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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197493210
Report Date: 10/15/2019
Date Signed: 10/15/2019 05:04:16 PM

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:CASTROHERNANDEZ,Y CHAVEZ,VFACILITY TYPE:
810
ADDRESS:TELEPHONE:
3108578351
CITY:CULVER CITYSTATE: CAZIP CODE:
90230
CAPACITY:14CENSUS: 6DATE:
10/15/2019
TYPE OF VISIT:Required - 3 YearUNANNOUNCEDTIME BEGAN:
03:25 PM
MET WITH:Yesenia Castro Hernandez, LicenseeTIME COMPLETED:
04:47 PM
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On 10/15/19 at 3:25pm Licensing Program Analyst (LPAs) Denise Miranda met with Ysenia Castro Hernandez, Licensee for the purpose of 3 year required Inspection. Co licensee was not present.
Upon arrival, LPA Miranda observed 6 children in care being supervised by licensee and 2 licensee’s assistant. LPA verified that all adults present in the facility has obtained criminal record clearances and are associated to the facility.
At 4:10pm LPA observed the co-licensee arrived at the facility.
The facility operation hours are 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/di35ning 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 the attached garage is used only for storage.
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 3:58pm LPA’s observed a complete first aid, full charged Fire extinguisher size 2-A:10-B:C Fire Extinguisher in the kitchen, working smoke and carbon monoxide detector. Telephone service, central heating, lighting and ventilation were evaluated and in good condition.

At 4:05pm LPA reviewed the children’s file that were completed and staff.

LPA reviewed the licensee’s Pediatric First Aid AED Infant/CPR completed: 7/20/20.

SUPERVISOR'S NAME: Jennie FerreiraTELEPHONE: (424) 301-3067
LICENSING EVALUATOR NAME: Denise MirandaTELEPHONE: (424) 301-3055
LICENSING EVALUATOR SIGNATURE:

DATE: 10/15/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/15/2019
This report must be available at Child Care and Group Home facilities for public review for 3 years.
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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: 10/15/2019
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Licensee was able to provide the fire drill log. The last fire drill conducted was on 8/12/2019. The licensee states that does not have weapons/firearms in the home and none observed by the LPA. LPA observed no pets. Per licensee no pets at the facility.

Per licensee at this time, licensee is not providing (IMS). 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.
SUPERVISOR'S NAME: Jennie FerreiraTELEPHONE: (424) 301-3067
LICENSING EVALUATOR NAME: Denise MirandaTELEPHONE: (424) 301-3055
LICENSING EVALUATOR SIGNATURE:

DATE: 10/15/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/15/2019
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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: 10/15/2019
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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. 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 FerreiraTELEPHONE: (424) 301-3067
LICENSING EVALUATOR NAME: Denise MirandaTELEPHONE: (424) 301-3055
LICENSING EVALUATOR SIGNATURE:

DATE: 10/15/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/15/2019
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: 10/15/2019
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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 DSS website: www.ccld.ca.gov

During this inspection, LPA provide the following forms:
Brochure Law Car Seat, Keep me safe, Safe Sleep (NIH), Prohibited items in Family Child Care, LIC311D Forms/Records to Keep in your FCCH and CDPH286 California School Immunization Record.

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 FerreiraTELEPHONE: (424) 301-3067
LICENSING EVALUATOR NAME: Denise MirandaTELEPHONE: (424) 301-3055
LICENSING EVALUATOR SIGNATURE:

DATE: 10/15/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/15/2019
LIC809 (FAS) - (06/04)
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