197493605-12-1-2023-30-CC-VWHY-CY53MU-20231201172256

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 197493605
Report Date: 11/30/2023
Date Signed: 12/01/2023 05:23:54 PM

Document Has Been Signed on 12/01/2023 05:23 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
CCLD Regional Office, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245

FACILITY NAME:	AVALOS FAMILY CHILD CARE		FACILITY NUMBER:	197493605
ADMINISTRATOR:	AVALOS, MARIA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(323) 283-2579
CITY:	LOS ANGELES	STATE: CA	ZIP CODE:	90044
CAPACITY:	14	CENSUS: 6	DATE:	11/30/2023
TYPE OF VISIT:	Required - 3 Year	UNANNOUNCED	TIME BEGAN:	01:30 PM
MET WITH:	Maria Avalos		TIME COMPLETED:	05:30 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	On November 30, 2023, Licensing Program Analyst (LPA), Veronica Wheatley and conducted an unannounced Annual Inspection and was met by Licensee's husband . Days and hours of operation are currently 23 hours or less. Licensee states the children here today arrive at 5:00am to 5:30pm, Monday through Friday. LPA toured the home inside and outside and a census was taken. LPA observed 6 children on the premises. Current facility sketch reviewed and confirmed that the living room and two bedrooms are used for the for the children. The children use the bathroom next to the kitchen. All other bedrooms are off-limits and made inaccessible. There is no swimming pool or other bodies of water on the premises. There are no firearms or ammunition on the premises per licensee. Detergents, cleaning compounds, medication and other hazardous items were made inaccessible. There is a working fire extinguisher, smoke detector, and carbon monoxide detector. The home has portable heating and air condition for safety and comfort. There are no stairs in the home. There is no fireplace on the premises. Safe toys and play equipment are observed. The home has working telephone service and LPA confirmed the phone number.LPA did not observe a children's roster. The licensee wrote the information for the current children that are enrolled. LPA discussed Safe Sleep Regulations with licensee. Cribs and play yards will be kept free from all loose articles and objects while infants are sleeping, and there are no objects hanging above or attached to the crib or play yard. Infants are not swaddled while in care. Provider physically checks on sleeping infants up to 2 years old every fifteen minutes and documents any signs of distress which includes but is not limited to flushed skin color, increase in body temperature, restlessness and labored breathing. Infants can be visually observed through an open door if sleeping in a separate room. Individual Infant Sleeping Plan is completed and in file for each infant up to 12 months of age. Infants up to 12 months of age are placed on their backs for sleeping. LPA observed 2 infants today including licensee's infant granddaughter.

SUPERVISOR'S NAME: Maureen Neal	TELEPHONE: (424) 301-3042
LICENSING EVALUATOR NAME: Veronica Wheatley	TELEPHONE: (424) 301-3051
LICENSING EVALUATOR SIGNATURE:	DATE: 11/30/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/30/2023

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: 11/30/2023

NARRATIVE

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Licensee ensures that children in care are supervised at all times and is aware children shall not be left in parked vehicles. Car seats are used for transportation purposes only and are not used for sleeping children. The outdoor play area is the front yard and is fenced. LPA observed several age appropriate toys. LPA observed a very large trampoline in the front yard. The licensee states the trampoline is only used by her own grandchildren and no day care children. The trampoline LPA observed a bottle of window cleaner that was removed during the visit. Capacity as specified on the license is being maintained.

LPA reviewed a sample of children’s files and observed files were complete with emergency information as required. Licensee’s Mandated Reporter Training expires 3/2025. Licensee’s pediatric CPR/First Aid expires on 5/2025. A review of records indicates that all employees and/or volunteers have immunization records on file for influenza, pertussis and measles.

All adults who reside or work in the home have a criminal record clearance or exemption. There are no excluded individuals present at this home. Incidental Medical Services (IMS) are not currently being provided. Licensee is aware that an IMS plan is required to be submitted to the licensing office if they provide any of these services. Information regarding Americans with Disability Act (ADA) can be obtained by contacting US Department of Justice toll free ADA Information line at (800) 514-0301(voice), (800) 514-0383 (TDD) and website link https://www.ada.gov/childqanda.htm.

LPA discussed with the licensee the Community Care Licensing website www.ccld.ca.gov which will provide access to Provider Information Notices (PINs), Quarterly Updates, COVID-19 Information and Resources, Mandated Reporter Training, Safe Sleep in Child Care, Lead Poisoning Facts, Forms and Regulations.

Per Title 22, Division 12, Chapter 3, of the California Code of Regulations, deficiencies are cited.

This report shall be made available to the public upon request. LIC 9213 Notice of Site Visit is provided and required to be posted for 30 days.

Exit interview conducted. A copy of this report will be emailed to the licensee due to technical difficulties with printer.

SUPERVISOR'S NAME: Maureen Neal	TELEPHONE: (424) 301-3042
LICENSING EVALUATOR NAME: Veronica Wheatley	TELEPHONE: (424) 301-3051
LICENSING EVALUATOR SIGNATURE:	DATE: 11/30/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/30/2023

LIC809 (FAS) - (06/04)

Page: 2 of 3

Document Has Been Signed on 12/01/2023 05:23 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
CCLD Regional Office, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245

FACILITY NAME: AVALOS FAMILY CHILD CARE	FACILITY NUMBER: 197493605
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 11/30/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

102418(a)

Immunizations

(a) Prior to admission to a family day care home, children shall be immunized against diseases as required by the California Code of Regulations, Title 17, beginning with Section 6000. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observations and record review, the licensee did not comply with the section cited above in that several children did not have required immunizations which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 12/07/2023
	Plan of Correction
1 2 3 4	The licensee understands that immunizations are required for children enrolled. The licensee will contact the parents and have them provide copies of the require immunization records for the children. The forms will be placed in the file. The licensee will submit proof of plan of correction to the Department by 12/07/23.

Type B

Section Cited

CCR

102417(g)(8)

Operation of A Family Child Care Home

(8) Each family child care home shall have a current roster of children as specified in Health and Safety Code Section 1596.841. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on [(observation) (interview) (record review)], the licensee did not comply with the section cited above in [count] out of [total count] [(objects) (persons)] [identifiers] which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 12/01/2023
	Plan of Correction
1 2 3 4	The licensee understands that a children's roster is required for children enrolled. The licensee will complete the LIC 9092 and submit a copy by email to LPA Wheatley by 12/1/23. The licensee understands the roster is to be kept for 3 years after the children are terminated or disenrolled. The licensee will submit proof of plan of correction to the Department by 12/01/23.

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: Maureen Neal	TELEPHONE: (424) 301-3042
LICENSING EVALUATOR NAME: Veronica Wheatley	TELEPHONE: (424) 301-3051
LICENSING EVALUATOR SIGNATURE:	DATE: 11/30/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/30/2023

LIC809 (FAS) - (06/04)

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