197419150-7-15-2021-30-CC-MCON-C4XSVQ-20210715141306

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 197419150
Report Date: 07/15/2021
Date Signed: 07/15/2021 02:13:19 PM

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:	FUENTES FAMILY CHILD CARE		FACILITY NUMBER:	197419150
ADMINISTRATOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY:	8	CENSUS: 4	DATE:	07/15/2021
TYPE OF VISIT:	Case Management - Licensee Initiated	UNANNOUNCED	TIME BEGAN:	01:45 PM
MET WITH:	Elsa Fuentes, Licensee		TIME COMPLETED:	02:15 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	This is an announced case management visit conducted for the purpose of considering the facility for an increased capacity. The inspection was conducted by LPA, Miriam Cohen. LPA Cohen met with Esmeralda Fuentes, licensee, who guided analyst on a tour of the facility. All areas identified on the facility sketch were inspected. This is a one story home. The home was inspected as follows: Living room, two bedrooms, one bathroom, kitchen toy room, and a backyard. Family members residing at facility include applicant, spouse, two young children (both boys ages 11 and 9 and a half years old). The home was inspected for safety, comfort, cleanliness, telephone service, heating and ventilation, inaccessibility to poisons, detergents, cleaning compounds, medicines, and hazardous items that can pose a danger to children. The First Aid kit was observed. Hours of operation is from 6:00 AM - 6:30 PM, Monday thru Friday. Per licensee, there are no weapons or firearms of any kind in the facility at this time. The LPA did not observe any weapons. There is no swimming pool on the premises. There are age appropriate toys and equipment on the premises. The required fire extinguisher (2A 10BC), smoke and carbon monoxide detectors are in operable condition. LPA observed licensee's current Pediatric CPR and Pediatric First Aid certificates, expire in Jan 2022. A copy of an Emergency Disaster Plan is posted on the Parent Board. The licensee has submitted documentation demonstrating control of property which remains on file in the department as initially licensed. LPA Cohen obtained an updated parent notification form to ensure the applicant is aware of her responsibility to notify parent if/when she is licensed at an increased capacity. Applicant used the affidavit regarding liability insurance. Areas off limits include: All bedrooms, kitchen, and a detached recreation room with a permit located in the back of the house. Rooms/Areas will be made inaccessible by doorknob locks. * IF CITED FOR TYPE A VIOLATION * Upon receipt, licensee shall post the report for 30 days in addition to the Notice of Site Visit & provide copies of the licensing report to parents/guardians of children in care at the facility by the close of business the following day or the next day child returns to the facility.

SUPERVISOR'S NAME: Maureen Neal	TELEPHONE: (424) 301-3042
LICENSING EVALUATOR NAME: Miriam Cohen	TELEPHONE: (424) 301-3058
LICENSING EVALUATOR SIGNATURE:	DATE: 07/15/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/15/2021

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: FUENTES FAMILY CHILD CARE	FACILITY NUMBER: 197419150
	VISIT DATE: 07/15/2021

NARRATIVE

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The same report must be provided to parents/guardians of children newly enrolled at the facility during the next 12 months & licensee will obtain a signed Acknowledgement of Licensing Reports (LIC 9224) from parent/guardian & place it in each child's file.
Note: Repeated violations within 12 months will be assessed a civil penalty.

A copy of this report was discussed and issued to the licensee, Esmeralda Fuentes.

SUPERVISOR'S NAME: Maureen Neal	TELEPHONE: (424) 301-3042
LICENSING EVALUATOR NAME: Miriam Cohen	TELEPHONE: (424) 301-3058
LICENSING EVALUATOR SIGNATURE:	DATE: 07/15/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/15/2021

LIC809 (FAS) - (06/04)

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