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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197494080
Report Date: 07/07/2021
Date Signed: 07/19/2021 09:08:01 AM

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:
(310) 701-6687
CITY:HAWTHORNESTATE: CAZIP CODE:
90250
CAPACITY:14CENSUS: 6DATE:
07/07/2021
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
11:12 AM
MET WITH:Jennifer AmadorTIME COMPLETED:
02:23 PM
NARRATIVE
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On On 0707/2021 at 11:11am Licensing Program Analyst (LPA) Laticia Thompson conducted an unannounced visit to Amador Familty Childcare to delivery finding of a complaint. LPA advised the licensee a Case Management is also being conducted regarding deficiencies observed during todays complaint visit. LPA Laticia Thompson observed the following deficiencies.
  • Staff Member Lisa Hughes, licensee assistant providing care for 4 infants and 2 small children alone. Licensee was not present at the facility. Staff member stated licensee had just left and would be back in 15 minutes. Licensee did not arrive at the facility until 12:01pm.

  • LPA observed multiple hazardous, poisonous material in the kitchen. LPA observed household cleaners on the kitchen counter sink and laundry area. LPA observed bottles of cleaning solution under the kitchen sink in an unlatched cabinet. The safety gate leading to the kitchen was unlocked open and not secured which allowed this area accessible to children.

  • Assistant was unable to provide LPA with a roster of children currently enrolled. Upon licensee arrival, LPA requested licensee to provide a current roster, children records, provider assistant CPR/First Aide and Mandated Reported certification information. Licensee refused to provide LPA with any documentation and stated that the licensee can just cite her.

The facility is cited 2 Type A violations. See LIC809-D for details. Each report (documenting a Type A citation) shall remain posted for 30 days along with the Notice of Site Visit (printed out during this inspection).
SUPERVISOR'S NAME: Peter FloresTELEPHONE: (424) 301-3077
LICENSING EVALUATOR NAME: Laticia S ThompsonTELEPHONE: (424) 301-3048
LICENSING EVALUATOR SIGNATURE:

DATE: 07/07/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/07/2021
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC809 (FAS) - (06/04)
Page: 1 of 4
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: 07/07/2021
NARRATIVE
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An exit interview was conducted with the Licensee, Jennifer Amador, in which this report was read to her. LPA provided licensee with a copy of this report, a Notice of Site Visit (LIC 9213) and Appeal rights. Licensee was cited Type A deficiencies, according to California Code of Regulations Title 22 (see LIC 809D report for deficiencies).

The Licensee was advised that the Notice of Site Visit and a copy of this report must be posted at the entrance of the facility for a period of 30 days.

In addition; A copy of this report must be provided to a parent or an authorized representatives of all currently enrolled children and any newly enrolled child for the following 12 months.

The ACKNOWLEDGEMENT OF RECEIPT OF LICENSING REPORTS (LIC9224) shall be signed and kept in each of the children’s records. The report shall be provided no later than the next business day or the next day the child is in care.

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

DATE: 07/07/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/07/2021
LIC809 (FAS) - (06/04)
Page: 2 of 4
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: 07/07/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
07/07/2021
Section Cited

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102417 Operation of a Family Child Care Home (g) The home shall be free from defects or conditions which might endanger a child.., .(4) Poisons, detergents, cleaning compounds.This requirement was not met as evidenced based on
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LPA's observation of cleaning material accessible to children.This poses an immediate Health and Safety risk to children in care.
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Type A
07/07/2021
Section Cited

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102391 (d) The licensee shall permit the Department to inspect, audit, and copy children's records or other family child care home records upon demand during normal business hours. This requirement was not met as evidenced based on
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Licensee refused to provide LPA with records requested. This poses an immediate Health and Safety risk to children in care.
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https://ccld.childcarevideos.org/family-child-care-providers/community-care-licensing-inspection-authority/
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: Peter FloresTELEPHONE: (424) 301-3077
LICENSING EVALUATOR NAME: Laticia S ThompsonTELEPHONE: (424) 301-3048
LICENSING EVALUATOR SIGNATURE:
DATE: 07/07/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/07/2021
LIC809 (FAS) - (06/04)
Page: 3 of 4
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: 07/07/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
07/07/2021
Section Cited

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02416.5 Staffing Ratio and Capacity (e) If no assistant provider is present at a Large Family Child Care Home, then the licensee shall comply with the capacity requirements for a Small Family Child Care Home as specified in subsections (b) and (c). This requirement was not met as evidenced Based on
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Licensee was not present and assitant was observed providning care for 4 infants and 2 small children. This poses an immediate Health and Safety risk to children in care.
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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: Peter FloresTELEPHONE: (424) 301-3077
LICENSING EVALUATOR NAME: Laticia S ThompsonTELEPHONE: (424) 301-3048
LICENSING EVALUATOR SIGNATURE:
DATE: 07/13/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/13/2021
LIC809 (FAS) - (06/04)
Page: 4 of 4