197493450-7-19-2024-58-CC-RLAA-D7BTAH-20240719143333

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 197493450
Report Date: 07/19/2024
Date Signed: 07/19/2024 02:33:45 PM

Document Has Been Signed on 07/19/2024 02:33 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO CC NORTH, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245

FACILITY NAME:	PERETZ FAMILY CHILD CARE		FACILITY NUMBER:	197493450
ADMINISTRATOR:	PERETZ, ETTI		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(424) 362-6822
CITY:	LOS ANGELES	STATE: CA	ZIP CODE:	90035
CAPACITY:	14	CENSUS:	DATE:	07/19/2024
TYPE OF VISIT:	Required - 3 Year	UNANNOUNCED	TIME BEGAN:	10:30 AM
MET WITH:	Licensee, Etti Peretz		TIME COMPLETED:	02:45 PM

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	Licensing Program Analysts (LPAs) Roberto Luque Avila and Lilia Hernandez conducted an unannounced annual inspection to the above facility on 7/19/2024. LPAs arrived at the facility at 10:30AM, identified self and met with, Licensee Etti Peretz who guided analyst on a tour of the facility. LPAs provided Licensee with a copy of the LIC 126 Entrance Checklist to help facilitate the inspection. LPAs observed 11 children and 2 staff upon arrival. Per Licensee, operation hours are 8AM to 3PM. The licensee is observed to be operating within the license capacity limitations. Emergency Disaster Plan, Parent’s Rights Poster and the Facility License were observed to be posted. Licensee was reminded that all adults 18 and over living or working in the home, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a licensed Family Child Care Home. A civil penalty of $100.00 minimum/day for a maximum of 5 days or, if the penalty is for a repeat violation, for a maximum of 30 days per person will be assessed if this regulation is violated. Upon arriving at 10:30AM, LPAs observed Staff #1 and Staff #2 working in the facility prior to obtaining background clearance. LPAs spoke with a Guardian representative who verified that Staff #1 was not associated to the facility due to an input error. Guardian representative advised to have Staff #1 background clearance redone. Staff #2 was unable to provide any form of identification to verify identity and name provided was not on facility roster obtain from Guardian. Pg. 1 of 5

SUPERVISOR'S NAME: Rita Ramos	TELEPHONE: (424) -301-3042
LICENSING EVALUATOR NAME: Roberto Luque Avila	TELEPHONE: (424) 301-3059
LICENSING EVALUATOR SIGNATURE:	DATE: 07/19/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/19/2024

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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Document Has Been Signed on 07/19/2024 02:33 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO CC NORTH, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245

FACILITY NAME: PERETZ FAMILY CHILD CARE	FACILITY NUMBER: 197493450
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 07/19/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type A

Section Cited

HSC

1596.871(c)(1)(A)

Administration of Child Day Care Licensing

Subsequent to initial licensure, a person specified in subdivision (b) who is not exempt from fingerprinting shall obtain either a criminal record clearance or an exemption from disqualification, pursuant to subdivision(f) of this section or Section 1522.7, from the State Department of Social Services prior to employment, residence, or initial presence in the facility. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on interview and record review, the licensee did not comply with the section cited above in Staff #1 and Staff 2 did not have criminal background clearance which poses an immediate health, safety or personal rights risk to persons in care.
	POC Due Date: 07/26/2024
	Plan of Correction
1 2 3 4	Per licensee Staff #1 and Staff #2 will complete their background clearance before returning to the facility. Licensee will submit proof of Staff #1 and Staff #2 association to facility via email to roberto.luqueavila@dss.ca.gov LPA Luque Avila by POC due date.

Section Cited


	Deficient Practice Statement
1 2 3 4
	POC Due Date:
	Plan of Correction
1 2 3 4

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: Rita Ramos	TELEPHONE: (424) -301-3042
LICENSING EVALUATOR NAME: Roberto Luque Avila	TELEPHONE: (424) 301-3059
LICENSING EVALUATOR SIGNATURE:	DATE: 07/19/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/19/2024

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
EL SEGUNDO CC NORTH, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245

FACILITY NAME: PERETZ FAMILY CHILD CARE	FACILITY NUMBER: 197493450
	VISIT DATE: 07/19/2024

NARRATIVE

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This is a one-story home which consists of 3 bedrooms, 2 bathrooms, kitchen, dining room, living room, laundry room, front yard and backyard (fenced). The children use the bathroom in the hallway. The restroom that children use was observed to be safe and sanitary. Children also use potty chairs for potty training. LPAs observed a fireplace in the living room made inaccessible with a wooden covering screwed onto the fireplace. Per Licensee, areas off limits to children and parents include: kitchen, laundry room and bedrooms 1,2,and 3, these areas are made inaccessible by locks and safety gates. The licensee provides food for children in care to include breakfast, lunch and snacks.

All areas identified on the facility sketch that are accessible for children to use were inspected for safety, comfort, and cleanliness. There is telephone service via a cellphone that is used and remains at the facility during operation hours. There is ventilation and heating (central/open face observed to be screened/barricaded). Safe toys, play equipment and materials were observed.

Detergents, cleaning compounds, medications, and other items which could pose a danger to children were observed to be inaccessible to children.

The licensee states that there are no poisons in the home and understands that storage areas for poisons must be locked with a key or combination lock.

The valve on the required 2A 10BC fire extinguisher indicates fully charged purchased August 2023. LPAs advised licensee to have fire extinguisher serviced or purchase new one on August 2024.

Smoke and carbon monoxide detectors are in the kitchen and were tested and are operable.

All homes shall conduct fire and disaster drills at least once every six months and document the date and time of each drill. Last drill documented was conducted on 7/10/2024.

Licensee states that there are no firearms stored in the home.

Pg. 2 of 5

SUPERVISOR'S NAME: Rita Ramos	TELEPHONE: (424) -301-3042
LICENSING EVALUATOR NAME: Roberto Luque Avila	TELEPHONE: (424) 301-3059
LICENSING EVALUATOR SIGNATURE:	DATE: 07/19/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/19/2024

LIC809 (FAS) - (06/04)

Page: 6 of 6

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO CC NORTH, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245

FACILITY NAME: PERETZ FAMILY CHILD CARE	FACILITY NUMBER: 197493450
	VISIT DATE: 07/19/2024

NARRATIVE

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Licensee states that she is currently caring for 3 infants. Licensee states that infants sleep in the living room.

LPAs did not observe the following items during the inspection: Infant Walkers, Johnny Jumpers, Saucer Chairs, Trampolines and/or any other item that fall into these categories are not permitted in a family child care facility.

LPAs discussed the safe sleep regulations with licensee and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPA also informed licensee of the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at https://www.cpsc.gov/ and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment.

LPAs did not observe any children left in parked vehicles. Car seats shall only be used for transportation. LPAs did not observe any children sleeping in car seats.

The licensee has completed training on preventive health practices including Pediatric First Aid and CPR. The licensee's Pediatric First Aid and CPR expires on December 2025.

LPAs observed that the Licensee does have proof of the Mandated Reporter AB 1207 compliant Child Care Training Certificate on file completed on 5/18/2024.

The licensee has proof of immunization against pertussis, and measles. Licensee also has a current influenza waiver on file.

Children’s records were reviewed, including emergency information and were observed to be completed.

Pg. 3 of 5

SUPERVISOR'S NAME: Rita Ramos	TELEPHONE: (424) -301-3042
LICENSING EVALUATOR NAME: Roberto Luque Avila	TELEPHONE: (424) 301-3059
LICENSING EVALUATOR SIGNATURE:	DATE: 07/19/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/19/2024

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
EL SEGUNDO CC NORTH, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245

FACILITY NAME: PERETZ FAMILY CHILD CARE	FACILITY NUMBER: 197493450
	VISIT DATE: 07/19/2024

NARRATIVE

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LPAs observe no pets on the premises.

LPAs did not observe any pools, spas, hot tubs, fish ponds, or similar bodies of water during the inspection.

Smoking is prohibited in a licensed Family Child Care Home. Per Licensee, no one smokes in the home.

Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02-CCP. 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: https://www.ada.gov/resources/child-care-centers/.
MyChildCarePlan.org

Licensee stated that if a child shows signs of illness they shall be separated from other children and parents are notified to pick up child.

To improve the quality and value of the new inspection process, a survey will be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or tools, please send them by email to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/process

LPAs advised the Applicant to access forms, regulations and quarterly updates on the Child Care Licensing website at: www.ccld.ca.gov LPA provided the following documents about SIDS: A Child Care Provider’s Guide to Safe Sleep from the American Academy of Pediatrics, Helping You to Reduce the Risk of SIDS, Never Shake a Baby, and Safe Sleeping practices.
Licensee was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain child care by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.

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SUPERVISOR'S NAME: Rita Ramos	TELEPHONE: (424) -301-3042
LICENSING EVALUATOR NAME: Roberto Luque Avila	TELEPHONE: (424) 301-3059
LICENSING EVALUATOR SIGNATURE:	DATE: 07/19/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/19/2024

LIC809 (FAS) - (06/04)

Page: 4 of 6

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO CC NORTH, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245

FACILITY NAME: PERETZ FAMILY CHILD CARE	FACILITY NUMBER: 197493450
	VISIT DATE: 07/19/2024

NARRATIVE

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To improve the quality and value of the new inspection process, a survey may be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or CARE tools, please send email inquiries to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/inspection-process.

The following deficiencies listed on the attached deficiency page are being cited in accordance with California Code of Regulations Title 22. Deficiencies that are being cited need to be cleared to protect the children’s health & safety.

A copy of this report shall be provided to the parent/guardian of children currently enrolled by the next business day or immediately upon return. A copy of this report shall also be provided to the parent/guardian of any newly enrolled children for the next 12 months (1 year). The Acknowledgement form must be maintained in each child’s file immediately upon receipt from parent. Licensee/Director was provided with a copy of the parent Acknowledgement of Receipt of Licensing Reports Form during this visit. A copy of the Parent Notification Requirements was also provided to the licensee/Director.

A notice of site visit was given and must remain posted for 30 days.

During the exit interview, the Etti Peretz, confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS.

Exit interview conducted and report was reviewed with the licensee Etti Peretz.

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SUPERVISOR'S NAME: Rita Ramos	TELEPHONE: (424) -301-3042
LICENSING EVALUATOR NAME: Roberto Luque Avila	TELEPHONE: (424) 301-3059
LICENSING EVALUATOR SIGNATURE:	DATE: 07/19/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/19/2024

LIC809 (FAS) - (06/04)

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