197494080-11-17-2020-30-CC-LSTN-BVFV3Y-20201117150531

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 197494080
Report Date: 11/17/2020
Date Signed: 11/17/2020 03:05:43 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: 11	DATE:	11/17/2020
TYPE OF VISIT:	POC	UNANNOUNCED	TIME BEGAN:	11:12 AM
MET WITH:	Jennifer Amador		TIME COMPLETED:	03:15 PM

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On 11/09/2020 at 7:35am Licensing Program Analyst (LPA) L Thompson received a phone call from licensee regarding Plan of Correction (POC). Licensee stated she was unable to provide children files and roster on due date of POC 11/09/2020 and she would provide the information on 11/11/2020 LPA informed licensee office would be closed due to the holiday. LPA instructed licensee to provide documentation by email, fax or in person at the regional office on 11/12/2020.

On 11/12/2020 licensee requested additional time to provide documentation. Per Licensing Program Manager (LPM) Karren Starks stated licensee must provide documentation by the close of business on 11/12/2020.

On 11/17/2020 at 11:12am LPA L Thompson conducted a plan of correction visit to facility, to deliver 809 and LIC 421FC due to failure to correct citations issued on 11/05/2020 with a due date of 11/09/2020. Licensee failed to provide proof of the following regulation of Title 22 Section 102417(g)(7) Operation of a Family Child Care Home

(g)The home shall be free from defects or conditions which might endanger a child. Safety precautions shall include but not be limited to

(7) An emergency information card shall be maintained for each child and shall include the child's full name, telephone number and location of a parent or other responsible adult to be contacted in an emergency, the name and telephone number of the child's physician and the parent's authorization for the licensee or registrant to consent to emergency medical care

SUPERVISOR'S NAME: Jennie Ferreira	TELEPHONE: (424) 301-3067
LICENSING EVALUATOR NAME: Laticia S Thompson	TELEPHONE: (424) 301-3048
LICENSING EVALUATOR SIGNATURE:	DATE: 11/17/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/17/2020

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: 11/17/2020

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On 11/17/2020 LPA was greeted by Jennifer Amador (licensee). LPA toured facility and observed 10 children and 3 adults. Parent dropped off one additional child during LPA inspection.

LPA inspected the facility and observed the following front room door unlocked and accessible to children under care. Per facility sketch room is off limits. LPA observed hazardous material in the room such as, needle containers, cleaning solution and medication accessible to children.

LPA observed an unlocked cabinet in the bathroom that contained poisonous and hazardous material which is accessible to children in care. LPA observed poisonous/hazardous material in the bath tub area.

LPA observed a broken closet door in the toy room. Licensee removed the door out of the room immediately and stated she will have it repaired.

LPA observed a sharp knife in the dish rack located in the kitchen that is accessible to children.

Licensee provided LPA with a current and updated roster.
LPA reviewed children records and found the records to be in compliance.

Deficiencies are being cited based on LPA observation in accordance with the California Code of Regulations, Title 22, see LIC 809D. Licensee has been issued a repeat violation and Civil penalties are hereby assessed see LIC421CF .

An exit interview was conducted and Plans of Correction was reviewed and developed with the Licensee. A copy of this report and appeal rights were discussed and left with Licensee

SUPERVISOR'S NAME: Jennie Ferreira	TELEPHONE: (424) 301-3067
LICENSING EVALUATOR NAME: Laticia S Thompson	TELEPHONE: (424) 301-3048
LICENSING EVALUATOR SIGNATURE:	DATE: 11/17/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/17/2020

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
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 11/17/2020

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type A 11/18/2020 Section Cited	1 2 3 4 5 6 7	1012417: The home shall be free from defects or conditions which might endanger a child. Safety precautions.. not be limited to(g)Poisons, detergents,...other items which could pose a danger if readily available to children shall be stored where they are inaccessible to children (A Storage areas for poisons... dangerous weapons shall be locked.
	8 9 10 11 12 13 14	This requirement was not met by, unlocked room and cabinet containing hazardous, poisonous material. Knives not stored in a lock inaccessible area which poses an immeidate health and safety risk to children under care.	8 9 10 11 12 13 14
	1 2 3 4 5 6 7
	1 2 3 4 5 6 7

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: Jennie Ferreira	TELEPHONE: (424) 301-3067
LICENSING EVALUATOR NAME: Laticia S Thompson	TELEPHONE: (424) 301-3048
LICENSING EVALUATOR SIGNATURE:	DATE: 11/17/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/17/2020

LIC809 (FAS) - (06/04)

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