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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197493605
Report Date: 09/27/2019
Date Signed: 09/27/2019 04:50:23 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:AVALOS FAMILY CHILD CAREFACILITY NUMBER:
197493605
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY:8CENSUS: 7DATE:
09/27/2019
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
03:05 PM
MET WITH:Maria AvalosTIME COMPLETED:
05:00 PM
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Licensing Program Analyst (LPA), Keyona Scott, conducted an unannounced Case Management Inspection on 09/27/2019. The purpose of the inspection was to inspect the home due to the Licensee has requested a capacity increase from a small family child care home to a large family child care home. The Fire clearance was granted on 07/30/2019 by L.A. City Fire Department. LPA met with Licensee, Maria Avalos, on 09/27/2019 at 1:45 PM. Licensee, Licensee's Assistant, Jesus Avalos and seven children (includes two infants) were present during the inspection. All adults, present, working and residing in the hone are fingerprint cleared and associated to the facility. LPA was guided on a tour inside and outside of the home at 1:50 PM. LPA also conducted an Annual Random inspection of the facility since the facility has not had an inspection since licensure on 08/29/2018. All rooms in the home were identified per the facility sketch.

LPA explained the capacity for the capacity increase as follows. The maximum capacity is 12 with no more than 4 infants and a qualified assistant. Without a qualified assistant the license reverts back to the requirements for a small family childcare. Optional care may be provided for a maximum capacity of 14 children with no more than three (3) infants, two (2) school age children and a qualified assistant. School age children are as follows: one (1) child attending Kindergarten and one (1) child at least six (6) years old.
The home is a one story three bedroom, two bathroom home with a kitchen, living room, and play room. The primary child care area of the home is in the playroom adjacent to the living room. LPA observed toys and playthings in the playroom to be safe, orderly and age-appropriate for the children. The children also use the living room, located at the entrance of the home as an additional play space. The children utilize bedroom #1 for napping. The children use the bathroom located through the hallway adjacent to bedroom #1. The off-limit areas of the home are the master bedroom at the rear of the home, bedroom #2 adjacent to the playroom, the bathroom adjacent to bedroom #2 and the kitchen. The bedrooms and bathroom are made inaccessible to children in care by closed doors during operation hours. The kitchen is made inaccessible by safety gate at the kitchen entrance. Licensee was advised that all areas of the home that are off-limits must remain inaccessible to children in care during operation hours. The children play in the front patio and driveway area of the home. The outdoor play area is fenced in and is also free from defects or dangerous conditions. Outside toys and playthings are also plentiful, safe, orderly and age appropriate.
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SUPERVISOR'S NAME: Mary RuizTELEPHONE: (424) 301-3061
LICENSING EVALUATOR NAME: Keyona ScottTELEPHONE: (424) 301-3091
LICENSING EVALUATOR SIGNATURE:

DATE: 09/27/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/27/2019
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: AVALOS FAMILY CHILD CARE
FACILITY NUMBER: 197493605
VISIT DATE: 09/27/2019
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The home was found to be clean and orderly with proper ventilation for safety and comfort. The bathroom was inspected for inaccessibility of chemicals/toxins and other potential hazards to children in care. There is a Fire Extinguisher (2A-10-BC) mounted on the wall in the hallway outside the entrance of the kitchen. There is a working smoke detector and carbon monoxide detector located in the home.

Licensee stated there are no firearms or weapons in the home; None were observed by LPA. LPA observed current Pediatric CPR (Adult/Infant /Child) and Pediatric First Aid certifications for Licensee and Licensee's Assistant with an expiration date of 05/04/2021 (Licensee) and 05/04/2021 (Assistant). Licensee has the required documents posted in the Family Child Care Home: Facility License (LIC 203), Emergency Disaster Plan (LIC610a), Notification of Parents' Rights Poster (PUB 394), Child Care Facility Roster (LIC9040).



The following was thoroughly discussed with the licensee:
All adults living and working in the home must be fingerprinted and cleared prior to entering the facility. 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.

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 informed once capacity increased to a large Family Child Care Home, Fire Disaster Drills are to be conducted at least once every month and log must be kept.



The licensee was informed of the responsibility to report suspected Child Abuse by calling the Child Abuse Hot line at 1-800-540-4000. Also call the CCL office within 24 hours of the Unusual Incident and follow up with a written Unusual Incident/Injury Report (LIC 624B) within 7 business days.

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

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SUPERVISOR'S NAME: Mary RuizTELEPHONE: (424) 301-3061
LICENSING EVALUATOR NAME: Keyona ScottTELEPHONE: (424) 301-3091
LICENSING EVALUATOR SIGNATURE:

DATE: 09/27/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/27/2019
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: AVALOS FAMILY CHILD CARE
FACILITY NUMBER: 197493605
VISIT DATE: 09/27/2019
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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.

The licensee was advised that, once licensed, the Notice of Site Visit must be posted at the entrance of the facility for a period of 30 days. If a serious violation is cited, (Type A violation), a copy of the licensing report (LIC809 or LIC9099) must also be posted for 30 days. If these requirements are not met, civil penalties in the amount of $100 per violation will be assessed.


Licensee was provided the following forms/brochures:
PIN 19-02-CCP: Safe Sleep Awareness Campaign
NIH Pub. No. 18-HD-5759: What Does A Safe Sleep Environment Look Like?
A Child Care Provider's Guide to Safe Sleep
Safe Sleep in Child Care
PUB 271: Preventing Shaken Baby Syndrome/Abusive Head Trauma
PIN 19-10-CCP U.S. Consumer Product Safety...Recall
Effects of Lead Exposure

The facility was operating in substantial compliance during this inspection on 09/27/2019. There were no Title 22 Deficiencies cited.

Effective today 09/27/2019 capacity increase is approved for a large family childcare. MAX. CAPACITY (WHEN THERE IS AN ASSISTANT PRESENT): 12 - NO MORE THAN 4 INFANTS. or MAX. CAPACITY (WHEN THERE IS AN ASSISTANT PRESENT): 14 - NO MORE THAN 3 INFANTS, 1 CHILD ATTENDING KINDERGARTEN OR ELEMENTARY SCHOOL AND 1 CHILD AT LEAST AGE 6.



New Appeal Process: A licensee may file an appeal, in writing 15 business days from the date of receiving the penalty assessment

An exit interview was conducted, and a copy of this report (LIC 809), Notice of Site Visit (LIC 9213), along with appeal rights were given to Licensee, Maria Avalos, whose signature confirms today's inspection and report. Page 3

SUPERVISOR'S NAME: Mary RuizTELEPHONE: (424) 301-3061
LICENSING EVALUATOR NAME: Keyona ScottTELEPHONE: (424) 301-3091
LICENSING EVALUATOR SIGNATURE:

DATE: 09/27/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/27/2019
LIC809 (FAS) - (06/04)
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