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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197492759
Report Date: 06/13/2019
Date Signed: 06/17/2019 08:55:07 AM

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:ESCOBAR FAMILY CHILD CAREFACILITY NUMBER:
197492759
ADMINISTRATOR:ESCOBAR, HEIDYFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(818) 216-7137
CITY:VAN NUYSSTATE: CAZIP CODE:
91406
CAPACITY:14CENSUS: 7DATE:
06/13/2019
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
07:35 AM
MET WITH:Heidy EscobarTIME COMPLETED:
10:15 AM
NARRATIVE
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Licensing Program Analyst (LPA) Silva Garibyan conducted an unannounced annual/random inspection to the aforementioned facility. Upon arrival, LPA met with Heidy Escobar, Licensee. LPA was guided on a tour of the facility inside and outside at 7:45 AM. There are no changes to the facility layout or to the off limit areas. Childcare is primarily conducted in the recreation room and children eat in the dining room and nap in 2 bedrooms. Children's restroom is located near the entrance of the facility. Per licensee, the residents of the home are licensee and her sister. Licensee was present with 7 children ( no infants) and three assistants.

The following was observed during this inspection:
1. All adults working or residing in the home are fingerprint cleared and associated.
2. There is no pool, spa or other bodies of water on the premises.
3. Per licensee, there are no guns or firearms in the home. None were observed.
4. The licensee maintains current roster.
5. The licensee maintains monthly disaster drills.
6. Children's records were reviewed.
7. The home is kept clean and orderly, with heating and ventilation for children's safety.
8. There are abundance of age appropriate children's toys and equipment that were observed to be in good repair.
9 The home is equipped with a fully charged fire extinguisher, smoke detectors and one carbon monoxide detector located in the hall way.
10. The children's bathroom was inspected for inaccessibility of chemicals and toxin that may be hazardous to the health and safety of children in care.
11. No current first aid and CPR cards were observed by LPA.
12. Per licensee, there are no children currently enrolled who require Incidental Medical Services. (Continued)
SUPERVISOR'S NAME: Mary RuizTELEPHONE: (424) 301-3061
LICENSING EVALUATOR NAME: Silva GaribyanTELEPHONE: (424) 301-3062
LICENSING EVALUATOR SIGNATURE:

DATE: 06/13/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/13/2019
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 3
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: ESCOBAR FAMILY CHILD CARE
FACILITY NUMBER: 197492759
VISIT DATE: 06/13/2019
NARRATIVE
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The following were discussed with the licensee:

Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Family Child Care Homes Section 102417. 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: http://www.ada.gov/childqanda.htm

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.

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 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. Licensee was also made aware that the quarterly updates are also in Spanish.

The facility was cited for a Title 22 violation during this inspection. Please see LIC 809 D page of this report for further details. Appeal Rights were discussed and provided. Copy of this report was provided. Exit interview was conducted.
Exit interview was conducted and a copy of the report was provided

SUPERVISOR'S NAME: Mary RuizTELEPHONE: (424) 301-3061
LICENSING EVALUATOR NAME: Silva GaribyanTELEPHONE: (424) 301-3062
LICENSING EVALUATOR SIGNATURE:

DATE: 06/13/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/13/2019
LIC809 (FAS) - (06/04)
Page: 2 of 3
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: ESCOBAR FAMILY CHILD CARE
FACILITY NUMBER: 197492759
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/13/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
06/27/2019
Section Cited
CCR
102416(c)
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Licensee is required to maintain current Pediatric CPR and First Aid certifications at all times..
This requirement is not met as evidenced by: Licensees was unable to demonstrate current proof of CPR/First Aid Certificates ( expired 01/2018)
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Licensee will provide proof of current Pediatric CPR & Pediatric First Aid certifications or registration for by 06/27/19
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This poses a potential risk to the health and safety of 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: Mary RuizTELEPHONE: (424) 301-3061
LICENSING EVALUATOR NAME: Silva GaribyanTELEPHONE: (424) 301-3062
LICENSING EVALUATOR SIGNATURE:

DATE: 06/13/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/13/2019
LIC809 (FAS) - (06/04)
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