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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197494524
Report Date: 05/26/2022
Date Signed: 05/26/2022 02:23:56 PM


Document Has Been Signed on 05/26/2022 02:23 PM - It Cannot Be Edited

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 CAREFACILITY NUMBER:
197494524
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY:8CENSUS: 3DATE:
05/26/2022
TYPE OF VISIT:Case Management - Licensee InitiatedANNOUNCEDTIME BEGAN:
12:04 PM
MET WITH:Johana Perez, LicenseeTIME COMPLETED:
02:25 PM
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On 5/26/2022 at 12:00 pm, Licensing Program Analyst (LPA) Silva Garibyan conducted an announced inspection with Johana Perez for the purpose of an increase of capacity inspection for 938 McFarland Ave, Wilmington, CA 90744. The purpose of this increase of capacity visit is to ensure the standards for a Family Child Care Home are being met in accordance to California Tittle 22 Regulations and California Health and Safety Codes. There were three children ( no infants) present at the time of the visit.

The licensee is applying for an increase of capacity; Large Family Child Care Home license for a maximum capacity of 14. A fire clearance was approved by LA City Fire Department on 5/47/2022. Facility was licensed for a Small (8) Family Child Care Home on 07/06/2020.

The capacity of the Large Family Child Care Home is 14. Per the application, at this time, the ages the applicant wishes to provide services for are children birth to 12 years old with the hours of Monday- Sunday from 6:00 a.m. to 12:00 a.m. Licensee was informed that any changes to ages, hours and days of operation shall be submitted to the department for approval prior to initiation of changes.

The home is a single story, 3 bedrooms, 2 bathroom house, with a living room/ kitchen, attached garage. Attached garage is accessible through living room/kitchen. Currently residing in the home is licensee and her minor daughter ( 2 years old).

Parents enter the home through main door. Entering the front door, LPA observed the Fire Alarm pull station in the hallway and Parent board outside the entry door. LPA discussed all necessary forms that need to be included on the board.

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SUPERVISOR'S NAME: Karren StarksTELEPHONE: (424) 301-3069
LICENSING EVALUATOR NAME: Silva GaribyanTELEPHONE: (424) 301-3062
LICENSING EVALUATOR SIGNATURE:
DATE: 05/26/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/26/2022
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: 05/26/2022
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LPA observed licensee test the carbon monoxide detector located in the hallway.

The attached garage observed and designated to be OFF LIMITS to the children in care. Applicant confirmed that door will remain locked during the hours of operations.

The kitchen area was observed to have a Fire Extinguisher mounted on the wall. The stove was observed to have plastic covers on the knobs. Refrigerator sink and counter space area were observed and inspected. Knifes and sharp object were observed to be made inaccessible to the children in care. Applicant confirmed that facility will be providing meals and snacks. LPA discuss food preparation, storage and ensuring a log and information regarding dietary restrictions and allergies are kept up to date. As a COVID precautions, LPA advised applicant to use disposable paper good. Kitchen is used as a walkway to other rooms.

Bathroom was observed to have a toilet, sink and under the sink cabinet. All electric outlets were covered and cabinet under the sink was secured with a safety latch. LPA discussed COVID-19 recommendation such as using paper towels and displaying a hand-washing sign for children to view.

LPA observed a variety of age appropriate materials, children’s size tables and chairs, one high chair and two cribs. The bedroom was observed to have children’s size cubbies.

The outdoor area/back yard is accessed through the bedroom. LPA observed a variety of age appropriate outdoor toys. A tarp/canopy is set up to provide a shaded area for children.

There is no swimming pool or other bodies of water on the premises. There are no firearms or ammunition on the premises.

The applicant have completed preventive health and safety/Childhood Nutrition/ Lead Exposure Prevention and Mandated Reporter training ( completed on 10/2020). The applicant has current pediatric CPR/First Aid training that will expire in September of 2023. Licensee's immunization records are up to date

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SUPERVISOR'S NAME: Karren StarksTELEPHONE: (424) 301-3069
LICENSING EVALUATOR NAME: Silva GaribyanTELEPHONE: (424) 301-3062
LICENSING EVALUATOR SIGNATURE:

DATE: 05/26/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/26/2022
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: 05/26/2022
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There are currently no infants enrolled in care. LPA discussed Safe Sleep Regulations with licensee: 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.

Licensee ensures that children in care are supervised at all times and is aware children shall not be left in parked vehicles. Car seats are used for transportation purposes only and are not used for sleeping children. The outdoor play area in the backyard is fenced and there are no hazards to children present. Capacity as specified on the license is being maintained.

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.


All adults who reside or work in the home have a criminal record clearance or exemption. There are no excluded individuals present at this home.

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.

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. Page 3

SUPERVISOR'S NAME: Karren StarksTELEPHONE: (424) 301-3069
LICENSING EVALUATOR NAME: Silva GaribyanTELEPHONE: (424) 301-3062
LICENSING EVALUATOR SIGNATURE:

DATE: 05/26/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/26/2022
LIC809 (FAS) - (06/04)
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