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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197493677
Report Date: 08/30/2021
Date Signed: 08/30/2021 01:28:48 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:PERALTA FAMILY CHILD CAREFACILITY NUMBER:
197493677
ADMINISTRATOR:JOSEPHINE PERALTAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(818) 288-7845
CITY:WEST HILLSSTATE: CAZIP CODE:
91304
CAPACITY:14CENSUS: 7DATE:
08/30/2021
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
10:52 AM
MET WITH:Josephine PeraltaTIME COMPLETED:
01:48 PM
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On 08/20/202 Licensing Program Analysts (LPA) conducted a case management inspection for the purpose to add a backyard play area. Upon arrival, LPA met with licensee, Josephine Peralta who guided analyst on a tour of the facility. LPA observed 3 infants, 4 toddlers and 2 assistants. LPA inspected on limit rooms. The home was inspected for safety, comfort, cleanliness, heating and ventilation, inaccessibility to poisons, detergents, cleaning compounds, medicines, and hazardous items that can pose a danger to children. The First Aid kit was observed in the kitchen The LPA did not observe any weapons. The required fire extinguisher (2A 10BC), carbon monixide and smoke detectors are in operable condition. LPA observed licensee's current Pediatric CPR and Pediatric First Aid certificates which expires on 01/27/2023. The backyard area does not have a pool, spa or other bodies of water on the premises. There are age appropriate toys, equipment and a shaded area in the backyard addition area. LPA did not observed any hazardous conditions in the area. Licensee has secured and covered the rose bushes that she is unable to remove due to landlord restriction.

LPA reviewed LIC 9149 signed by Suthia Chea on 11/28/2018. LPA reviewed children roster dated 08/09/2021. LPA advised licensee to provide a copy of assistant immunization records and mandated reporter certificates for all staff that provide care for children to LPA by 09/07/2021.

Backyard play area addition is pending managerial review.

An exit interview was conducted with Licensee. A copy of this report, notice of site inspection, were given and explained during this inspection.

SUPERVISOR'S NAME: Peter FloresTELEPHONE: (424) 301-3077
LICENSING EVALUATOR NAME: Laticia S ThompsonTELEPHONE: (424) 301-3048
LICENSING EVALUATOR SIGNATURE:

DATE: 08/30/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/30/2021
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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