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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197494224
Report Date: 06/19/2019
Date Signed: 06/19/2019 10:30:26 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:DIAZ & DIAZ FAMILY CHILD CAREFACILITY NUMBER:
197494224
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY:8CENSUS: 0DATE:
06/19/2019
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
07:45 AM
MET WITH:Socara Diaz, Applicant and Lisa Diaz Co-ApplicantTIME COMPLETED:
10:30 AM
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On 6/19/2019 at 7:45am, Licensing Program Analyst (LPA) Denise Miranda conducted an announced pre-licensing inspection to the facility to ensure the health and safety standards as required governing California family child care homes. Present at the time of inspection were Socora Diaz, Applicant and Lisa Diaz Co-Applicant.
Applicants state hours of operation for day care are Monday through Friday, 6:30 am to 6:00 pm. Applicants were advised during hours of child care that the applicant shall be present in the home and shall ensure children in care are visually supervised at all times.

The facility is a single home. There are no bodies of water on the premises. At 7:50am LPA toured the facility indoors and outdoors.

The following were observed during the inspection: One living combined with dining room (converted as a play area), kitchen, 5 bedrooms and 2 bathrooms, front yard, side yards and backyard area that is fully fenced. LPA inspected the guess house 2 stories (off limit) located at the back of the house. The guess house is located at the second floor. LPA observed one additional bedroom, 1 bathroom, kitchen combined with dining/living room, also, LPA observed a detached garage on the back of the house.
Per applicants, primary care will be provided in the living/dining room and bedroom#2 (infant room), children will use the bathroom#1 located at the hallway located in front of the bedroom#2.
Additional areas accessible to children in care are as follows: during the inspection front yard, and the right side of the house did not meet compliance standard, applicant will make the
SUPERVISOR'S NAME: Jennie FerreiraTELEPHONE: (424) 301-3067
LICENSING EVALUATOR NAME: Denise MirandaTELEPHONE: (424) 301-3055
LICENSING EVALUATOR SIGNATURE:

DATE: 06/19/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/19/2019
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: DIAZ & DIAZ FAMILY CHILD CARE
FACILITY NUMBER: 197494224
VISIT DATE: 06/19/2019
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Applicants were informed, Absence of Supervision: including, but not limited to, a child left unattended, a child left alone with a person under 18 years of age, and lack of supervision resulting in a child wandering away. (HSC 1597.58(c)(2)). Regulation(s): 102417(k)(1) Children shall not be left in parked vehicles. Civil penalty applies when a child is left unattended in a parked vehicle.

-A current roster of children enrolled must be available and maintained for a period of three years, even after children no longer are attending the facility.
-Annual fees must be paid promptly and by the due date or a late fee shall be assessed, and/or the License shall be terminated.
-The fire extinguisher type 2A10BC must be serviced annually or as often as necessary and smoke and carbon monoxide detectors should check and batteries replaced as needed.

-Changes should be reported to the Department as soon as they occur such as construction, remodeling, telephone number changes and/or if you move from your home.
-Any unusual incidents or injuries must be reported to the Department within 24 hours via telephone and within seven (7) days in writing. (use LIC624B for written report)
-Fire and safety drills must be performed every six months and documented for review by the Department.
-Smoking is prohibited in a family child care home.

Children and Staff records must be maintained and updated as needed and must be available for review by the Department.


-Dog(s) and or pets are recommended to be isolated from children in care.
Only children eating may be in high chairs and that car seats are utilized only for transportation
- No infant walkers, No Johnny jumpers, No saucer chairs, No trampolines and any other item that falls into that category are not permitted in the facility.
SUPERVISOR'S NAME: Jennie FerreiraTELEPHONE: (424) 301-3067
LICENSING EVALUATOR NAME: Denise MirandaTELEPHONE: (424) 301-3055
LICENSING EVALUATOR SIGNATURE:

DATE: 06/19/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/19/2019
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: DIAZ & DIAZ FAMILY CHILD CARE
FACILITY NUMBER: 197494224
VISIT DATE: 06/19/2019
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LPA advised the licensee how to access forms, regulations and quarterly updates on the Child Care Licensing website at: www.ccld.ca.gov.

In addition, LPA distributed LIC-311D and explained the following forms:

LIC311D: CHILDREN RECORDS: LIC: 700 Identification and Emergency Information, 702 Child’s Pre-admission Health History LIC 995E Caregiver Background Check Process, 995A Notification of Parent’s Rights, 627 Consent For Emergency Medical Treatment, 613A Personal Rights, LIC282 Affidavit Regarding Liability Insurance, LIC9150 Parent Notification, Additional Children in Care.
FACILITY RECORDS: LIC9149 Property Owner/Landlord Consent, PUB 394 Notification of Parents Rights, PUB 269 California Child Passenger Safety Law, LIC 9040 Facility Roster, LIC624A Death Report, LIC6101A Emergency Disaster Plan, LIC9148 Earthquake Preparedness Checklist, LIC 624 Unusual Incident/Injury Report. LIC311D Forms/Records to keep In Your Family Child Care Home, Family Child Care Self-Assessment Guide.
STAFF RECORDS: LIC 508 Criminal Record Statement, LIC 501 Personnel Record, LIC 503 Health Screening/TB, LIC9052 Employee Rights, LIC9108 Statement Acknowledging Requirement to Report Child Abuse, LIC 9163 Request for LIVESCAN, LIC9188 Criminal Record Exemption Transfer Request, LIC 9182 Criminal Background Clearance Transfer Request, LIC9052 Employee Rights.

The licensee was informed of The Child Care Advocate Program (CCAP) that is administered from within the Community Care Licensing Division. CCAP participates in many community activities and special projects in order to disseminate information on the State’s licensing role, provide information to the public and parents on child care licensing, and provide many other helpful resources to the licensees and the public. CCAP’s direct contact information is as followed: Phone number: (916) 654-1541
Email Address: childcareadvocatesprogram@dss.ca.gov
The following were also discussed with the licensee:
Assembly Bill 633: Upon receipt by the licensee, licensees are to provide to parents/guardians t
SUPERVISOR'S NAME: Jennie FerreiraTELEPHONE: (424) 301-3067
LICENSING EVALUATOR NAME: Denise MirandaTELEPHONE: (424) 301-3055
LICENSING EVALUATOR SIGNATURE:

DATE: 06/19/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/19/2019
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: DIAZ & DIAZ FAMILY CHILD CARE
FACILITY NUMBER: 197494224
VISIT DATE: 06/19/2019
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necessary corrections and keep analyst updated.
The off-limit area: located at the main house: bedroom#1, #3, #4 and #5, kitchen, bathroom #2, left side yard, backyard guess house and detached garage. Per applicants the garage is off limit and no care and supervision will be provide in this area.

Applicants has submitted a disaster plan and demonstrated control of property at the above address by presenting rental agreement. The applicant has completed preventive health and safety/Childhood Nutrition and Mandated Reporter training.
There are age appropriate toys and equipment for the children. Per applicants, there are no firearms and weapons on the premises. The valve on the required 2A10BC fire extinguisher indicates fully charged (purchased on 05/2019). Smoke and carbon monoxide detectors were observed and tested during this inspection.
Applicants has proof of CPR and First Aid training as indicated on the certificate. The applicants does have proof of Health and Safety training and Pediatric First Aid and CPR (expires 3/2021).

The following was discussed with the applicants:
Individuals who are 18 years of age or older living in the home must obtain a criminal record clearance. Individuals within one month of their 18th birthday must be fingerprinted immediately. Failure to obtain a criminal record background check clearances prior to initial presence in the home will result in an immediate $100.00 dollar or more per day Civil Penalty. Requirements for fingerprint clearances and associations were discussed with the licensee. Licensee can be cited a civil penalty of $100 per day, up to $500.00 (5 days) for the 1st offense and up to $3000.00 for the 2nd offense within a 12-month period.
In the absence of the licensee a qualified adult must be present supervising the children; a qualified adult is an individual who has a valid and current adult/infant CPR & Pediatric First Aid certification and a valid criminal record clearance associated to the facility license and immunization.
SUPERVISOR'S NAME: Jennie FerreiraTELEPHONE: (424) 301-3067
LICENSING EVALUATOR NAME: Denise MirandaTELEPHONE: (424) 301-3055
LICENSING EVALUATOR SIGNATURE:

DATE: 06/19/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/19/2019
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: DIAZ & DIAZ FAMILY CHILD CARE
FACILITY NUMBER: 197494224
VISIT DATE: 06/19/2019
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-All adults living and working in the home shall be made of aware of the Departments right to inspection authority, which includes but not limited to the right to enter the home when children are being cared for, interview children and adults and review documentation.
- Licensees shall reveal each facility license number in all advertisements, publications or announcements with the intent to attract clients.
- Emergency Disaster Plan, Parent’s Rights Poster and the Facility License are required to be posted.
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. Incidental Medical Services Include: Blood-Glucose Monitoring for Diabetic Children, Administering Inhaled Medication, Administering EpiPen Jr. and EpiPen or other Epinephrine Auto-Injectors, Glucagon Administration, Gastrostomy Tube Care (G-tube care), Insulin Injections Administration, Anti-Seizure Administration, and Carrying out medical orders when the child’s physician has determined that a layperson can be trained and safely carry out the orders. 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.
During this inspection, LPA also provided, consulted and explained the following documents about SIDS. 1) A Child Care Provider’s Guide to Safe Sleep by the American Academy of Pediatrics, 2) 1-844-LET-US-NO, 3) Never ever shake a baby by the California Department of Social Services 4) California School Immunization Record form CDPH286, 5) California Law – Car Seat by California Department of Public Health and 6) Mandate report form PUB458 by California Department of Social Services and 7) Brochure Prohibited items in family child care homes per health &Safety Code$1596.846 (b) and (c) and 8) LIC311D Child Care.
SUPERVISOR'S NAME: Jennie FerreiraTELEPHONE: (424) 301-3067
LICENSING EVALUATOR NAME: Denise MirandaTELEPHONE: (424) 301-3055
LICENSING EVALUATOR SIGNATURE:

DATE: 06/19/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/19/2019
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: DIAZ & DIAZ FAMILY CHILD CARE
FACILITY NUMBER: 197494224
VISIT DATE: 06/19/2019
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New Appeal Process: A licensee may file an appeal, in writing 15 business days from the date of receiving the penalty assessment. All appeals must be sent to:
300 N. Continental Blvd., Suite 290-A
El Segundo, CA 90245

New Immunization Requirement: Law enacted by SB 277, beginning January 1, 2016, personal beliefs exemptions will no longer be an option for the vaccines that are currently required for entry into child care or school in California. Personal beliefs exemptions already on file will remain valid until the child reaches the next immunization checkpoint.
Assembly Bill 1207: California Child Care Workers; Mandated Training Requirement. Beginning January 1, 2018, all licensed providers, applicants, directors and employees must complete Mandated Reported Training prior to March 30, 2018 and renew training every two years at: www.mandatedreporterca.com.
Nutrition Requirement: Beginning January 1, 2016, AB 290 will require for each new license issued, at least one director or teacher at each child care center or family child care home to have at least one hour of training in the importance of childhood nutrition. This applies to anyone submitting a new application, relocating their facility, selling their facility or transferring their license. Please note this training cannot be completed online or by home study programs. The training must be taken from an Emergency Medical Services Authority (EMSA) approved training program OR an accredited college or university.
LPA recommended and applicant agreed to provide the following proof of correction no later than 06/24/2019.
LPA inspected the front yard and observed that all tripping hazardous area shall be repair prior to use the front yard area.

An exit interview was conducted and a copy of this report was provided to Socora Diaz, Applicant and Lisa Diaz and co-applicant, at the conclusion of this inspection
SUPERVISOR'S NAME: Jennie FerreiraTELEPHONE: (424) 301-3067
LICENSING EVALUATOR NAME: Denise MirandaTELEPHONE: (424) 301-3055
LICENSING EVALUATOR SIGNATURE:

DATE: 06/19/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/19/2019
LIC809 (FAS) - (06/04)
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