197415181-8-7-2019-30-CC-HESA-BETN84-20190807101343

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 197415181
Report Date: 08/07/2019
Date Signed: 08/07/2019 10:13:57 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:	FERNANDO FAMILY CHILD CARE HOME		FACILITY NUMBER:	197415181
ADMINISTRATOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY:	8	CENSUS: 4	DATE:	08/07/2019
TYPE OF VISIT:	Case Management - Other	UNANNOUNCED	TIME BEGAN:	08:15 AM
MET WITH:	Dilrukshi Fernando - Licensee		TIME COMPLETED:	09:15 AM

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 8/7/19, Licensing Program Analyst (LPA) Helen Estrella conducted an announced case management inspection to the family child care home for the purpose of an increase in capacity. The licensee is applying for a large family child care home. Upon arrival, LPA met with the licensee and her assistant. LPA confirmed with the licensee that all adults working in the home have criminal record/TB clearances. The fire clearance was granted for 14 children on 7/25/19 by Inspector Tritenbach from Los Angeles County Fire Department. The home is a 3-bedroom, 2-bathroom home that includes family room, kitchen with dining area, front yard, back yard with patio and detached garage. The licensee provides main care in the bedroom #1 & #2. The other accessible areas of the home are: bathroom in bedroom #2 and back yard. The off limits areas are: front yard, detached garage, the licensee's room, bathroom #2, kitchen and dining area. There was 4 children in care at the time of the inspection. (3 out of the 4 children in care were infants). The licensee does not have children in care at this time that require Incidental Medical Services (IMS). There are no bodies of water present at the facility. The licensee was informed of the following during the inspection: The licensee was informed to have a qualified assistant when the capacity exceeds 8 children. The assistant must be at least 14 years of age, but can not be left alone with the children in care. If the assistant is 18 years of age and older, the assistant must have current Adult/Infant & Pediatric First Aid certificates if left alone with children while the licensee is out of the home. Each assistant must also have TB clearance, valid criminal record clearance and be associated to the facility license.

SUPERVISOR'S NAME: Jennie Ferreira	TELEPHONE: (424) 301-3073
LICENSING EVALUATOR NAME: Helen Estrella	TELEPHONE: (424) 301-3073
LICENSING EVALUATOR SIGNATURE:	DATE: 08/07/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/07/2019

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: FERNANDO FAMILY CHILD CARE HOME	FACILITY NUMBER: 197415181
	VISIT DATE: 08/07/2019

NARRATIVE

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The licensee was informed of the responsibility to report suspected Child Abuse by calling the Child Abuse Hot line at 1-800-540-4000. Also call the CCL office and follow up with a written Unusual Incident/Injury Report (LIC 624B).

Update on Incidental Medical Services: Facilities that provide Incidental Medical Services (IMS) must identify those services in their facility’s Plan of Operation and submit an updated Plan of Operation to the Department. 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 Emptying an Ileostomy Bag.

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) 524-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: http://www.ada.gov/childqanda.htm

The facility is operating within substantial compliance during today's inspection. The Los Angeles Fire Department granted capacity of 14 children for the family child care home. The Department agrees to the increase of capacity to the family child care home of 14 children for the facility license.

An exit interview was conducted and a copy of this report was given to licensee.

SUPERVISOR'S NAME: Jennie Ferreira	TELEPHONE: (424) 301-3073
LICENSING EVALUATOR NAME: Helen Estrella	TELEPHONE: (424) 301-3073
LICENSING EVALUATOR SIGNATURE:	DATE: 08/07/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/07/2019

LIC809 (FAS) - (06/04)

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