197414248-1-8-2025-30-CC-RRID-DCQTXM-20250108140721

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 197414248
Report Date: 01/08/2025
Date Signed: 01/08/2025 02:07:47 PM

Document Has Been Signed on 01/08/2025 02:07 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
EL SEGUNDO CC RO, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245

FACILITY NAME:	CHAVEZ FAMILY CHILD CARE		FACILITY NUMBER:	197414248
ADMINISTRATOR/ DIRECTOR:	CHAVEZ, MARIA & SUSANA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(310) 398-4910
CITY:	CULVER CITY	STATE: CA	ZIP CODE:	90230
CAPACITY: 14	TOTAL ENROLLED CHILDREN: 14	CENSUS: 1	DATE:	01/08/2025
TYPE OF VISIT:	Required - 3 Year	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	09:02 AM
MET WITH:	Maria Chavez		TIME VISIT/ INSPECTION COMPLETED:	02:20 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	On 01/08/2025, Licensing Program Analyst (LPA) Ranita Richmond conducted an unannounced visit to the above-named Home to conduct the Required 3-year Inspection. LPA was greeted by licensee Maria Chavez, also present during visit was adult daughter Maria Ortiz Chavez who was visiting from Mexico. The visitor’s luggage was observed in the FCC. Per licensee, co licensee Susana does not reside in the home since approximately 2019 and is still assisting with the FCC at half day intervals as necessary. LPA Richmond observed 1 child, being supervised and cared for appropriately by licensee. Hours of operation are Monday through Friday, 7:30am – 5:30pm. Licensee provides meals, snacks, and water. LPA Richmond toured the home inside and outside for a Health and Safety inspection. LPA was provided assistance with translation from Interpreter Adan, ID # 56223772 during the facility walk through. The home is neat and clean with heating and ventilation for safety and comfort. LPA Richmond confirmed that the home consists of living room, dining room/ kitchen, 2 bedrooms, 1 bathroom, fenced front yard, fenced back yard, detached converted garage, and storage unit. The ON LIMIT AREAS are as follows: living room (napping/isolation area/main daycare room), dining room/ kitchen (eating area), bedroom #1, bedroom #2, and fenced front yard. The OFF-LIMIT AREAS are as follows: detached converted garage, gated back yard, and storage unit. Children enter through the front door entrance. Upon entrance you are in the living room. To the right of the entrance is the dining room/kitchen, there is a door leading to the side of the house (driveway) between the living room and dining room /kitchen. The driveway leads to the gated back yard from the front of the home. From the entrance, straight through the hallway is on the left is the bathroom, and on the right, bed room #1, at the end of the hallway is bedroom #2. Inside bedroom #2 is a door that leads to outdoors, fenced back yard. page 1 of 4

Claudia Escobedo	TELEPHONE: (424) 301-3044
Ranita Richmond	TELEPHONE: (424) 301-3065
	DATE: 01/08/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/08/2025

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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Document Has Been Signed on 01/08/2025 02:07 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
EL SEGUNDO CC RO, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245

FACILITY NAME: CHAVEZ FAMILY CHILD CARE	FACILITY NUMBER: 197414248
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 01/08/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Section Cited

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: (4) Poisons, detergents, cleaning compounds, medicines, firearms and other items which could pose a danger if readily available to children shall be stored where they are inaccessible to children. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation the licensee did not comply with the section cited above in 1 of 2. Disinfectants, cleaning solutions, and beauty supplies accessible to children in care which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 01/23/2025
	Plan of Correction
1 2 3 4	Licensee will place all cleaning compounds, disinfectants, and other hazardous items where they are inacessible to children in care at all times.

Section Cited

Infant Safe Sleep

The provider shall supervise infants while they are sleeping and adhere to the following requirements: The provider shall check and document the following: This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation and record review, the licensee did not comply with the section cited above in 2 of 2. Licensee does not have infant sleep log completed and or on file which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 01/29/2025
	Plan of Correction
1 2 3 4	Licensee will complete and keep infant sleep log on file for all children 24 months of age and under at all times.

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

Claudia Escobedo	TELEPHONE: (424) 301-3044
Ranita Richmond	TELEPHONE: (424) 301-3065
	DATE: 01/08/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/08/2025

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 01/08/2025 02:07 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
EL SEGUNDO CC RO, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245

FACILITY NAME: CHAVEZ FAMILY CHILD CARE	FACILITY NUMBER: 197414248
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 01/08/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Section Cited

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
1 2 3 4	Based on observation and record review, the licensee did not comply with the section cited above in 1 of 2. Licensee's 1st aid/ cpr training not current up to date which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 01/22/2025
	Plan of Correction
1 2 3 4	Licensee will update 1st aid/cpr training.

Section Cited

Immunizations

(g) The licensee shall document each child's immunizations as required by the California Code of Regulations, Title 17, Section 6070, and shall maintain such documentation for as long as the child is enrolled. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on record review, the licensee did not comply with the section cited above in 2 of 2. Current immunization records for children not present on file which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 01/23/2025
	Plan of Correction
1 2 3 4	Licensee will request immunization records for children's file.

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

Claudia Escobedo	TELEPHONE: (424) 301-3044
Ranita Richmond	TELEPHONE: (424) 301-3065
	DATE: 01/08/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/08/2025

LIC809 (FAS) - (06/04)

Page: 3 of 10

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO CC RO, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245

FACILITY NAME: CHAVEZ FAMILY CHILD CARE	FACILITY NUMBER: 197414248
	VISIT DATE: 01/08/2025

NARRATIVE

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Licensee is aware that the children must nap and have meals in the home. During walkthrough LPA observed Lysol disinfectant in living room where accessible to children in care. LPA observed shampoo, conditioners, and other beauty and hygiene products in the bath/shower, which were accessible to children in care. LPA observed the bathroom cabinet which housed cleaning supplies to be open and cleaning products were accessible to children in care. Type B citation cited.

LPA Richmond observed a fully charged 2A:10B:C Fire Extinguisher in the kitchen and working smoke detectors throughout and carbon monoxide detector in the hallway.

There are no firearms or ammunition on the premises.

There are no pools, ponds or other bodies of water on the premises.

LPA Richmond observed age-appropriate toys, books and furnishings. Furniture and equipment are in good condition, free of sharp, loose, or pointed parts.

LPA reviewed 3 children’s files and observed them to be missing forms: LIC 282, LIC 627, and LIC 995A, and immunization records. Type B citation cited. LPA provided copies of the forms for completion by parents of children enrolled in the facility.

LPA Richmond observed the licensees updated mandated reporter training completed on 05/09/24 and compliance with immunizations requirements for childcare providers. Licensee has a current 1^st aid/cpr completed on 03/14/21. Type B citation cited.

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. During file review LPA observed missing infant sleep charts. Type B citation cited. LPA provided licensee with infant sleep charts for daily completion.

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SUPERVISOR'S NAME: Claudia Escobedo	TELEPHONE: (424) 301-3044
LICENSING EVALUATOR NAME: Ranita Richmond	TELEPHONE: (424) 301-3065
LICENSING EVALUATOR SIGNATURE:	DATE: 01/08/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/08/2025

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

FACILITY NAME: CHAVEZ FAMILY CHILD CARE	FACILITY NUMBER: 197414248
	VISIT DATE: 01/08/2025

NARRATIVE

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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 Richmond reminded Licensee of 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.

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 was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain childcare by connecting them to childcare providers and Resource and Referral Agencies (R&R) throughout California. Deborah confirmed that there are no Registered Sex Offenders living in the home and LPA completed the RSO profile in FAS.

In addition, LPA Richmond informed applicant of the following:

o There is an effective 24/7 ban on smoking tobacco in a home that is licensed as a family day care home, and in those areas of the family day care home where children are present.
o Children and Staff records must be maintained and updated as needed and must be available for review by the Department.
o Saucer chairs, bouncers, walkers, or any similar items are prohibited.
o All adults living and working in the home shall be made of aware of the Departments right to inspection authority, which includes but not limited to the right to enter the home when children are being cared for, interview children and adults and review documentation.
o LPA provided and advised the applicant how to access forms, regulations and quarterly updates on the Child Care Licensing website at: www.ccld.ca.gov

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SUPERVISOR'S NAME: Claudia Escobedo	TELEPHONE: (424) 301-3044
LICENSING EVALUATOR NAME: Ranita Richmond	TELEPHONE: (424) 301-3065
LICENSING EVALUATOR SIGNATURE:	DATE: 01/08/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/08/2025

LIC809 (FAS) - (06/04)

Page: 9 of 10

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO CC RO, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245

FACILITY NAME: CHAVEZ FAMILY CHILD CARE	FACILITY NUMBER: 197414248
	VISIT DATE: 01/08/2025

NARRATIVE

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Deficiencies were cited today, per Title 22 Regulations and Health and Safety Codes. See LIC 809D.

An exit interview was conducted in Spanish by LPA Judy Laureno with licensee Maria Chavez. A copy of report and appeal rights were provided to licensee.

Notice of Site Visit provided and required to be posted for 30 days.

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SUPERVISOR'S NAME: Claudia Escobedo	TELEPHONE: (424) 301-3044
LICENSING EVALUATOR NAME: Ranita Richmond	TELEPHONE: (424) 301-3065
LICENSING EVALUATOR SIGNATURE:	DATE: 01/08/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/08/2025

LIC809 (FAS) - (06/04)

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