197415246-4-27-2023-58-CC-JLAO-CRALL4-20230427085029

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 197415246
Report Date: 04/26/2023
Date Signed: 04/27/2023 08:51:38 AM

Document Has Been Signed on 04/27/2023 08:51 AM - 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 NORTH, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245

FACILITY NAME:	MATAL-BANOS FAMILY CHILD CARE		FACILITY NUMBER:	197415246
ADMINISTRATOR:	MATAL-BANOS, ANA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(818) 919-4771
CITY:	NORTH HOLLYWOOD	STATE: CA	ZIP CODE:	91606
CAPACITY:	14	CENSUS: 8	DATE:	04/26/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	11:15 AM
MET WITH:	Ana Matal Banos		TIME COMPLETED:	01:20 PM

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On 4/26/2023 at approximately 11:15 am Program Analyst (LPA), Judy Laureano conducted an unannounced Annual Required Inspection at 6200 Elmer Avenue, North Hollywood, CA 91606. LPA was greeted by licensee Ana Matal-Banos. During today’s inspection, Assistant G. Banos was present with licensee’s husband and minor daughter.

Facility operates Monday through Saturday from 6:30 a.m. to 11:00 p.m. Currently licensee is available to care for children newborn age to 12 years old.

LPA toured the home inside and outside and a census was taken, 8 children were present during today’s inspection.

Facility is licensed for a larege child care license with a max capacity of 14. Currently living in the home is licensee and husband, adult daughter and one minor child. The home is a 4 bedroom 2 bathroom home with a living room, dining room, kitchen and family room. The home has a attached garage that has a one bedroom one bath unit upstairs.

Licensee confirmed the day care areas are: Bedroom 1, closet to the living room, living room and bathroom 1. The front yard is the designated outside area for the day care. The kitchen and dining room area is sometimes use for nap time only.

LPA observed all under the sink kitchen cabinets to have safety latch, making the content inaccessible. 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 doors when children are present.

SUPERVISOR'S NAME: Claudia Escobedo	TELEPHONE: (424) 301-3044
LICENSING EVALUATOR NAME: Judy Laureano	TELEPHONE: 424-301-3060
LICENSING EVALUATOR SIGNATURE:	DATE: 04/26/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/26/2023

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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

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

FACILITY NAME: MATAL-BANOS FAMILY CHILD CARE	FACILITY NUMBER: 197415246
	VISIT DATE: 04/26/2023

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Licensee confirmed the following areas as OFF LIMITS : Bedroom 2, Master bedroom and bathroom, bedroom 3, dining room area, kitchen and family room. detached garage with the one bedroom one bath unit upstairs and the pool area in the back yard. LPA observed all areas designated as OFF LIMITS have a door knob cover and/or door remains locked or closed during the hours of operations.

LPA observed a carbon monoxide and smoke detector in the home. One working fire extinguisher in the kitchen are. Licensee confirmed that program offers meals and snacks to families enrolled. LPA discussed the importance of maintaining a system where allergies and food restrictions are noted.

LPA observed a swimming pool in the back yard that meets all regulations. Pool fence was observed to be over 5ft high with a self latching self closing gate. There are no firearms or ammunition on the premises. No poisons were observed during the inspection.

Detergents and cleaning compounds are kept in the laundry area that is locked and OFF LIMITS to the children in care.

LPA discussed administering medication and licensee confirmed that currently program does have any child that needs medication administered.

Adequate heating and ventilation for safety and comfort were observed in the space. Safe toys and play equipment are observed. The home has working telephone service and LPA confirmed the phone number (818) 919-4771. 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.

LPA reviewed 9 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.

SUPERVISOR'S NAME: Claudia Escobedo	TELEPHONE: (424) 301-3044
LICENSING EVALUATOR NAME: Judy Laureano	TELEPHONE: 424-301-3060
LICENSING EVALUATOR SIGNATURE:	DATE: 04/26/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/26/2023

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

FACILITY NAME: MATAL-BANOS FAMILY CHILD CARE	FACILITY NUMBER: 197415246
	VISIT DATE: 04/26/2023

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Licensee’s Pediatric CPR and First certification was completed on 5/21/2021. Licensee’s Mandated Reporter training was taken on 2/25/2021. Assistant’s Preventative Health and Safety Training was taken on 1/19/2022.

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/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 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.

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. Exit interview conducted and report was reviewed with the licensee Ana Matal Banos

SUPERVISOR'S NAME: Claudia Escobedo	TELEPHONE: (424) 301-3044
LICENSING EVALUATOR NAME: Judy Laureano	TELEPHONE: 424-301-3060
LICENSING EVALUATOR SIGNATURE:	DATE: 04/26/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/26/2023

LIC809 (FAS) - (06/04)

Page: 2 of 4

Document Has Been Signed on 04/27/2023 08:51 AM - 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 NORTH, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245

FACILITY NAME: MATAL-BANOS FAMILY CHILD CARE	FACILITY NUMBER: 197415246
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 04/26/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type A

Section Cited

CCR

102425(i)

Infant Safe Sleep

If an infant falls asleep before being placed in a crib or play yard, the provider shall move the infant to a crib or play yard as soon as possible. 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 2 counts, 2 children were found sleeping in toddler chairs, which poses an immediate health, safety or personal rights risk to persons in care.
	POC Due Date: 05/03/2023
	Plan of Correction
1 2 3 4	Licensee removed children immediately from chairs and agrees to review the Safe Sleep Regulations and Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep. Statement will be submitted to LPA.

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: Claudia Escobedo	TELEPHONE: (424) 301-3044
LICENSING EVALUATOR NAME: Judy Laureano	TELEPHONE: 424-301-3060
LICENSING EVALUATOR SIGNATURE:	DATE: 04/26/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/26/2023

LIC809 (FAS) - (06/04)

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