197494524-7-20-2021-30-CC-LCLN-C54RZP-20210720132815

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 197494524
Report Date: 07/20/2021
Date Signed: 07/20/2021 01:28:30 PM

COMPREHENSIVE INSPECTION

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:	PEREZ FAMILY CHILD CARE		FACILITY NUMBER:	197494524
ADMINISTRATOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY:	8	CENSUS:	DATE:	07/20/2021
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	10:30 AM
MET WITH:	Johana Perez, Licensee		TIME COMPLETED:	01:40 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 7/20/2021 at 11am Licensing Program Analyst (LPA) Clayton made an unannounced visit to the Perez Family Child Care home for the purpose of conducting a Required-1-year Annual visit. Upon arrival LPA was greeted by licensee Johana Perez. Also present during the inspection was the licensee’s fingerprint cleared father Miguel Guerrero Ruiz, and 6 children in care, including the licensees 1-year old daughter. The following was observed: Current roster First Aid Kit with the required supplies; scissors, bandages; antibacterial ointments, thermometer and tweezers. Facility files was reviewed and is up to date Children were observed eating lunch in the childcare area of the home. LPA toured the home inside and outside for a Health and Safety inspection. Current facility sketch was reviewed, and Licensee confirmed that the master bedroom /daycare area and 1 bath (located in the rear) of the home and the back yard are accessible to children in care. The living room is to be used as an isolation area. All other rooms (2 bedrooms, 1 bathroom, kitchen) are off-limits and made inaccessible by use of locked doors and supervision. There is no swimming pool or other bodies of water on the premises. There are no firearms or ammunition on the premises. Detergents, cleaning compounds, medication and other hazardous items are made inaccessible. There is a fully charged 3A10BC fire extinguisher, working smoke detector/carbon monoxide detector and adequate heating and ventilation for safety and comfort. There are no stairs in this home. Safe toys and play equipment are observed. The home has working telephone service and LPA confirmed the phone number is 323-304-6887. continued on LIC 809C

SUPERVISOR'S NAME: Mary Ruiz	TELEPHONE: (424) 301-3061
LICENSING EVALUATOR NAME: Lisa Clayton	TELEPHONE: (424) 301-3206
LICENSING EVALUATOR SIGNATURE:	DATE: 07/20/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/20/2021

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, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245

FACILITY NAME: PEREZ FAMILY CHILD CARE	FACILITY NUMBER: 197494524
	VISIT DATE: 07/20/2021

NARRATIVE

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LPA reviewed 2 children’s files and observed files were complete with emergency information as required. Licensee’s Mandated Reporter Training is due for renewal in October 2021. Licensee’s pediatric CPR/First Aid expires on 9/30/2021. Capacity as specified on the license is being maintained. LPA instructed licensee to submit a current Flu Declination via fax or email. All adults who reside or work in the home have a criminal record clearance.
Licensee ensures that children in care are supervised at all times and is aware that children shall not be left in parked vehicles. Car seats are used for transportation purposes only and are not used for sleeping children.
LPA discussed Safe Sleep Regulations with licensee. There is one crib or play yard for each infant in care, cribs and play yards are kept free from all loose articles and objects while infants are sleeping, and there are no objects hanging above or attached to the crib or play yard. Infants are not swaddled while in care. Provider physically checks on sleeping infants every fifteen minutes and documents any signs of distress which includes but is not limited to flushed skin color, increase in body temperature, restlessness and labored breathing. Infants can be visually observed through an open door if sleeping in a separate room. Individual Infant Sleeping Plan is completed and in file for each infant up to 12 months of age. Infants up to 12 months of age are placed on their backs for sleeping.
Incidental Medical Services (IMS) are not currently being provided. Licensee is aware that an IMS plan is required to be submitted to the licensing office if they provide any of these services. Information regarding Americans with Disability Act (ADA) can be obtained by contacting US Department of Justice toll free ADA Information line at (800) 514-0301(voice), (800) 514-0383 (TDD) and website link https://www.ada.gov/childqanda.htm.
LPA and Licensee discussed the Community Care Licensing website www.ccld.ca.gov which will provide access to Provider Information Notices (PINs), Quarterly Updates, COVID-19 Information and Resources, Mandated Reporter Training, Safe Sleep in Child Care, Lead Poisoning Facts, Forms and Regulations.
Per Title 22, Division 12, Chapter 3, of the California Code of Regulations, no deficiencies are cited.

An Exit interview was conducted. This report shall be made available to the public upon request. LIC 9213 Notice of Site Visit is provided and required to be posted for 30 days.

SUPERVISOR'S NAME: Mary Ruiz	TELEPHONE: (424) 301-3061
LICENSING EVALUATOR NAME: Lisa Clayton	TELEPHONE: (424) 301-3206
LICENSING EVALUATOR SIGNATURE:	DATE: 07/20/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/20/2021

LIC809 (FAS) - (06/04)

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