197419137-11-29-2023-58-CC-AMOY-CY2SFJ-20231129125024

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 197419137
Report Date: 11/29/2023
Date Signed: 11/29/2023 12:50:34 PM

Document Has Been Signed on 11/29/2023 12:50 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 NORTH, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245

FACILITY NAME:	SANDOVAL FAMILY CHILD CARE		FACILITY NUMBER:	197419137
ADMINISTRATOR:	SANDOVAL, ELIZABETH		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(818) 809-7756
CITY:	RESEDA	STATE: CA	ZIP CODE:	91335
CAPACITY:	14	CENSUS: 5	DATE:	11/29/2023
TYPE OF VISIT:	Required - 3 Year	UNANNOUNCED	TIME BEGAN:	09:45 AM
MET WITH:	Elizabeth Sandoval, Licensee		TIME COMPLETED:	01:00 PM

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Licensing Program Analyst (LPA) Alicia Mooberry conducted an unannounced Required Annual Inspection on this date. Upon arrival at 9:45am LPA met with Elizabeth Sandoval, Licensee, who provided tour of facility. LPA explained the purpose of inspection and provided the inspection Entrance Checklist, LIC 126. LPA inspected rooms/areas on the facility sketch in which child-care services are provided and to which children have access. Per licensee the current hours of operation are Monday-Friday 7:00am - 7:00pm. The licensee offers overnight care, LPA discussed with licensee Overnight Care Requirements. Care provided during the day and overnight combined shall not exceed 24 hours from the time the child entered care. There were 5 children present, including 3 infant. Also present were Assistants Stephanie Rojas and Ivonne Yanes. All adults present have been cleared and associated. Individuals residing in the home were discussed and noted.

This is a single story home consists of four (4) bedrooms, two (2) bathrooms and attached garage.

Areas accessible to children are: living room and family room by the kitchen, one (1) bathroom, dining room, kitchen and backyard.

Off limit areas: All four bedrooms, one bathroom and attached garage. Off-limit bedrooms and garage was observed to be closed with safety doorknobs.

All areas identified on the facility sketch that are accessible for children to use were inspected for safety, comfort, and cleanliness. The following was observed and reviewed during this inspection:

LPA observed the facility license, Publication (PUB) 394- Notification of Parent Rights and Licensing Form (LIC) 9148- Earthquake Preparedness form posted at entrance to facility visible to parent/guardians of children in care. LPA reviewed completed facility records including LIC 9040- Facility Roster, LIC 610- Facility Disaster Plan.
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SUPERVISOR'S NAME: Valarie Cook	TELEPHONE: (323) 981-3362
LICENSING EVALUATOR NAME: Alicia Mooberry	TELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:	DATE: 11/29/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/29/2023

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: SANDOVAL FAMILY CHILD CARE	FACILITY NUMBER: 197419137
	VISIT DATE: 11/29/2023

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The home maintains telephone service via cell phone line. Smoke and carbon monoxide detectors were tested and are operable. The required 2A10BC fire extinguisher was observed at entrance to garage. Per licensee the extinguisher was purchased on 09/2023, Licensee was reminded that fire extinguisher needs to be serviced yearly. LPA observed that cleaning compounds are stored inaccessible to children in care. The bathroom that children use is in hallway and observed to be clean and free of hazards.
Licensee states that there are no poisons stored in the home and understands that all poisons must be lock, not only inaccessible to children.
LPA discussed with Licensee firearms or weapons stored in the home. Children waiting to be picked due to illness, are supervised and away from the other children. LPA discussed reporting requirements including in case of communicable disease outbreak.

The licensee provides care for infants, LPA provided PIN 20-24-CCP and discussed the safe sleep regulations with licensee and 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.

Currently, children are using the back yard for outdoor play. The outdoor play area was observed to be fenced with age appropriate toys and other materials. LPA reminded licensee to continually assess the condition of the toys and materials to ensure children safety, and make sure there are no broken toys, sharp edges, insects, bird droppings, etc. The facility does not have a pool or similar bodies of water. Per licensee, pets in home are a turtle and lizard and are kept inaccessible to daycare children.

Adult and Children’s records were reviewed for (LIC) 282- Affidavit Regarding Liability Insurance, Immunization's Records, LIC 700- Identification and Emergency Information, LIC 627- Consent for Medical Treatment, LIC 995A Notification of Parents’ Rights, and documentation of 15-minute Infant Sleep Check (0-24 months) Licensee will update the LIC 995A with updated Licensing Office information.

Staff Pediatric First Aid and CPR certification expires on 03/2024 Proof of immunizations against measles, pertussis and influenza or influenza declination, TB clearance or risk assessment, LIC 9108- Statement Acknowledging Requirement to Report Child Abuse and current Mandated Reporter Training Certificate.-------------------Page 2 – Report Continues

SUPERVISOR'S NAME: Valarie Cook	TELEPHONE: (323) 981-3362
LICENSING EVALUATOR NAME: Alicia Mooberry	TELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:	DATE: 11/29/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/29/2023

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: SANDOVAL FAMILY CHILD CARE	FACILITY NUMBER: 197419137
	VISIT DATE: 11/29/2023

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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/

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.

To improve the quality and value of the new inspection process, a survey may 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 CARE tools, please send email inquiries 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

Based on the LPA's observations and records review no deficiencies will be cited today in accordance with California Title 22 Regulations.

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&Rs) throughout California.

During the exit interview, the Licensee Elizabeth Sandoval confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS.

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

Exit interview conducted and report was reviewed with the licensee Elizabeth Sandoval.

SUPERVISOR'S NAME: Valarie Cook	TELEPHONE: (323) 981-3362
LICENSING EVALUATOR NAME: Alicia Mooberry	TELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:	DATE: 11/29/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/29/2023

LIC809 (FAS) - (06/04)

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