: 08/12/2021 02:30:18 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:	PENALOZA FAMILY CHILD CARE		FACILITY NUMBER:	197412962
ADMINISTRATOR:	PENALOZA, CLAUDIA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(310) 313-0912
CITY:	CULVER CITY	STATE: CA	ZIP CODE:	90230
CAPACITY:	14	CENSUS: 10	DATE:	08/12/2021
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	01:00 PM
MET WITH:	Licensee Claudia Penaloza		TIME COMPLETED:	03:00 PM

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On 8/12/21 Licensing Program Analyst (LPA) Lisa Rios, conducted an unannounced Annual Required Inspection and was met by Licensee, Claudia Penazola. Also present were Staff #1 Adrianna Alejandre (S1). Days and hours of operation are Monday-Friday 7:30am-5:30pm.

LPA toured the home inside and outside and a census was taken. Current facility sketch reviewed, and Licensee confirmed that the kitchen, bathroom, outdoor patio, backyard and accessory dwelling off the backyard are used for providing care and are accessible to children. All other rooms are off-limits and made inaccessible by use of remaining closed. 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 a working fire extinguisher, 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 cell phone number is 310-292-0409.

There is currently 1 infant in care. LPA discussed Safe Sleep Regulations and New Infant Regulations with licensee 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 off the kitchen and the side of the house 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: 08/12/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/12/2021

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: PENALOZA FAMILY CHILD CARE	FACILITY NUMBER: 197412962
	VISIT DATE: 08/12/2021

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LPA reviewed a sample of children’s files and observed files were complete with emergency information as required. Licensee’s Mandated Reporter Training was completed on 1/14/2020 and assistant's was competed on 1/14/2020. Licensee’s pediatric CPR/First Aid expires on 3/2023. 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 no deficiencies are 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: 08/12/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/12/2021

LIC809 (FAS) - (06/04)

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