197494372-5-13-2020-30-CC-ARAZ-BPKSDM-20200513134721

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 197494372
Report Date: 05/13/2020
Date Signed: 05/13/2020 01:48:27 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:	VERA FAMILY CHILD CARE		FACILITY NUMBER:	197494372
ADMINISTRATOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY:	8	CENSUS: 0	DATE:	05/13/2020
TYPE OF VISIT:	Prelicensing	ANNOUNCED	TIME BEGAN:	10:00 AM
MET WITH:	Graciela Vera		TIME COMPLETED:	01:00 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	On 5/13/2020 at 10:00 AM Licensing Program Analyst (LPA) Angelica Ramirez conducted an announed Pre-Licensing tele-inspection with applicant Graciela Vera via Facetime due to the current public health crisis (COVID-19). The applicant guided the LPA on a virtual tour of the facility. This inspection was conducted in Spanish. Areas identified on the facility sketch were inspected. This is a one-story home with three bedrooms and two bathrooms. Two bedrooms and one master bedroom with a bathroom inside of the master. The home has central heating and air. There are no bodies of water on the property. Residing in the home is applicant, spouse, biological daughter (age 24), and one biological son (age 15). Applicant intends to provide meals for day care children. The home was inspected inside and out for safety, comfort, cleanliness, telephone service, heating and ventilation, poisons, detergents/cleaning compounds, medication and hazardous items that can pose a danger to children. LPA observed age appropriate safe toys and napping equipment (cots & crib) on the premises. Per applicant, the children will nap in the living daycare room. The home was inspected as follows: Living room, Dining room, Kitchen, three bedrooms, two bathrooms, Laundry room, day care room, front and back yard, and the detached garage. Areas that are inaccessible to children are as follows: Three bedrooms, one bathroom (located in master), laundry room (located off daycare room), side yard (A/C unit), and the detached garage. Areas that are accessible to children are as follows: living room, dining room, kitchen and Bathroom that is off the hallway adjacent to the dining room, and backyard. Fire extinguisher (2A10BC) is up to date and applicant purchased on 3/22/2020. Applicant has a Smoke Detector and Carbon Monoxide Detector in the dining room and day care room. Tested and operating.

SUPERVISOR'S NAME: Sharalyn Jenkins-Sweeten	TELEPHONE: (424) 301-3077
LICENSING EVALUATOR NAME: Angelica Ramirez	TELEPHONE: (424) 301-3071
LICENSING EVALUATOR SIGNATURE:	DATE: 05/13/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/13/2020

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: VERA FAMILY CHILD CARE	FACILITY NUMBER: 197494372
	VISIT DATE: 05/13/2020

NARRATIVE

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Medications were observed to be kept away from children in the upper kitchen cabinet, a latch will be added. Cleaning products are kept in the kitchen (underneath the sink), latched and inaccessible.
Facility Administration: Pediatric First Aid and CPR expires 2/16/2021 for the applicant, immunizations are on file.

The following was discussed with the applicant:
· 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. If the aforementioned is not adhered to, a Civil Penalty of up to $500, per non-cleared adult will be assessed immediately. Please advise your analyst of any person who will be visiting regularly or for longer than one week.
· 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.
· Commencing September 1, 2016, a person shall not be employed or volunteer at a family day care home if he or she has not been immunized against influenza, pertussis, and measles. Each employee and volunteer shall receive an influenza vaccination between August 1 and December 1 of each year. The family day care home shall maintain documentation of the required immunization's or exemptions from immunization, as set forth in this section, in the person’s personnel record that is maintained by the family day care home.
· 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 2A-10BC must be serviced annually or as often as necessary. Smoke and carbon monoxide detectors should be checked, and batteries should be replaced.
· Changes should be reported the to the Department as soon as they occur such as construction and remodeling
· Telephone number changes and/or if you move from home
· Any unusual incidents or injuries must be reported to the Department within 24 hours via telephone and within seven (7) days in writing.
· Fire and safety drills must be performed every six months and documented for review by the Department.

SUPERVISOR'S NAME: Sharalyn Jenkins-Sweeten	TELEPHONE: (424) 301-3077
LICENSING EVALUATOR NAME: Angelica Ramirez	TELEPHONE: (424) 301-3071
LICENSING EVALUATOR SIGNATURE:	DATE: 05/13/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/13/2020

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: VERA FAMILY CHILD CARE	FACILITY NUMBER: 197494372
	VISIT DATE: 05/13/2020

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· There is an effective 24/7 ban on smoking tobacco in a home that is licensed as a family day care home, and in those areas of the family day care home where children are present.
· Children and Staff records must be maintained and updated as needed and must be available for review by the Department.
· Saucer chairs, bouncers, walkers, or any similar items are prohibited.
· 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.
· Emergency Disaster Plan, Parent’s Rights Poster and the Facility License are required to be posted.
· LPA advised the applicant how to access forms, regulations and quarterly updates on the Child Care Licensing website at: www.ccld.ca.gov

The applicant 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 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: childcareadvocatesprogram@dss.ca.gov

AB 1207: Beginning on January 1, 2018, this law requires all licensed providers, applicants, directors and employees to complete training as specified on their mandated reporter duties and to renew their training every two years. Volunteers are encouraged but not required to take the training. Website: www.mandatedreporterca.com

Update on Incidental Medical Services (IMS):
Facilities that provide Incidental Medical Services (IMS) must identify those services in their facility’s Plan of Operation and submit an updated Plan of Operation to the Department.
IMS Include: Blood-Glucose Monitoring for Diabetic Children, Administering Inhaled Medication, Administering Epinephrine Auto-Injectors, Glucagon Administration, Gastrostomy Tube Care (G-tube care), Insulin Injections Administration, Anti-Seizure Administration, and Emptying an Ileostomy Bag. Incidental Medical Services (IMS) policy was discussed.

SUPERVISOR'S NAME: Sharalyn Jenkins-Sweeten	TELEPHONE: (424) 301-3077
LICENSING EVALUATOR NAME: Angelica Ramirez	TELEPHONE: (424) 301-3071
LICENSING EVALUATOR SIGNATURE:	DATE: 05/13/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/13/2020

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: VERA FAMILY CHILD CARE	FACILITY NUMBER: 197494372
	VISIT DATE: 05/13/2020

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For further 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.
Currently, the facility does not provide Incidental Medical Services - IMS.
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

SIDS & SHAKEN BABY SYNDROME INFORMATION discussed.
Safe Sleep Practices were also discussed with the applicant. When putting infants down for naps or long periods of sleep, the children must be placed on their backs, in a crib, on a firm mattress with nothing in the crib except for a fitted sheet over the mattress. The child should be physically monitored every 15 minutes along with their temperatures, color of skin, and breathing.

Children’s records requirements:
· LIC 700 Identification and Emergency Information
· LIC 627 Consent for Emergency Medical Treatment
· LIC 282 Affidavit Regarding Liability Insurance
· LIC 9150 Parent Notification Additional Children in Care
· Immunization record
· PUB 72- Family Child Care Consumer Guide
· LIC 995A Notification of Parent’s Rights

FORMS TO BE POSTED
· LIC203 Facility License
· LIC 610A Emergency Disaster Plan
· LIC 9148 Earthquake Preparedness Checklist
· PUB394 Notification of Parents Rights Poster

SUPERVISOR'S NAME: Sharalyn Jenkins-Sweeten	TELEPHONE: (424) 301-3077
LICENSING EVALUATOR NAME: Angelica Ramirez	TELEPHONE: (424) 301-3071
LICENSING EVALUATOR SIGNATURE:	DATE: 05/13/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/13/2020

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: VERA FAMILY CHILD CARE	FACILITY NUMBER: 197494372
	VISIT DATE: 05/13/2020

NARRATIVE

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FACILITY RECORDS:
· LIC 624B Unusual Incident/Injury Report
· LIC 9040 Child Care Facility Roster
· LIC 9052 Employee Rights,
· LIC 9108 Statement Acknowledging Requirement to Report Child Abuse
· LIC 9149 Property Owner/Landlord Consent Form
· LIC 9151 Property Owner/Landlord Notification Form
· Proof of current pediatric CPR and First Aid Certificates
· Copy of your deed or lease/rental agreement
· Documentation of Fire and Disaster drills
· Proof of immunizations against pertussis (TDAP), measles (MMR), and influenza
· Mandated Reporter certificate – www.mandatedreporterca.com – renewed every two years

A complete packet that includes the documents listed above, as well as a ratio flyer, were emailed to and discussed with the applicant during this inspection.

The following items are pending prior to licensure to be completed by 5/20/2020.
· Update facility sketch with off limits areas
· Add latches to lower kitchen cabinet (right hand side) & cabinets with meds & cleaning products, move knives
· Add lock to closet with detergents in dining room
· Add latch to two white cabinets in daycare bathroom

Exit interview was conducted with the applicant. A copy of this report and all other Licensing reports must be made available to the public for 3 years. A copy of this report was emailed to the applicant with a read receipt request attached.

SUPERVISOR'S NAME: Sharalyn Jenkins-Sweeten	TELEPHONE: (424) 301-3077
LICENSING EVALUATOR NAME: Angelica Ramirez	TELEPHONE: (424) 301-3071
LICENSING EVALUATOR SIGNATURE:	DATE: 05/13/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/13/2020

LIC809 (FAS) - (06/04)

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