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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197494080
Report Date: 01/17/2020
Date Signed: 01/17/2020 04:14:11 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:AMADOR FAMILY CHILD CAREFACILITY NUMBER:
197494080
ADMINISTRATOR:AMADOR, JENNIFERFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(323) 674-7261
CITY:HAWTHORNESTATE: CAZIP CODE:
90250
CAPACITY:14CENSUS: 7DATE:
01/17/2020
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
03:21 PM
MET WITH:Jennifer AmadorTIME COMPLETED:
04:27 PM
NARRATIVE
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Licensing Program Analyst (LPA) Keyona Scott conducted an unannounced Plan of Correction (POC) inspection on 01/17/2020 at 3:21 PM. The purpose of the inspection was to ensure the Type A deficiency cited on 12/20/2019 has been cleared and verify that ID# 7509021753 was not present at the home. LPA met with Licensee, Jennifer Amador, at 3:25 PM and explained the reason for the inspection. Licensee, Licensee's Assistants (Adult # 1, Adult # 2), Licensee's mother (Adult # 3) and seven children, which includes one infant, were present during the inspection.

LPA was guided on tour of the home on 01/17/2020 at 3:28 PM. The following was observed during the inspection:

Six children and one infant were playing in the backyard play area and being supervised by Licensee's Assistants.

Per Licensee, ID# 7509021753 has not returned to the home since was removed on 12/20/2019. Licensee stated contacted Caregiver Background Check Bureau (CBCB) and was advised in order for an exemption to be requested for ID# 7509021753, must begin the process from the beginning with the livescan and the process can take approximately two months.

During the inspection on 12/20/2019, LPA obtained a signed and dated Declaration (LIC 855) from Licensee stating ID# 7509021753 will not work or be present in facility until a criminal record exemption is requested and granted. A copy of this declaration has been placed in the office physical file.

At this time, the Licensee is in compliance with California Title 22 Regulations; therefore, no deficiencies are being cited. Page 1
SUPERVISOR'S NAME: Mary RuizTELEPHONE: (424) 301-3061
LICENSING EVALUATOR NAME: Keyona ScottTELEPHONE: (424) 301-3091
LICENSING EVALUATOR SIGNATURE:

DATE: 01/17/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/17/2020
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: AMADOR FAMILY CHILD CARE
FACILITY NUMBER: 197494080
VISIT DATE: 01/17/2020
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LPA cleared deficiency on this date with an effective date of 12/20/2019 and provided a copy of the Licensing Report to Licensee, Jennifer Amador, as well as issued POC clearance letter.

The following was thoroughly discussed with the Licensee:



Licensee was made aware that state law prohibits baby walkers, bouncy seats, exer-saucers and any other items that fall into that category.

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.



Licensee was also reminded that only children eating may be in high chairs and that car seats are utilized only for transportation.

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.

An exit interview was conducted and a copy of this report and the Notice of Site Visit (LIC 9213) was provided to Licensee, Jennifer Amador, whose signature confirms today's inspection and report.


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

DATE: 01/17/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/17/2020
LIC809 (FAS) - (06/04)
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