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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197420069
Report Date: 02/19/2020
Date Signed: 02/19/2020 03:35:52 PM

COMPREHENSIVE INSPECTION
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:EZRA FAMILY CHILD CAREFACILITY NUMBER:
197420069
ADMINISTRATOR:EZRA, ESTERFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(818) 399-0021
CITY:WOODLAND HILLSSTATE: CAZIP CODE:
91364
CAPACITY:14CENSUS: DATE:
02/19/2020
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Licensee-Ester EzraTIME COMPLETED:
03:55 PM
NARRATIVE
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On 02/19/2020 at 1:00 p.m., Licensing Program Analyst (LPA) Escobedo conducted an unannounced annual required visit at the family child care home to ensure that health, safety, and personal rights, as required by Title 22 Regulations governing California Family Care Homes (FCCH) are met. The FCCH operates Monday-Thursday-8:00 a.m.-4:30 p.m. and Friday-8:00 a.m.-3:00 p.m.

Upon arrival, LPA Escobedo was met by the Licensee, Ester Ezra. LPA Escobedo informed Licensee the purpose of today's meeting. LPA Escobedo observed 12 children in care, 3 of which were infants. Licensee guided LPA Escobedo on a tour of the indoor and outdoor areas of the home. LPA Escobedo observed the home to be a one story dwelling with 3 bedrooms, 3 bathrooms, front yard, backyard with pool, kitchen, living-room/dining room combo area, playroom off the kitchen area, laundry room, and an attached converted garage. Off limit areas include 3 bedrooms and 1 bathroom in the master bedroom and pool area. Child care is primarily conducted in the play room area next to the kitchen area. Other areas children have access to include the bathroom next to the living-room/dining room combo area, bathroom in the playroom/converted garage, kitchen area, and the converted garage area. LPA Escobedo verified that during the annual random visit on 05/17/2017, a certificate of occupancy for the converted garage area was observed by the visiting LPA.

The following were observed/discussed during this visit:

1. All adults working/residing in the home are fingerprint cleared and associated. A housekeeper was observed to be in the home who is not fingerprint cleared. Licensee states that Staff 2 does not provide care to children and is in the home once weekly at 5 hours/week. Licensee further states that Staff 2 is in the process of being fingerprint cleared.
2. The in ground pool in the backyard is made inaccessible to children in care by use of a lock with a key. At 1:25 p.m. LPA Escobedo observed the pool to not be self-latching.

Continued on LIC 809-C
SUPERVISOR'S NAME: Victor BautistaTELEPHONE: (424) 301-3008
LICENSING EVALUATOR NAME: Claudia EscobedoTELEPHONE: (424) 301-3044
LICENSING EVALUATOR SIGNATURE:

DATE: 02/19/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/19/2020
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 5
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: EZRA FAMILY CHILD CARE
FACILITY NUMBER: 197420069
VISIT DATE: 02/19/2020
NARRATIVE
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Licensee informed LPA Escobedo that she will have the self-latching mechanism fixed by 02/24/2020.
3. Per licensee, there are no firearms in the home. None were observed by LPA.
4. The licensee has current pediatric CPR/1st aid training issued 11/24/2019
5. The licensee maintains current roster.
6. The licensee maintains monthly disaster drills.
7. The home is kept clean and orderly, with heating and ventilation for children's safety.
8. Age appropriate children's toys and equipment was observed and were in good repair.
9. The home is equipped with a fully charged fire extinguisher, a smoke detector, and a carbon monoxide detector.
10. The children's bathroom was inspected for inaccessibility of chemicals and toxins that may be hazardous to the health and safety of children in care.
11. At this time, the facility does not provide Incidental Medical Services - IMS.

The following was thoroughly discussed with the licensee:

Incidental Medical Services (IMS) policy was discussed. When any IMS is provided, a Plan for Providing IMS must be submitted 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 Carrying out medical orders when the child’s physician has determined that a layperson can be trained and safely carry out the orders. 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: http://www.ada.gov/childqanda.htm

Licensee was made aware of The Child Care Advocate Program (CCAP) that is administered from within the Community Care Licensing Division. CCAP participates in many community activities and special projects in order to disseminate information on the State’s licensing role, provide information to the public and parents on child care licensing, and provide many other helpful resources to the licensees and the public. CCAP’s direct contact information is as follow: Phone number: (916) 654-1541


Continued LIC 809-C
SUPERVISOR'S NAME: Victor BautistaTELEPHONE: (424) 301-3008
LICENSING EVALUATOR NAME: Claudia EscobedoTELEPHONE: (424) 301-3044
LICENSING EVALUATOR SIGNATURE:

DATE: 02/19/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/19/2020
LIC809 (FAS) - (06/04)
Page: 2 of 5
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: EZRA FAMILY CHILD CARE
FACILITY NUMBER: 197420069
VISIT DATE: 02/19/2020
NARRATIVE
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Email Address: childcareadvocatesprogram@dss.ca.gov

Licensee was reminded it is the licensee’s responsibility to know the regulations as well as anyone who assists in providing care. Licensee was advised on how to access quarterly reports, forms, and regulations for Child Care online at www.ccld.ca.gov. Licensee was also encouraged to read the Child Care quarterly updates every season as the come out to stay informed of any changes or updates to the regulations.

The licensee has been informed that all employees must be associated to the facility. If the licensee fails to have proof of a fingerprint clearance or fails to associate a previously cleared individual to the facility, a civil penalty of $100.00, per day the person has been present, will be assessed. The first violation is subject to the penalty for up to five days. If there is a subsequent violation in a 12 month period, the fine will continue for up to 30 days. The "Notification of Parent's Rights" (PUB394) was discussed with the licensee and the licensee was advised that it must be posted in an area of the home accessible to parents.

Licensee was advised that regulation prohibits the smoking of tobacco in a private residence licensed as a family child care home during the hours of operation. Licensee was made aware that state law prohibits baby walkers, bouncy seats, exersaucers and any other items that fall into that category. Licensee was reminded of her responsibility to report suspected child abuse. Mandatory Forms for the children’s files and provider’s files were discussed. Applicant was referred to LIC 311D: Records To Be Maintained At The Facility - Family Child Care Home.

Licensee was reminded that all infants must be placed on their backs when sleeping to prevent S.I.D.S. (Sudden Infant Death Syndrome), and that the Provider is required to wash hands after every diaper change and to never shake a baby to prevent the Shaken Baby Syndrome. Licensee was also reminded that only children eating may be in high chairs and that car seats are utilized only for transportation.

Licensee was advised tha the Notice of Site Visit must be posted at the entrance of the facility for a period of 30 days. If a serious violation is cited, (Type A violation), a copy of the licensing report (LIC809 or LIC9099) must also be posted for 30
Continued LIC 809-C
SUPERVISOR'S NAME: Victor BautistaTELEPHONE: (424) 301-3008
LICENSING EVALUATOR NAME: Claudia EscobedoTELEPHONE: (424) 301-3044
LICENSING EVALUATOR SIGNATURE:

DATE: 02/19/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/19/2020
LIC809 (FAS) - (06/04)
Page: 3 of 5
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: EZRA FAMILY CHILD CARE
FACILITY NUMBER: 197420069
VISIT DATE: 02/19/2020
NARRATIVE
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days. If these requirements are not met, civil penalties in the amount of $100 per violation will be assessed. The Licensee was made aware that a licensee may file an appeal, in writing 15 business days from the date of receiving the penalty assessment.

Commencing September 1, 2016, SB 792, prohibits a person from being employed or volunteering at a child care facility or family day care if he or she has not been immunized against influenza, pertussis, and measles.

Law enacted by SB 277, beginning January 1, 2016, personal beliefs exemptions will no longer be an option for the vaccines that are currently required for entry into child care or school in California. Personal beliefs exemptions already on file will remain valid until the child reaches the next immunization checkpoint.

There was 1 deficiency cited during today's visit in accordance to the California Code of Regulations Title 22, Division 12, Chapter. See LIC 9099-D for additional information.

Upon receipt of this report, the Licensee shall post the Notice of Site Visit. Failure to maintain posting as required, will result in an immediate $100 civil penalty.



Exit interview, copy of report was given. Appeal rights were issued and discussed.
SUPERVISOR'S NAME: Victor BautistaTELEPHONE: (424) 301-3008
LICENSING EVALUATOR NAME: Claudia EscobedoTELEPHONE: (424) 301-3044
LICENSING EVALUATOR SIGNATURE:

DATE: 02/19/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/19/2020
LIC809 (FAS) - (06/04)
Page: 4 of 5
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: EZRA FAMILY CHILD CARE
FACILITY NUMBER: 197420069
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/19/2020
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
02/24/2020
Section Cited

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102417(g)(5)(A)-Operation of a FCCH-...All licensees shall ensure the inaccessibility of pools...fences, gates shall swing away from the pool, self-close and have a self-latching device...This requirement is not met as evidenced by:
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Based on observation, the Licensee did not ensure that the pool was self-latching, which poses a potetial Health, Safetly or Personal Rights risk to persons 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: Victor BautistaTELEPHONE: (424) 301-3008
LICENSING EVALUATOR NAME: Claudia EscobedoTELEPHONE: (424) 301-3044
LICENSING EVALUATOR SIGNATURE:
DATE: 02/19/2020
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/19/2020
LIC809 (FAS) - (06/04)
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