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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197413712
Report Date: 07/10/2019
Date Signed: 07/10/2019 10:21:51 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:MELGAR FAMILY CHILD CAREFACILITY NUMBER:
197413712
ADMINISTRATOR:MELGAR, ANA L.FACILITY TYPE:
810
ADDRESS:TELEPHONE:
(310) 822-7027
CITY:LOS ANGELESSTATE: CAZIP CODE:
90066
CAPACITY:14CENSUS: 7DATE:
07/10/2019
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
08:40 AM
MET WITH:Ana L. Melgar - Licensee TIME COMPLETED:
10:40 AM
NARRATIVE
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Licensing Program Analysts (LPA), Peter Flores, conducted an unannounced Annual Random Inspection to the facility. At 08:40 AM, LPA met with licensee Ana L. Melgar, who guided LPA on a tour of the home inside and outside. There are no changes to the facility layout or to the off limit areas of the home. LPA observed 7 children in care with licensee and 1 assistant. Licensee utilizes the kitchen, eating area and sitting area for the children's activity areas. Napping is conducted in a bedroom next to the living room. Licensee was reminded, children shall have 100% supervision at all times, including nap time.

The following were observed/discussed during this inspection:
1. All adults living or working in the home are fingerprint cleared and associated to the facility.
2. The backyard is completely fenced in. There are no bodies of water observed.
3. The toys were observed to be abundant, in good repair and age appropriate.
4. There were no baby walkers or exersaucers.
5. According to the licensee, there are no firearms or other dangerous weapons in the home; none were observed.
6. The home has working telephone service.
7. The licensee has documented that date and time of fire and disaster drills conducted. The licensee was reminded that as a facility that is licensed for large capacity, she is required to conduct the drills on a monthly basis to comply with fire marshal standards.
8. The home is equipped with operable smoke detector, carbon monoxide detector, and a 2A10BC fire extinguisher.
SUPERVISOR'S NAME: Mary RuizTELEPHONE: (424) 301-3061
LICENSING EVALUATOR NAME: Peter FloresTELEPHONE: (424) 301-3063
LICENSING EVALUATOR SIGNATURE:

DATE: 07/10/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/10/2019
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 3
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: MELGAR FAMILY CHILD CARE
FACILITY NUMBER: 197413712
VISIT DATE: 07/10/2019
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9. The kitchen and bathroom drawers were inspected for inaccessibility of chemicals and sharp objects.
10. The staff has current CPR/1st Aid certificates.
11. The licensee produced current children's roster.
12. Sample children's records were reviewed to include the required licensing forms.

At this time the facility does not provide Incidental Medical Services (IMS).

The following was thoroughly discussed during the inspection:
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.

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

SUPERVISOR'S NAME: Mary RuizTELEPHONE: (424) 301-3061
LICENSING EVALUATOR NAME: Peter FloresTELEPHONE: (424) 301-3063
LICENSING EVALUATOR SIGNATURE:

DATE: 07/10/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/10/2019
LIC809 (FAS) - (06/04)
Page: 2 of 3
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: MELGAR FAMILY CHILD CARE
FACILITY NUMBER: 197413712
VISIT DATE: 07/10/2019
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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

Licensee was reminded it is the licensee’s responsibility to know the regulations as well as anyone who assists in providing care. 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 the come out to stay informed of any changes or updates to the regulations. Licensee was advised to child care video's on the following site: ccld.childcarevideos.org

Licensee was reminded that the following are guidelines and recommendations for best practices only. When the regulation is approved providers will be notified through Provider Information Notice (PIN).
*Always place infants on their backs for sleeping
*Use 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 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.

An exit interview was conducted and a copy of this report was given to licensee Ana L. Melgar.
SUPERVISOR'S NAME: Mary RuizTELEPHONE: (424) 301-3061
LICENSING EVALUATOR NAME: Peter FloresTELEPHONE: (424) 301-3063
LICENSING EVALUATOR SIGNATURE:

DATE: 07/10/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/29/2019
LIC809 (FAS) - (06/04)
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