197494155-6-9-2021-54-CC-DGIS-C3TURD-20210609154833

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 197494155
Report Date: 06/09/2021
Date Signed: 06/09/2021 03:48:42 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME:	CABRERA FAMILY CHILD CARE		FACILITY NUMBER:	197494155
ADMINISTRATOR:	CABRERA, DELFINA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(323) 495-7070
CITY:	LOS ANGELES	STATE: CA	ZIP CODE:	90037
CAPACITY:	14	CENSUS: 9	DATE:	06/09/2021
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	02:25 PM
MET WITH:	Delfina Cabrera, Licensee		TIME COMPLETED:	04:00 PM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	Licensing Program Analyst (LPA) Denise Gibbs conducted an unannounced annual required inspection to the above facility on 6/9/21 at 2:25 PM. LPA met with Delfina Cabrera, Licensee who guided analyst on a tour of the facility. Also present during this inspection, was Staff One (S1) and Staff Two (S2), Licensee’s Assistants. There were ten children when LPA arrived. Two are licensee's children. This is a one-story home which consists of three bedrooms, one office, one bathroom, kitchen, dining room, living room, laundry area, front yard and backyard (fenced) and detached garage. Main care is provided in the living room, dining room and bedroom adjacent to the bathroom. Per Licensee, areas off limits to children and parents include: two bedrooms, one office and detached garage. Hours of operation are Mon-Fri 7am-6pm. Individuals residing in the home have been discussed and noted. All adults present in the home have obtained a criminal record clearance or exemption. Licensee states that there are no firearms or weapons stored in the home. All areas identified on the facility sketch that are accessible for children to use were inspected for safety, comfort, and cleanliness. There is operable telephone service at the facility. There is ventilation and heating (air condition units and portable heater). The following was observed and reviewed during this inspection: LPA observed that cleaning products are stored in a locked cabinet in the bathroom and medication is stored in a locked cabinet in the kitchen. The licensee states that there are no poisons in the home and understands that storage areas for poisons must be locked with a key or combination lock. The restroom that children use was observed to be clean and free of hazards. ------------------Page 1

SUPERVISOR'S NAME: Trevino Cochran	TELEPHONE: (323) 981-3385
LICENSING EVALUATOR NAME: Denise Gibbs	TELEPHONE: (323) 558-2794
LICENSING EVALUATOR SIGNATURE:	DATE: 06/09/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/09/2021

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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME: CABRERA FAMILY CHILD CARE	FACILITY NUMBER: 197494155
	VISIT DATE: 06/09/2021

NARRATIVE

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The valve on the required 2A 10BC fire extinguisher indicates fully charged and was last serviced on 4/2021, as indicated on service tag. Smoke and carbon monoxide detectors were observed but were not tested due to sleeping children.

The home is observed to be clean and orderly. There are toys and other age appropriate material available for children. Children nap on cots in the main care bedroom and in the main care bedroom when additional space is needed. Infant crib is visible in main care living room. Crib has a tight fitted sheet and is free of hazards.

Infant Care: Licensee cares for one infant less than 12 months old at this time. There is one crib for one infant. Applicant states the following for nap supervision: Assistant will supervise sleeping infant at all times, check infant every 15 minutes and document requirements. LPA informed applicant of the new Safe sleep regulation and provided PIN 20-24-CCP. LPA provided the applicant with a copy of the Child Care Provider’s Guide to Safe Sleep, by American Academy of Pediatrics. Online copy can be downloaded at: https://www.cdph.ca.gov/programs/SIDS/Documents/SIDSchildcaresafesleep.pdf

Currently, children are using the back yard for outdoor play. The outdoor play area was observed to be fence. LPA observed that the outdoor yard has toys and other materials for children to play with. LPA did not observe any objects that can pose a danger to children on the outdoor yard. There are no pools or spas, or other bodies of water.

The licensee and other personnel have completed training on preventive health practices including Pediatric First Aid and CPR. The licensee and staff do have proof of immunization against influenza, pertussis, and measles. LPA observed staff do have proof of the Mandated Reporter AB 1207 compliant Child Care Training Certificate on file.

Children’s records were reviewed, including emergency information and LIC 9227, Individual Infant Sleeping Plan and were observed to be complete. LPA issued a Confidential Names List (LIC 811) to the licensee which documents staff and children’s files reviewed during this inspection.

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SUPERVISOR'S NAME: Trevino Cochran	TELEPHONE: (323) 981-3385
LICENSING EVALUATOR NAME: Denise Gibbs	TELEPHONE: (323) 558-2794
LICENSING EVALUATOR SIGNATURE:	DATE: 06/09/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/09/2021

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, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME: CABRERA FAMILY CHILD CARE	FACILITY NUMBER: 197494155
	VISIT DATE: 06/09/2021

NARRATIVE

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Health and Safety Code 1596.7996 Effective January 1, 2019, Child Care Centers and Family Child Care Homes are required to provide parents and guardians of children enrolled, enrolling or reenrolling in care with written information on the risks and effects of lead exposure, blood lead testing requirements and recommendations and options for locations of affordable blood lead tests. 2019 Lead flyer Provided.

Incidental Medical Services (IMS):
The licensee states that she will provide IMS. Per licensee, there are no children enrolled that require IMS at this time. Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Family Child Care Homes Section 102417. When any IMS is provided, a Plan for Providing IMS must be submitted to the Department. The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice)/ (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: http://www.ada.gov/childqanda.htm.

LPA advised the licensee to access forms, regulations and quarterly updates on line at: www.ccld.ca.gov.

At this time, the licensee is in compliance with California Code of Regulations Title 22. No deficiencies cited today 6/8/21.

The Notice of Site Visit (LIC 9213) – must remain posted for 30 days during the hours of operation after each site visit made by a licensing representative. Failure to maintain posting as required will result in a civil penalty of $100.00.

Exit interview was conducted with Delfina Cabrera, Licensee, including, but not limited to Appeal Procedures and Appeal Rights. -----------------------Page 4

SUPERVISOR'S NAME: Trevino Cochran	TELEPHONE: (323) 981-3385
LICENSING EVALUATOR NAME: Denise Gibbs	TELEPHONE: (323) 558-2794
LICENSING EVALUATOR SIGNATURE:	DATE: 06/09/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/09/2021

LIC809 (FAS) - (06/04)

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