197414872-11-30-2023-30-CC-SGAA-CY47GS-20231130203935

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 197414872
Report Date: 11/30/2023
Date Signed: 11/30/2023 08:39:56 PM

Document Has Been Signed on 11/30/2023 08:39 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
L.A. DAYCARE-NO.WEST, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245

FACILITY NAME:	PEREZ FAMILY CHILD CARE		FACILITY NUMBER:	197414872
ADMINISTRATOR:	PEREZ, ANTONIA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(424) 570-0607
CITY:	WILMINGTON	STATE: CA	ZIP CODE:	90744
CAPACITY:	14	CENSUS: 3	DATE:	11/30/2023
TYPE OF VISIT:	Required - 3 Year	UNANNOUNCED	TIME BEGAN:	09:15 AM
MET WITH:	Licensee, Antonia Perez		TIME COMPLETED:	02:15 PM

NARRATIVE

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On 11/30/2023 at 9:15am, Licensing Program Analyst (LPA), Sarah Garcia conducted an unannounced Required Inspection at the above-mentioned facility. LPA was greeted by licensee, Antonia Perez. During the initial inspection, LPA observed 3 children in care.

Facility operates Monday through Friday from 6:00 a.m. to 5:30 p.m. Currently licensee is available to care for children 1 years old to 7 years old. Facility is a Large Family Child Care Home with a max capacity of 14. Licensee provides transportation to children. Licensee provided a copy of driver's license to LPA.

LPA toured the home inside and outside. The home is an apartment complex with 1 bedroom, 1 bathroom, living room dining room, kitchen area, outdoor area, and garage. Licensee confirmed the following areas are designated for day care only: Living room, bathroom, and outdoor area. LPA inspected the living room and observed the space to be clean and orderly. LPA observed cots and 1 play yard to utilize for sleeping children. LPA observed age-appropriate toys, materials, children's tables and books. LPA observed a fish tank on top of a cabinet that was 3 ft. The bathroom that children use is located inside the hallway near the kitchen area. LPA inspected the bathroom and observed a safety latch under the sink to ensure medications, toxins or cleaning compounds are inaccessible to the children in care. LPA advised licensee that all cleaning compounds should be locked and shampoos stored out of reach to ensure inaccessible to children in care. LPA inspected the kitchen and observed the knives and sharp objects to be out of reach to the children. LPA observed a safety latch under the kitchen sink cabinet to ensure all poisons, detergents, cleaning compounds, medications and other items which can pose a risk to children in care made inaccessible.

The following areas are OFF LIMITS to the children in care: 1 Bedroom, kitchen area, and garage.

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SUPERVISOR'S NAME: Maureen Neal	TELEPHONE: (424) 301-3042
LICENSING EVALUATOR NAME: Sarah Garcia	TELEPHONE: (424) 301-3066
LICENSING EVALUATOR SIGNATURE:	DATE: 11/30/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/30/2023

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 11/30/2023 08:39 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
L.A. DAYCARE-NO.WEST, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245

FACILITY NAME: PEREZ FAMILY CHILD CARE	FACILITY NUMBER: 197414872
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 11/30/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type A

Section Cited

CCR

102417(g)(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: (1) Fireplaces and open face heaters shall be screened to prevent access by children. The home shall contain a fire extinguisher and smoke detector device which meet standards established by the State Fire Marshall. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation and interview, the licensee does not have an operational smoke detector which poses an immediate health, safety or personal rights risk to persons in care.
	POC Due Date: 12/01/2023
	Plan of Correction
1 2 3 4	Licensee will replace batteries in the smoke detector by 12/01/2023. LPA will conduct a FaceTime video call on 12/04/2023 to confirm that the smoke detector is operational. LPA cell phone number is (916) 605-9569.

Section Cited


	Deficient Practice Statement
1 2 3 4
	POC Due Date:
	Plan of Correction
1 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: Maureen Neal	TELEPHONE: (424) 301-3042
LICENSING EVALUATOR NAME: Sarah Garcia	TELEPHONE: (424) 301-3066
LICENSING EVALUATOR SIGNATURE:	DATE: 11/30/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/30/2023

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 11/30/2023 08:39 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
L.A. DAYCARE-NO.WEST, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245

FACILITY NAME: PEREZ FAMILY CHILD CARE	FACILITY NUMBER: 197414872
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 11/30/2023

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
1 2 3 4	Based on observation, interview, record review, the licensee did not complete the mandated reporter training certificate which poses a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 12/04/2023
	Plan of Correction
1 2 3 4	Licensee will complete the mandated reported training at website: www.mandatedreporterca.com. Licensee will provide a copy of the certificate to LPA via email at sarah.garcia@dss.ca.gov by 5pm on 12/04/2023.

Type B

Section Cited

HSC

1597.622(c)

Administration of Child Day Care Licensing

(c) The family day care home shall maintain documentation of the required immunizations or exemptions from immunization, as set forth in this section, in the person's personnel record that is maintained by the family day care home. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation, interview, record review, the licensee does not have the measles immunization on file which poses a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 12/09/2023
	Plan of Correction
1 2 3 4	Licensee will provide proof of measles immunization and send to LPA via email at sarah.garcia@dss.ca.gov by 5pm on 12/09/2023.

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: Maureen Neal	TELEPHONE: (424) 301-3042
LICENSING EVALUATOR NAME: Sarah Garcia	TELEPHONE: (424) 301-3066
LICENSING EVALUATOR SIGNATURE:	DATE: 11/30/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/30/2023

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
L.A. DAYCARE-NO.WEST, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245

FACILITY NAME: PEREZ FAMILY CHILD CARE	FACILITY NUMBER: 197414872
	VISIT DATE: 11/30/2023

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LPA inspected the outdoor area and observed safe toys, play equipment, and a sandbox. LPA observed a children's trampoline. LPA instructed licensee to make the trampoline inaccessible to the children in care by caution tape and closing the zipper. LPA developed a plan of correction (POC) with licensee. Licensee will send a picture of caution tape on trampoline due on 12/04/2023. Licensee signed a written declaration during today's visit stating they will cease operation of the trampoline for the children and make it inaccessible. Outdoor area is clean and free from debris. There are two staircases leading to the two properties (1169 and 1171) that are barricaded with safety gates. The outdoor area has a laundry area that stores compounds such as detergent made inaccessible with a safety gate.

Per licensee, there is (1) dog and (2) bunnies in the home. LPA discussed the importance of making sure that parents know program has pets in the home. Dogs remain locked in off limits bedroom in the home and bunnies stay on the side of the home.

All electrical outlets were observed to be covered. LPA reminded licensee to ensure all areas that have been designated as OFF LIMITS need to have doors closed, locked, and made inaccessible when children are present.

LPA observed licensee test the carbon monoxide detector in the home. LPA observed a non-operational smoke detector and will develop a POC with licensee. LPA reminded licensee that smoke and carbon monoxide detectors should be checked, and batteries should be replaced. One working fire extinguisher 2A10BC was observed. LPA observed first aid kit with thermometer and Band-Aids. Licensee provides meals and snacks. LPA discussed the importance of maintaining a system where allergies and food restrictions are noted. When a child is ill licensee will isolate them in the kitchen area. No swimming pools or bodies of water were observed in the space. There are no firearms or ammunition on the premises.

Licensee currently does not administer medication. Adequate ventilation for safety and comfort were observed in the space. LPA advised licensee to purchase portable heaters to provide adequate heating for the children in care. The home has working telephone service and LPA confirmed the phone number (424) 570-0607.

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 during today’s inspection.

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SUPERVISOR'S NAME: Maureen Neal	TELEPHONE: (424) 301-3042
LICENSING EVALUATOR NAME: Sarah Garcia	TELEPHONE: (424) 301-3066
LICENSING EVALUATOR SIGNATURE:	DATE: 11/30/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/30/2023

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
L.A. DAYCARE-NO.WEST, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245

FACILITY NAME: PEREZ FAMILY CHILD CARE	FACILITY NUMBER: 197414872
	VISIT DATE: 11/30/2023

NARRATIVE

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LPA reviewed 4 children’s files and observed files to be complete. LPA discussed all necessary forms needed in each children’s file and provided licensee with the LIC 311D- Records to be maintain in the facility and provided licensee with a current copy to use as a reference when auditing files.

Licensee is currently enrolled in Pediatric CPR and first aid course taking place on 12/02/2023 and will send LPA certificate once complete. LPA observed and verified the enrollment and receipt for the course. Licensee’s Mandated Reporter training was not available for review. LPA developed a POC with licensee and provided the Website: www.mandatedreporterca.com. Licensee was reminded of their responsibility to report suspected child abuse.

LPA instructed licensee to complete the Family Child Care Orientation by 12/04/2023 and provided the website to enroll in course: https://cdss.ca.gov/inforesources/child-care-licensing/how-to-become-licensed/register-for-an-orientation

Licensee was reminded that all adults 18 and over living or working in the home, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, 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 for a maximum of 5 days or, if the penalty is for a repeat violation, for a maximum of 30 days per person will be assessed if this regulation is violated.

LPA discussed the safe sleep regulations with licensee 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 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.

Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02-CCP. 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: https://www.ada.gov/resources/child-care-centers/.
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SUPERVISOR'S NAME: Maureen Neal	TELEPHONE: (424) 301-3042
LICENSING EVALUATOR NAME: Sarah Garcia	TELEPHONE: (424) 301-3066
LICENSING EVALUATOR SIGNATURE:	DATE: 11/30/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/30/2023

LIC809 (FAS) - (06/04)

Page: 11 of 12

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
L.A. DAYCARE-NO.WEST, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245

FACILITY NAME: PEREZ FAMILY CHILD CARE	FACILITY NUMBER: 197414872
	VISIT DATE: 11/30/2023

NARRATIVE

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Licensee was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain child care by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.

During the exit interview, the LICENSEE Antonia Perez, confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS.

Per Title 22, Division 12, Chapter 3, of the California Code of Regulations, the following deficiencies are being cited: (see next pages, 809D) Licensee was provided with a copy of appeal rights.

LPA Sarah Garcia informed licensee Antonia Perez that this report dated 11/30/2023 document(s) (1) Type A citation(s) which shall be posted for 30 consecutive days as there are immediate risk(s) to the health, safety, or personal rights of children in care.
Also, LPA Garcia informed the licensee to provide a copy of this licensing report dated 11/30/2023 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.

A notice of site visit was given and must remain posted for 30 days.

Exit interview conducted and report along with appeal rights was reviewed with the licensee, Antonia Perez.

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 atwww.cdss.ca.gov/inforesources/community-care-licensing/inspection-process.

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SUPERVISOR'S NAME: Maureen Neal	TELEPHONE: (424) 301-3042
LICENSING EVALUATOR NAME: Sarah Garcia	TELEPHONE: (424) 301-3066
LICENSING EVALUATOR SIGNATURE:	DATE: 11/30/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/30/2023

LIC809 (FAS) - (06/04)

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