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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197493210
Report Date: 07/17/2019
Date Signed: 07/17/2019 09:04:54 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:CHAVEZ & CASTRO HERNANDEZ FAMILY CHILD CAREFACILITY NUMBER:
197493210
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY:8CENSUS: 1DATE:
07/17/2019
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
07:20 AM
MET WITH:Virginia Chavez, licensee and Yesenia Castro Hernandez and licensee's assistant
TIME COMPLETED:
09:05 AM
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On 7/17/2019, Licensing Program Analyst (LPA) Denise Miranda conducted an announced case management inspection to the family child care home for the purpose of an increase in capacity. The licensee is applying for a large family child care home. Upon arrival, at 7:20am LPA met with the licensee and co-licensee and licensee's assistant. LPA confirmed with the licensee that all adults working in the home have criminal record/TB. The fire clearance was granted for 14 children on 7/8/2019 by Inspector Reddick from Los Angeles County Fire Department.
The facility operation hours is from: 7:30am to 5:30am from Monday to Friday and Saturday from 4:00pm to 8:00pm.
This is a single dwelling home that consists of 3 bedrooms, 2-bathrooms, kitchen/dining room, living room, and playroom, attached garage, front yard and back yard.
The accessible areas are: bedroom#3, playroom/kitchen area and bathroom#2.
The off limit: bedroom#1, bedroom #2, living/dining room, kitchen, 1 bathroom#1, and attached garage. LPA inspected the attached garage, that is used only for storage. Per licensee and co-licensee the attached garage is used only for storage.

At 8:30am LPA observed one child arrived at the facility and one licensee’s assistant.

Records were reviewed and appeared complete with the required licensing documents. The licensee does not have children in care at this time that require Incidental Medical Services (IMS). The licensee states there are no pets and weapons/firearms in the home and none observed by the LPA. There are no bodies of water present at the facility.
The home was inspected inside and outside for safety, comfort, cleanliness, telephone services, heating and ventilation. There is operable smoke/carbon monoxide detector in the home. LPA observed toxins, sharp objects, detergents/cleaning compounds and hazardous items that can pose a danger to children are
SUPERVISOR'S NAME: Jennie FerreiraTELEPHONE: (424) 301-3067
LICENSING EVALUATOR NAME: Denise MirandaTELEPHONE: (424) 301-3055
LICENSING EVALUATOR SIGNATURE:

DATE: 07/17/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/17/2019
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: CHAVEZ & CASTRO HERNANDEZ FAMILY CHILD CARE
FACILITY NUMBER: 197493210
VISIT DATE: 07/17/2019
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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 made aware that state law prohibits baby walkers, bouncy seats, exer-saucers and any other items that fall into that category.

The licensee was also recommended the following safe sleep practices: always place infants on their backs for sleeping; use only a tight-fitting sheet on the crib or play yard mattress; do not hang any items from the crib or above the crib; keep all items, including blankets, out of the crib or play yard; pacifiers may be used as long as they do not have items attached to them; infants should not be swaddled or have any items covering them while sleeping; the temperature of the room should be comfortable enough for an adult to wear a t-shirt and not be too hot or too cold. Please note, these guidelines are recommendations for best practices only, until regulations are approved and adopted.


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. Phone number: (916) 654-1541. Email Address: childcareadvocatesprogram@dss.ca.gov
The following was provided to the licensee:
· Child Ratio for Large Family Child Care home (with and without an assistant present)
· Safe Sleep For Your Baby Brochure from the National Institute of Child Health & Human Development
· Effects of Lead Exposure from Child Care Licensing Department
· LIC311 – Forms/Records to keep in your Family Child Care Home
· Health Drinks for young Children from the California Health Program
The facility appears to operate within substantial compliance during today's inspection. The Los Angeles County Fire Department granted Capacity of 14 children for the family child care home and the Department agrees to the increase of Capacity to 14 children for the facility license.

An exit interview was conducted and a copy of this report was given to licensee
SUPERVISOR'S NAME: Jennie FerreiraTELEPHONE: (424) 301-3067
LICENSING EVALUATOR NAME: Denise MirandaTELEPHONE: (424) 301-3055
LICENSING EVALUATOR SIGNATURE:

DATE: 07/17/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/17/2019
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: CHAVEZ & CASTRO HERNANDEZ FAMILY CHILD CARE
FACILITY NUMBER: 197493210
VISIT DATE: 07/17/2019
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inaccessible to children. A fire/disaster drill last conducted on 7/12/2019, LPA observed current CPR/First Aid certification in physical file, age appropriate toys and equipment, a required 2A10BC fire extinguisher in the home, and a first aid kid in the storage closet. LPA observed outlet covers throughout the home.

Update on Incidental Medical Services: Facilities that provide Incidental Medical Services (IMS) must identify those services in their facility’s Plan of Operation and submit an updated Plan of Operation 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 Emptying an Ileostomy Bag.


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) 524-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA, available at:http://www.ada.gov/childqanda.htm

The licensee was informed of the following during the inspection:
The licensee was informed to have a qualified assistant when the capacity exceeds 8 children. The assistant must be at least 14 years of age, but can not be left alone with the children in care. If the assistant is 18 years of age and older, the assistant must have current Adult/Infant & Pediatric First Aid certificates if left alone with children while the licensee is out of the home. Each assistant must also have TB clearance, valid criminal record clearance and be associated to the facility license.
Fire and safety drills must be performed every month and documented for review by the Department. The licensee was informed of the responsibility to report suspected Child Abuse by calling the Child Abuse Hot line at 1-800-540-4000. The licensee is informed to call the office to report an Unusual Incident/Injury and to follow up with a written Unusual Incident/Injury Report (LIC 624B) within 7 days.

The licensee was informed that the presence of adults in the home without Criminal Record Clearance or Exemption will be cited and civil penalty assessed for $100 per day. The licensee may find additional information and forms on the DSS website at www.ccld.ca.gov including information on the Live Scan application (LIC 9163). Appointments can be made for Live Scan at 1-800-315-4507.
SUPERVISOR'S NAME: Jennie FerreiraTELEPHONE: (424) 301-3067
LICENSING EVALUATOR NAME: Denise MirandaTELEPHONE: (424) 301-3055
LICENSING EVALUATOR SIGNATURE:

DATE: 07/17/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/17/2019
LIC809 (FAS) - (06/04)
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