197493072-10-2-2019-30-CC-DMIA-BGKNVK-20191002104804

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 197493072
Report Date: 10/02/2019
Date Signed: 10/02/2019 10:48:14 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:	PACLEB FAMILY CHILD CARE		FACILITY NUMBER:	197493072
ADMINISTRATOR:	PACLEB, BYANKA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(424) 500-2960
CITY:	CULVER CITY	STATE: CA	ZIP CODE:	90230
CAPACITY:	14	CENSUS: 6	DATE:	10/02/2019
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	07:55 AM
MET WITH:	Byanca Pacleb, Licensee		TIME COMPLETED:	10:45 AM

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	On 10/2/19 at 7:55am Licensing Program Analyst (LPAs) Denise Miranda and Lisa Rios met with Byanka Pacleb, licensee and licensee’s assistant for the purpose of an Annual Required Inspection. Upon arrival, LPA Miranda observed 9 children in care being supervised by 2 adults (Staff #1 and Staff #2) and licensee. The children were engaged in different activities in the backyard. LPA verified that all adults present in the facility has obtained criminal record clearances and are associated to the facility. This is a 1 story, 1 master bedroom with 1 bathroom, 2-bedroom which one is converted in office, 1 bathroom, living room, dining room, kitchen. The following areas are used for daycare. Main care is provided in playroom, dining room and outdoor area at backyard of the house. Off limit areas: master bedroom with 1 bathroom, 1 bedroom located at the front of the house. There is not a swimming pool, no fountain was observed. Age appropriate toys, books and games were observed to be safe, no sharp parts clean and in good repair. LPA observed rooms to be free and clear from hazards and safe for children in care. At 9:41am LPA’s observed a complete first aid, full charged Fire extinguisher size 2-A:10-B:C Fire Extinguisher in the guest house, working smoke and carbon monoxide detector, age appropriate toys. Telephone service, central heating, lighting and ventilation were evaluated and in good condition. LPA reviewed the licensee’s Pediatric First Aid AED Infant/CPR 4/2021. Licensee was able to provide the fire drill log. The last fire drill conducted was on 09/10/2019. The licensee states that does not have weapons/firearms in the home and none observed by the LPA. LPA’s observed no pets. Per licensee no pets at the facility.

SUPERVISOR'S NAME: Jennie Ferreira	TELEPHONE: (424) 301-3067
LICENSING EVALUATOR NAME: Denise Miranda	TELEPHONE: (424) 301-3055
LICENSING EVALUATOR SIGNATURE:	DATE: 10/02/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/02/2019

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: PACLEB FAMILY CHILD CARE	FACILITY NUMBER: 197493072
	VISIT DATE: 10/02/2019

NARRATIVE

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Incidental Medical Services (IMS) policy was discussed. For IMS information, see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226. When any IMS is provided, an updated Plan of Operation that includes 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
The ADA requires that child care providers not discriminate against persons with disabilities on the basis of disability, that is, that they provide children and parents with disabilities with an equal opportunity to participate in the child care center's programs and services.

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 Emptying an Ileostomy Bag.

The following was discussed with the licensee:
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. LPA provide brochures will information regarding SIDS and never shake a baby to prevent the shaken baby syndrome.
Individuals who are 18 years of age or older living in the home must obtain a criminal record clearance. Individuals within one month of their 18th birthday must be fingerprinted immediately. Failure to obtain a criminal record background check clearances prior to initial presence in the home will result in an immediate $100.00 dollar or more per day Civil Penalty.
In the absence of the licensee a qualified adult must be present supervising the children; a qualified adult is an individual who has a valid and current adult/infant CPR & Pediatric First Aid certification and a valid criminal record clearance associated to the facility license and immunization. Licensee was informed, Absence of Supervision: including, but not limited to, a child left unattended, a child left alone with a person under 18 years of age, and lack of supervision resulting in a child wandering away. (HSC 1597.58(c)(2)). Regulation(s): 102417(k)(1) Children shall not be left in parked vehicles. Civil penalty applies when a child is left unattended in a parked vehicle.

SUPERVISOR'S NAME: Jennie Ferreira	TELEPHONE: (424) 301-3067
LICENSING EVALUATOR NAME: Denise Miranda	TELEPHONE: (424) 301-3055
LICENSING EVALUATOR SIGNATURE:	DATE: 10/02/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/02/2019

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: PACLEB FAMILY CHILD CARE	FACILITY NUMBER: 197493072
	VISIT DATE: 10/02/2019

NARRATIVE

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Senate Bill 792: This bill, commencing September 1, 2016, 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.
New Immunization Requirement: 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.

New Appeal Process: A licensee may file an appeal, in writing 15 business days from the date of receiving the penalty assessment. All appeals must be sent to:

300 N. Continental Blvd., Suite 290-A
El Segundo, CA 90245

Also, LPA discussed with the licensee the following: A current roster of children enrolled must be available and maintained for a period of three years, even after children no longer are attending the facility. Annual fees must be paid promptly and by the due date or a late fee shall be assessed, and/or the License shall be terminated. The fire extinguisher type 2-A:10-B:C must be serviced annually or as often as necessary and smoke and carbon monoxide detectors should check, and batteries replaced as needed. Changes should be reported to the Department as soon as they occur such as construction, remodeling, telephone number changes and/or if you move from your home. Any unusual incidents or injuries must be reported to the Department within 24 hours via telephone and within seven (7) days in writing. (use LIC624B for written report). Fire and safety drills must be performed every six months and documented for review by the Department. Children and Staff records must be maintained and updated as needed and must be available for review by the Department. No smoking, No infant walkers, No Johnny jumpers, No saucer chairs, No trampolines and any other item that falls into that category are not permitted in the facility.

SUPERVISOR'S NAME: Jennie Ferreira	TELEPHONE: (424) 301-3067
LICENSING EVALUATOR NAME: Denise Miranda	TELEPHONE: (424) 301-3055
LICENSING EVALUATOR SIGNATURE:	DATE: 10/02/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/02/2019

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: PACLEB FAMILY CHILD CARE	FACILITY NUMBER: 197493072
	VISIT DATE: 10/02/2019

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All adults living and working in the home shall be made of aware of the Departments right to inspection authority, which includes but not limited to the right to enter the home when children are being cared for, interview children and adults and review documentation.

Emergency Disaster Plan, Parent’s Rights Poster and the Facility License are required to be posted.

Licensee informed fire drill to be completed every 6 month and to keep a log and to ensure records for staff and children as well as a roster are kept for 3 years.

Licensee was also reminded that only children eating may be in high chairs and that car seats are utilized only for transportation.

LPA reminded licensee every two year to take the Mandated Reporter training: www.mandatedreporterca.com.

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 followed: Phone number: (916) 654-1541. Email Address: childcareadvocatesprogram@dss.ca.gov.

LPA informed about the quarterly update that licensee will be able to enroll trough DDS website: www.ccld.ca.gov

During this inspection, LPA also provided the following documents about: 1) California School Immunization Record form CDPH286, form LIC279B application form (updated), LIC9148 Checklist Preparedness Checklist and PUB394 Notifications of Parent’s Right’s.

Licensee will provide the follwing forms: LIC279B,and LIC9148 no later than 10/4/2019.

The facility was found to be in substantial compliance per Title 22 Regulations. A copy of report, Notice of Site Visit and were issued and explained to the Licensee.

SUPERVISOR'S NAME: Jennie Ferreira	TELEPHONE: (424) 301-3067
LICENSING EVALUATOR NAME: Denise Miranda	TELEPHONE: (424) 301-3055
LICENSING EVALUATOR SIGNATURE:	DATE: 10/01/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/02/2019

LIC809 (FAS) - (06/04)

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