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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197419957
Report Date: 03/21/2024
Date Signed: 03/21/2024 12:32:13 PM


Document Has Been Signed on 03/21/2024 12:32 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:FARIAS FAMILY CHILD CAREFACILITY NUMBER:
197419957
ADMINISTRATOR:FARIAS, LEONORFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(424) 298-8846
CITY:LOS ANGELESSTATE: CAZIP CODE:
90034
CAPACITY:14CENSUS: 6DATE:
03/21/2024
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
08:00 AM
MET WITH:LEONOR FARIAS, LICENSEETIME COMPLETED:
12:15 PM
NARRATIVE
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On 03/21/2024, Licensing Program Analyst (LPA) Lisa Clayton arrived at the facility for the purpose of conducting a case management- deficiencies visit. Upon arrival LPA met with Licensee Leonor Farias and fingerprint cleared assistant Emilce Farias, who translated due to language barrier. LPA observed 6 children in care being supervised and cared for appropriately by licensee and 3 fingerprint cleared assistants.

Upon arrival LPA Clayton requested to review the Unusual Incident report filed with the department regarding an injury to a child for which the licensee provided care. Licensee stated that the incident was not reported to the department because the child was not injured at the FCCH. LPA Clayton advised licensee and staff that any injuries to a child in care, whether sustained in or out of care, that require medical attention, are to be reported to the department by phone within 24 hours and in writing within 7 days. Licensee and staff acknowledged understanding. LPA Clayton reviewed the LIC 624B form with licensee and provided a copy of the LIC 624 for her records and future use.

Deficiency is cited in accordance with Title 22 of the California Code of Regulations and/or Health & Safety Codes (809-D).

An exit interview was conducted, a copy of this report, appeals rights and a notice of site visit were discussed and provided to Licensee Leonor Farias.

SUPERVISOR'S NAME: Karren StarksTELEPHONE: (310) 740-3038
LICENSING EVALUATOR NAME: Lisa ClaytonTELEPHONE: (424) 301-3206
LICENSING EVALUATOR SIGNATURE:
DATE: 03/21/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/21/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 2


Document Has Been Signed on 03/21/2024 12:32 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: FARIAS FAMILY CHILD CARE
FACILITY NUMBER: 197419957

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/21/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
03/21/2024
Section Cited
HSC
1597.467

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(b)(1) A report shall be made to the department by telephone or fax during the department's normal business hours before the close of the next working day following the occurrence during the operation of a family day care home of... the...events: (B) Any injury to any child that requires medical treatment.
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LPA Clayton reminded licensee and staff of the inportance of completing and submitting the Unusual Incident Form (LIC624B) to the department in the time frame and indicated on the form. Licensee acknowldeges understanding and ensures that the forms will be completed and submitted to the department as incidents occur.
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This requirement was not met as evidenced by: LPA Clayton review of FAS and children's records which showed no UIR form was completed and the report was not called in to the department per licensee, which posed and immediate Helath and Safety risk to children in care.
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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: Karren StarksTELEPHONE: (310) 740-3038
LICENSING EVALUATOR NAME: Lisa ClaytonTELEPHONE: (424) 301-3206
LICENSING EVALUATOR SIGNATURE:
DATE: 03/21/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/21/2024
LIC809 (FAS) - (06/04)
Page: 2 of 2