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Department of
SOCIAL SERVICES
Community Care Licensing
FACILITY EVALUATION REPORT
Facility Number:
197414180
Report Date:
05/05/2022
Date Signed:
05/05/2022 01:30:34 PM
Document Has Been Signed on
05/05/2022 01:30 PM
- It Cannot Be Edited
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:
RUBIN FAMILY CHILD CARE
FACILITY NUMBER:
197414180
ADMINISTRATOR:
RUBIN, ELENA
FACILITY TYPE:
810
ADDRESS:
TELEPHONE:
(818) 342-3358
CITY:
LAKE BALBOA
STATE:
CA
ZIP CODE:
91406
CAPACITY:
14
CENSUS:
12
DATE:
05/05/2022
TYPE OF VISIT:
Required - 1 Year
UNANNOUNCED
TIME BEGAN:
09:02 AM
MET WITH:
Elena Rubin, Licensee
TIME COMPLETED:
12:30 PM
NARRATIVE
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On 5/5/2022 Licensing Program Analyst (LPA), Judy Laureano conducted an unannounced Annual Required Inspection and was met by Elena Rubin. Facility currently operates Monday through Friday with the hours of operation being 7 am to 6:00 p.m.
LPA toured the home inside and outside and a census was taken. Current facility sketch reviewed and Licensee confirmed that a new facility sketch will be submitted to the El Segundo Child Care Regional Office reflecting the use of the converted garage into additional activity space. Licensee confirmed that Bedroom 1, Living Room, Dinning Room and Bathroom 1 is currently used for the day care. The outdoor area outside the home- enclosed patio, backyard and detached garage are also being used for activity space.
Licensee confirmed that Bedroom 1 is used for the napping area. LPA informed licensee that converted garage is not to be used for napping or eating, it is only to be used for additional day care activity space.
The following areas are currently OFF LIMITS: the kitchen-only used as a walkway to access the outdoor area, bedroom 2, used as an office space and the master bedroom and bathroom. LPA reminded licensee that doors need be locked during the hours of operations.
There is no swimming pool or other bodies of water on the premises. No poisons were observed during the inspection. Detergents and cleaning compounds were observed to be stored in the cabinet above the washer and dryer unit, making them inaccessible to the children in care.
SUPERVISOR'S NAME:
Claudia Escobedo
TELEPHONE:
(424) 301-3044
LICENSING EVALUATOR NAME:
Judy Laureano
TELEPHONE:
(424) 301-3060
LICENSING EVALUATOR SIGNATURE:
DATE:
05/05/2022
I acknowledge receipt of this form and understand my
licensing
appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
05/05/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC809
(FAS) - (06/04)
Page:
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Document Has Been Signed on
05/05/2022 01:30 PM
- It Cannot Be Edited
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:
RUBIN FAMILY CHILD CARE
FACILITY NUMBER:
197414180
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE:
05/05/2022
DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
102416(c)
Personnel Requirements
(c) The licensee and other personnel as specified shall complete training on preventive health practices, including pediatric cardiopulmonary resuscitation and pediatric first aid, pursuant to Health and Safety Code Section 1596.866.
This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation and record review, the licensee did not comply with the section cited above in maintaining current CPR and First Aid certificationout of which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date:
05/23/2022
Plan of Correction
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Licensee agrees to complete CPR and First aid certification and email/text a copy of certification to LPA.
Section Cited
Deficient Practice Statement
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4
POC Due Date:
Plan of Correction
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2
3
4
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:
Claudia Escobedo
TELEPHONE:
(424) 301-3044
LICENSING EVALUATOR NAME:
Judy Laureano
TELEPHONE:
(424) 301-3060
LICENSING EVALUATOR SIGNATURE:
DATE:
05/05/2022
I acknowledge receipt of this form and understand my
appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
05/05/2022
LIC809
(FAS) - (06/04)
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Document Has Been Signed on
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- It Cannot Be Edited
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:
RUBIN FAMILY CHILD CARE
FACILITY NUMBER:
197414180
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE:
05/05/2022
DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102417(g)(9)(A)1
Operation of A Family Child Care Home
(g) The home shall be free from defects or conditions which might endanger a child. Safety precautions shall include but not limited to: (9) Each family child care home shall have a written disaster plan of action prepared on a form approved by the Department. All children, age and ability permitting, and the provider, the assistant provider, and other members of the household, shall be instructed in their duties under the disaster plan. As their age and ability permit, newly enrolled children shall be informed promptly of their duties as required in the plan. (A) Each family child care home shall conduct fire drills and disaster drills at least once every six months. 1. The licensee shall document the drills, including the date and time of each drill. This documentation shall kept at the family child care home.
This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation and record review, the licensee did not comply with the section cited above in providing a disaster log documenting disaster drills are being completed every 6 month, which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date:
05/12/2022
Plan of Correction
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Licensee agrees to submit via email the disaster log and agrees to complete drills every 6 months.
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:
Claudia Escobedo
TELEPHONE:
(424) 301-3044
LICENSING EVALUATOR NAME:
Judy Laureano
TELEPHONE:
(424) 301-3060
LICENSING EVALUATOR SIGNATURE:
DATE:
05/05/2022
I acknowledge receipt of this form and understand my
appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
05/05/2022
LIC809
(FAS) - (06/04)
Page:
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Document Has Been Signed on
05/05/2022 01:30 PM
- It Cannot Be Edited
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:
RUBIN FAMILY CHILD CARE
FACILITY NUMBER:
197414180
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE:
05/05/2022
DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
HSC
1596.8662(b)(1)
Administration of Child Day Care Licensing
(1) On or before March 30, 2018, a person who, on January 1, 2018, is a licensed child day care provider, administrator, or employee of a licensed child day care facility shall complete the mandated reporter training provided pursuant to paragraphs (2) and (3) of subdivision (a), and shall complete renewal mandated reporter training every two years following the date on which he or she completed the initial mandated reporter training.
This requirement is not met as evidenced by:
Deficient Practice Statement
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2
3
4
Based on record review, the licensee did not comply with the section cited above in providing proof of completion of Mandated Reporter Training, which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date:
05/12/2022
Plan of Correction
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LIcensee agrees to submit proof of completion of mandated reporter training via email to LPA. Mandated reporter training needs to be completed by licensee and two assistants.
Type B
Section Cited
HSC
1597.622(a)(1)
General Provisions and Definitions
(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:
Deficient Practice Statement
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Based on record review, the licensee did not comply with the section cited above in 3 out of 3 counts of not having vaccinations available for review, which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date:
05/12/2022
Plan of Correction
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Licensee agrees to submit proof of vaccination to LPA via email for MMR, DTap and Flu vaccine and/or waiver for licensee and assistants.
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:
Claudia Escobedo
TELEPHONE:
(424) 301-3044
LICENSING EVALUATOR NAME:
Judy Laureano
TELEPHONE:
(424) 301-3060
LICENSING EVALUATOR SIGNATURE:
DATE:
05/05/2022
I acknowledge receipt of this form and understand my
appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
05/05/2022
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:
RUBIN FAMILY CHILD CARE
FACILITY NUMBER:
197414180
VISIT DATE:
05/05/2022
NARRATIVE
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The fireplace located in the living room, outside the dinning room, is made inaccessible by a glass door with a safety latch making inaccessible to the children in care. Licensee confirmed fire place will not be used during the hours of daycare.
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 phone number is 818 342-3358
There are currently no infants in care but LPA observed 3 cribs in the napping room. LPA discussed Safe Sleep Regulations with licensee. There is one crib or play yard for each infant in care, cribs and play yards are kept free from all loose articles and objects while infants are sleeping, and there are no objects hanging above or attached to the crib or play yard. Infants are not swaddled while in care. Provider physically checks on sleeping infants every fifteen minutes and documents any signs of distress which includes but is not limited to flushed skin color, increase in body temperature, restlessness and labored breathing. Infants can be visually observed through an open door if sleeping in a separate room. Individual Infant Sleeping Plan is completed and in file for each infant up to 12 months of age. Infants up to 12 months of age are placed on their backs for sleeping.
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 fenced and there are no hazards to children present. Capacity as specified on the license is being maintained.
LPA reviewed a sample of children’s files and observed 8 out of 10 files were complete with emergency information as required. Licensee’s Mandated Reporter Training was not available for review and Licensee agreed to submit proof of completion to LPA by 5/23/2022. Licensee’s pediatric CPR/First Aid expired on 6/2021. A review of records
SUPERVISOR'S NAME:
Claudia Escobedo
TELEPHONE:
(424) 301-3044
LICENSING EVALUATOR NAME:
Judy Laureano
TELEPHONE:
(424) 301-3060
LICENSING EVALUATOR SIGNATURE:
DATE:
05/05/2022
I acknowledge receipt of this form and understand my licensing appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
05/05/2022
LIC809
(FAS) - (06/04)
Page:
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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:
RUBIN FAMILY CHILD CARE
FACILITY NUMBER:
197414180
VISIT DATE:
05/05/2022
NARRATIVE
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indicates that all employees and/or volunteers will have immunization records on file for influenza, pertussis and measles, mandated reporter training and employee rights.
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.
To improve the quality and value of the new inspection process, a survey will be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or tools, please send them by email to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at
www.cdss.ca.gov/inforesources/community-care-licensing/inspection-process
.
Licensee was reminded that all adults 18 and over living or working in the home, including employees and volunteers, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a licensed Family Child Care Home. A civil penalty of $100.00 minimum/day up to $500.00 maximum per day/per person will be assessed if this regulation is violated.
LPA discussed the safe sleep regulations with licensee Elena Rubin and discussed the Child Care Licensing Safe Sleep webpage at
https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep
as an additional resource. LPA also informed licensee Elena Rubin of the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at
https://www.cpsc.gov/
and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment.
A notice of site visit was given and must remain posted for 30 days.
Failure to comply with posting requirements shall result in an immediate civil penalty of $100.
SUPERVISOR'S NAME:
Claudia Escobedo
TELEPHONE:
(424) 301-3044
LICENSING EVALUATOR NAME:
Judy Laureano
TELEPHONE:
(424) 301-3060
LICENSING EVALUATOR SIGNATURE:
DATE:
05/05/2022
I acknowledge receipt of this form and understand my licensing appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
05/05/2022
LIC809
(FAS) - (06/04)
Page:
10
of
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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:
RUBIN FAMILY CHILD CARE
FACILITY NUMBER:
197414180
VISIT DATE:
05/05/2022
NARRATIVE
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LPA Laureano informed licensee Elena Rubin that this report dated 5/5/2022 document (1) Type A citation which shall be posted for 30 consecutive days as there is/are immediate risk(s) to the health, safety, or personal rights of children in care.
Also, LPA Judy Laureano informed the licensee to provide a copy of this licensing report dated 5/5/2022 that documents any Type A citation(s) to parents/guardians of all children currently enrolled by the next business day or the next day the children are in care, and to any newly enrolled parents/guardians for 12 months from the date of this report. A signed Acknowledgement of Receipt of Licensing Report (LIC 9224), or other written statement, must be placed in the child's file for verification.
Exit interview conducted and report was reviewed with the licensee Elena Rubin.
SUPERVISOR'S NAME:
Claudia Escobedo
TELEPHONE:
(424) 301-3044
LICENSING EVALUATOR NAME:
Judy Laureano
TELEPHONE:
(424) 301-3060
LICENSING EVALUATOR SIGNATURE:
DATE:
05/05/2022
I acknowledge receipt of this form and understand my licensing appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
05/05/2022
LIC809
(FAS) - (06/04)
Page:
11
of
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