197494080-12-20-2019-30-CC-KSCT-BK2VKG-20191220153019

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 197494080
Report Date: 12/20/2019
Date Signed: 12/20/2019 03:30:30 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 CARE		FACILITY NUMBER:	197494080
ADMINISTRATOR:	AMADOR, JENNIFER		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(323) 674-7261
CITY:	HAWTHORNE	STATE: CA	ZIP CODE:	90250
CAPACITY:	14	CENSUS: 8	DATE:	12/20/2019
TYPE OF VISIT:	Case Management - Other	UNANNOUNCED	TIME BEGAN:	12:58 PM
MET WITH:	Jennifer Amador		TIME COMPLETED:	03:45 PM

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Licensing Program Analyst (LPA), Keyona Scott, conducted a Case Management Inspection following the Department’s receipt of a Case Closure Letter dated 12/06/2019 for ID# 7509021753.

LPA met with Licensee, Jennifer Amador, on 12/20/2019 at 10:40 AM. Licensee, Licensee's Assistant, Adult #1, Adult #2 and eight children, which includes three infants, were present during the inspection. LPA was guided on a tour inside and outside of the home. Adults, residing, working and present in the home that are fingerprint cleared and associated to the facility are Licensee and Licensee's Assistant.

Adult #1, ID# 7509021753 was present at the time of the inspection. Adult # 1 has obtained a livescan, however, did not receive a criminal record clearance. In order for Adult #1 to work or be present in the home, Adult #1 must obtain a criminal record exemption. Per Licensee, Adult #1 was only present for the day (12/20/2019) to assist in running errands and helping with Christmas program on 12/20/2019.

Per Licensee, received Case Closure Letter, CBCB-9 (Revision 4) Agency Initiated Closure from the Department of Social Services, Caregiver Background Check Bureau, on 12/19/2019. Licensee stated the individual, ID# 7509021753, is a close friend. LPA explained and provided a copy of the Case Closure Letter, CBCB-9 (Revision 4) Agency Initiated Closure to Licensee.

LPA advised Licensee and Licensee's Assistants, that individual, ID# 7509021753, is not allowed to work or be present in the facility because the individual no longer has a criminal record clearance or exemption. This individual must be prevented from having contact with clients.

LPA provided copies of LIC 995B (Addendum to Notification of Parents Rights) Regarding Removal / Exclusion) for the licensee to provide to the parents and have signed. LPA explained to Licensee that the parent's of children currently in care must be notified that individual, ID# 7515041328, has been removed from the facility and the Addendum to Notification of Parent's Rights (LIC 995B) is to be used for this purpose.

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SUPERVISOR'S NAME: Mary Ruiz	TELEPHONE: (424) 301-3061
LICENSING EVALUATOR NAME: Keyona Scott	TELEPHONE: (424) 301-3091
LICENSING EVALUATOR SIGNATURE:	DATE: 12/20/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/20/2019

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: AMADOR FAMILY CHILD CARE	FACILITY NUMBER: 197494080
	VISIT DATE: 12/20/2019

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The following was thoroughly discussed with the Licensee's Assistant:
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

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:

PUB 271: Preventing Shaken Baby Syndrome/Abusive Head Trauma
PIN 19-10-CCP U.S. Consumer Product Safety... Fisher-Price Infant Equipment Accessory Recall
PIN 19-12-CCP U.S. Cosumer Product Safety... Infant Sleeper Recall
PIN 19-09-CCLD Division Mailchimp Account Information... Subscribe For Updates
SafeBaby2indd- Safe Sleep

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, a copy of this report (LIC 809) (LIC 809-C), along with appeal rights were given to Licensee, Jennifer Amador, whose signature confirms today's inspection and report.

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SUPERVISOR'S NAME: Mary Ruiz	TELEPHONE: (424) 301-3061
LICENSING EVALUATOR NAME: Keyona Scott	TELEPHONE: (424) 301-3091
LICENSING EVALUATOR SIGNATURE:	DATE: 12/20/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/20/2019

LIC809 (FAS) - (06/04)

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