197495032-5-20-2022-30-CC-JLAO-CELM3Z-20220520091555

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 197495032
Report Date: 05/11/2022
Date Signed: 05/20/2022 09:17:13 AM

Document Has Been Signed on 05/20/2022 09:17 AM - 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:	MONTEIRO FAMILY CHILD CARE		FACILITY NUMBER:	197495032
ADMINISTRATOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY:	8	CENSUS: 6	DATE:	05/11/2022
TYPE OF VISIT:	Case Management - Other	ANNOUNCED	TIME BEGAN:	09:30 AM
MET WITH:	Shavon Monteiro		TIME COMPLETED:	11:30 AM

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 5/11/2022 Licensing Program Analyst (LPA) Judy Laureano conducted an announced inspection with applicant, Shavon Monteiro, for the purpose of an increase of capacity inspection of 4161 4th Avenue, Los Angeles, CA 90008. The purpose of this inspection 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. The applicant is applying for an increase of capacity- large family childcare license with a max capacity of 14. Applicant was licensed at location on 3/2022. Applicant was previously licensed at 513 S. Mariposa Avenue #302, Los Angeles, CA 90020- Facility # 198017801. Applicant resides in the home with her 3 minor children. Property owner/landlord consent (LIC 9151) is currently on file. Lease agreement/control of property was received. Per the application, currently, the ages the applicant wishes to provide services for children 2-months to 12 years old with the hours of operation of 24 hours a day Monday through Friday. Applicant will be available for overnight care. Applicant 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. LPA toured the home and reviewed facility sketch with applicant. LPA observed 6 children and applicant and two adults providing care and supervision. All adults have a current criminal background clearance on file. The home is a single-family two story home with 3 bedrooms, 2 bathrooms, living room, den, Kitchenette, Kitchen and laundry room. Home has both a front yard and a back yard, back yard is enclosed with a wooden gate. The home does have an detached garage that

SUPERVISOR'S NAME: Claudia Escobedo	TELEPHONE: (424) 301-3044
LICENSING EVALUATOR NAME: Judy Laureano	TELEPHONE: (424) 301-3060
LICENSING EVALUATOR SIGNATURE:	DATE: 05/11/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/11/2022

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: MONTEIRO FAMILY CHILD CARE	FACILITY NUMBER: 197495032
	VISIT DATE: 05/11/2022

NARRATIVE

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will be OFF LIMITS to the children in care. Applicant confirmed that the second floor is off limits to the children in care. LPA observed a safety gate at the bottom of the stairs and a safety gate at the top of the stairs.

Entering the home, LPA observed the entry way where parents will arrive, and children will complete a wellness check. The parent board was observed to be in the entry way of the home. All necessary posting were observed by LPA. A storage closet across from the main entrance was observed to have extra day care supplies and napping cots.

Entering the living room, LPA observed a safety gate making the main door inaccessible to the children in care. The living room was observed to have a fire place barricaded with a metal gate and a children’s storage unit. Applicant confirmed she will not be using the fire place. A television set was observed to be mounted above the fire place. LPA observed a couch and a child size cubbie with age appropriate toys. LPAs observed children’s size desks, children size tables with soft chairs and a variety of cubbies for children to use. A First Aid Kit was observed by the main door.

Next to living room LPA observed the den area to have 4 pack and plays, a changing table and additional toys for children to use. A safety gate was observed at all entry ways. All electrical outlets were covered.

Next to the den, a safety gate was observed making bedroom 1 and the basement inaccessible to the children in care. LPA observed all door to have a plastic doorknob
cover making the areas in accessible.

The bathroom that children will use is located next to bedroom 1. A toilet, sink, cabinets and shower were inspected. 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 handwashing sign for children to view.

SUPERVISOR'S NAME: Claudia Escobedo	TELEPHONE: (424) 301-3044
LICENSING EVALUATOR NAME: Judy Laureano	TELEPHONE: (424) 301-3060
LICENSING EVALUATOR SIGNATURE:	DATE: 05/11/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/11/2022

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: MONTEIRO FAMILY CHILD CARE	FACILITY NUMBER: 197495032
	VISIT DATE: 05/11/2022

NARRATIVE

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The kitchenette was observed to be next to the kitchen, one is able to enter the kitchenette through the den and kitchen area. The kitchenette was observed to have a dinning room table, a high chair and a water dispenser. All electrical outlets were covered. Fire pull station was observed in the space.

Outside the kitchenette you are able to access the kitchen. A safety gate was observed making the kitchen inaccessible. Kitchen cabinets were observed to have safety latches. The stove, 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, LPAs advised applicants to use disposable paper goods. LPA observed two working fire extinguishers next to the stove. LPA observed applicant test the carbon monoxide and smoke detector.

The kitchen leads you to the laundry room and has been designated off limits. Laundry room was observed to have a side door that leads to the backyard.
The backyard and side of the yard have been designated as the outdoor area that children will use. LPA observed age appropriate toys such as children’s size basketball set and outdoor children’s size plastic slides. LPA observed a canopy offering a shaded area for children in care.

LPA observed the garage that has been designated as OFF LIMITS to the children in care and will remain locked during the hours of operations.

LPA observed the second story to have storage closet, bedroom 2, bathroom 2 and bedroom 3; all designated as off limits to the children in care. LPA observed bedroom 3 to have a door that lead to a patio area. Applicant confirmed all areas in the 2nd floor are off limits.

SUPERVISOR'S NAME: Claudia Escobedo	TELEPHONE: (424) 301-3044
LICENSING EVALUATOR NAME: Judy Laureano	TELEPHONE: (424) 301-3060
LICENSING EVALUATOR SIGNATURE:	DATE: 05/11/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/11/2022

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: MONTEIRO FAMILY CHILD CARE	FACILITY NUMBER: 197495032
	VISIT DATE: 05/11/2022

NARRATIVE

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The following areas are off limits to the children in care:
Second Story: Bedroom 2, Bedroom 3 with the Patio and Bathroom 2
First Floor: Bedroom 1 and Basement

LPA observed all door to have plastic doorknob covers to make the areas inaccessible as well as safety gates in all entry ways of the home. LPA did not observe any firearms or bodies of water in the home.

No corrections were observed during today’s inspections.

Exit interview was conducted with applicant Shavon Monteiro. The licensing determination of this application will be reviewed with Licensing Program Manager for final resolution.

SUPERVISOR'S NAME: Claudia Escobedo	TELEPHONE: (424) 301-3044
LICENSING EVALUATOR NAME: Judy Laureano	TELEPHONE: (424) 301-3060
LICENSING EVALUATOR SIGNATURE:	DATE: 05/11/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/11/2022

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: MONTEIRO FAMILY CHILD CARE	FACILITY NUMBER: 197495032
	VISIT DATE: 05/11/2022

NARRATIVE

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The following was discussed with the applicant:
Applicant was made aware 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 childcare 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

Immunizations: Commencing September 1, 2016, SB 792, prohibits a person from being employed or volunteering at a childcare facility or family day care if he or she has not been immunized against influenza, pertussis and measles. LPA discussed the influenza waiver during the inspection.

Mandated Reporter Training: Beginning on January 1, 2018, AB 1207, 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. Licensee was reminded of their responsibility to report suspected child abuse.

LPA reviewed with applicant the LIC 311D, Forms/Records To Keep In Your Family Child Care Home, children’s forms/records, family forms/records, and information to be posted.

LPA also informed applicant of the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at https://www.cpsc.gov/ and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment.

SUPERVISOR'S NAME: Claudia Escobedo	TELEPHONE: (424) 301-3044
LICENSING EVALUATOR NAME: Judy Laureano	TELEPHONE: (424) 301-3060
LICENSING EVALUATOR SIGNATURE:	DATE: 05/11/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/11/2022

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: MONTEIRO FAMILY CHILD CARE	FACILITY NUMBER: 197495032
	VISIT DATE: 05/11/2022

NARRATIVE

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This facility plans to provide Incidental Medical Services – IMS. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Family Child Care Homes Section 102417. 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

· Applicant was reminded that all adults 18 and over responsible for administration or direct supervision of staff, persons who provides care and supervision to children, and staff who have contact with children, including employees and volunteers, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a Child Care Center. A civil penalty of $100.00 minimum/day up to $500.00 maximum per day/per person will be assessed.

· 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. · 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. (If paying by check please make sure to write facility number on check to ensure that payment is applied to your facility number)
· 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.
· Reporting requirements: Applicant must report any unusual incident or injuries to the Child Care Regional office by telephone within 24 hours and in writing within 7 days. Applicant was provided with LIC 624 as a reference.
· Fire and safety drills must be performed every six months and documented for review by the Department.
· 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.

SUPERVISOR'S NAME: Claudia Escobedo	TELEPHONE: (424) 301-3044
LICENSING EVALUATOR NAME: Judy Laureano	TELEPHONE: (424) 301-3060
LICENSING EVALUATOR SIGNATURE:	DATE: 05/11/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/11/2022

LIC809 (FAS) - (06/04)

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