197414248-4-28-2022-30-CC-LPHS-CDWQES-20220428120649

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 197414248
Report Date: 04/28/2022
Date Signed: 04/28/2022 12:06:59 PM

Document Has Been Signed on 04/28/2022 12:06 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:	CHAVEZ FAMILY CHILD CARE		FACILITY NUMBER:	197414248
ADMINISTRATOR:	CHAVEZ, MARIA & SUSANA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(310) 398-4910
CITY:	CULVER CITY	STATE: CA	ZIP CODE:	90230
CAPACITY:	14	CENSUS: 4	DATE:	04/28/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	09:20 AM
MET WITH:	MARIA & SUSANA CHAVEZ		TIME COMPLETED:	12:15 PM

NARRATIVE

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On 4/28/2022 Licensing Program Analysts (LPA), Loyce Phillips conducted an unannounced Annual Required Inspection and was met by Licensees, Maria Chavez and Susana Chavez. LPA observed 4 children in care. All adults present have a criminal record clearance. Days and hours of operation are Monday through Friday 7:30am to 5:30pm. The Family Child Care Home has a Certificate of Insurance.

LPA toured the home inside and outside. The current facility sketch was reviewed and Licensee confirmed that living room (main day care room), kitchen, bathroom, bedroom #1 and Bedroom #2 are accessible to children. The front yard is enclosed and is accessible for outdoor activities for children. The backyard, driveway and detached garage are off limits to children. The detached was converted into living space for Licensee Susana Chavez. The converted garage has small living room and 2 additional rooms with a bathroom. LPA observed a storage unit to the left of the garage that was locked. Licensee stated the storage is off limits to children. No poisons were observed during the inspection. Detergents, cleaning compounds, medication and other hazardous items are made inaccessible and kept under the kitchen cabinet inaccessible to children.

There is a working fire extinguisher, smoke detectors, carbon monoxide detector and adequate heating and ventilation for safety and comfort. There are no stairs in the home. Safe toys and play equipment are observed. Children sleep on mats. The home has working telephone service and LPA confirmed the phone number is (310) 490-8741.

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. Capacity as specified on the license is being maintained.

SUPERVISOR'S NAME: Peter Flores	TELEPHONE: (424) 301-3063
LICENSING EVALUATOR NAME: Loyce Phillips	TELEPHONE: (424) 301-3206
LICENSING EVALUATOR SIGNATURE:	DATE: 04/28/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/28/2022

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: CHAVEZ FAMILY CHILD CARE	FACILITY NUMBER: 197414248
	VISIT DATE: 04/28/2022

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Licensee’s Mandated Reporter Training expired on 1/11/2023. Licensee’s pediatric CPR/First Aid expires on 3/14/2023. A review of records indicates that Licensee have immunization records on file for influenza, pertussis and measles.

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

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.

Licensee is not caring for infants. LPA discussed the safe sleep regulations with licensee and discussed the Child Care Licensing Safe Sleep web page at: https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPA also informed licensee 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.

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.

SUPERVISOR'S NAME: Peter Flores	TELEPHONE: (424) 301-3063
LICENSING EVALUATOR NAME: Loyce Phillips	TELEPHONE: (424) 301-3206
LICENSING EVALUATOR SIGNATURE:	DATE: 04/28/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/28/2022

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: CHAVEZ FAMILY CHILD CARE	FACILITY NUMBER: 197414248
	VISIT DATE: 04/28/2022

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 26 27 28 29 30 31 32	Per Title 22, Division 12, Chapter 3, of the California Code of Regulations, no deficiencies are cited. An exit interview was conducted, a copy of this report was read and provided to the Licensee. This report shall me made available to the public upon request. LIC 9213 Notice of Site Visit was provided and required to be posted for 30 days.

SUPERVISOR'S NAME: Peter Flores	TELEPHONE: (424) 301-3063
LICENSING EVALUATOR NAME: Loyce Phillips	TELEPHONE: (424) 301-3206
LICENSING EVALUATOR SIGNATURE:	DATE: 04/28/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/28/2022

LIC809 (FAS) - (06/04)

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