198001079-5-26-2023-54-CC-FWHE-CS7PK9-20230526112245

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 198001079
Report Date: 05/26/2023
Date Signed: 05/26/2023 11:23:49 AM

Document Has Been Signed on 05/26/2023 11:23 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
MONTEREY PARK S WEST, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME:	SANDOVAL FAMILY CHILD CARE		FACILITY NUMBER:	198001079
ADMINISTRATOR:	SANDOVAL, YOLANDA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(323) 589-1174
CITY:	LOS ANGELES	STATE: CA	ZIP CODE:	90001
CAPACITY:	14	CENSUS:	DATE:	05/26/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	09:00 AM
MET WITH:	Yolanda Sandoval		TIME COMPLETED:	11:45 AM

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At 9:00 a.m. Licensing Program Analysts (LPAs) Franchesca White and T. Tran conducted an unannounced annual inspection at the facility listed above. LPA met with licensee, Yolanda Sandoval, explained the purpose of inspection and provided the inspection Entrance Checklist, LIC 126. Per licensee the hours of operation are Monday-Sunday 4:00am - 9:30 pm. There were six (6) children present during inspection. Individuals residing in the home were discussed and noted. LPA inspected rooms/areas on the facility sketch in which child-care services are provided and to which children have access, as well as off limit areas.

This is a one-story home consisting of three (3) bedrooms, two (2) bathrooms, kitchen,living room and front and back yard(fenced). The children use the bathroom located in Bedroom 1, enter through the living room in the rear of the home, Bedroom 2 (napping area), kitchen areas. The restroom that children use was observed to be safe and sanitary.

Per Licensee, areas off limits to children and parents include: one bedrooms(located in front of the home), and detached garage and storage shed.

At 9:15 a.m., LPAs observed appropriate sleeping arrangements including mats, beds and fitted sheets were observed.

The licensee does understand that licensing staff may have access to off-limit areas during inspection visit if necessary.

At 9:25 a.m., LPAs observed the facility license, Publication (PUB) 394- Notification of Parent Rights and Licensing Form (LIC) 9148- Earthquake Preparedness form posted in the living room/daycare room.

Page 1 – Report Continues

SUPERVISOR'S NAME: Valarie Cook	TELEPHONE: (323) 513-3858
LICENSING EVALUATOR NAME: Franchesca White	TELEPHONE: 323-981-3350
LICENSING EVALUATOR SIGNATURE:	DATE: 05/26/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/26/2023

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
MONTEREY PARK S WEST, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME: SANDOVAL FAMILY CHILD CARE	FACILITY NUMBER: 198001079
	VISIT DATE: 05/26/2023

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10:15 a.m., LPA White observed all the required posted documentation including Facility Roster, Facility Disaster Plan, Parent Rights, Personal Rights, and Fire Drill / Disaster Log posted on the Parent Board.. Most Recent Fire Drill was conducted on 5/5/2023.

The licensee provides food for children in care. The home is observed to be clean and orderly.

Smoke and carbon monoxide detectors were tested and are operable. Fire extinguisher indicated fully charged and was serviced on 07/2022. The home maintains telephone service via cell phone.

There are toys and other age appropriate material available for children. LPAs observed that cleaning compounds are in kitchen inaccessible to children. The bathroom that children use is located in the observed to be clean and free of hazards.

Licensee states that there are no poisons stored in the home and understands that all poisons must be lock, not only inaccessible to children.

Per Licensee there are no firearms or weapons stored in the home.
Isolation area for sick children waiting to be picked up is in living room, away from the other children.

LPA discussed the safe sleep regulations with licensee and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep

LPA also informed licensee 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.

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SUPERVISOR'S NAME: Valarie Cook	TELEPHONE: (323) 513-3858
LICENSING EVALUATOR NAME: Franchesca White	TELEPHONE: 323-981-3350
LICENSING EVALUATOR SIGNATURE:	DATE: 05/26/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/26/2023

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
MONTEREY PARK S WEST, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME: SANDOVAL FAMILY CHILD CARE	FACILITY NUMBER: 198001079
	VISIT DATE: 05/26/2023

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Children’s records were reviewed for (LIC) 282- Affidavit Regarding Liability Insurance, Immunization's Records, LIC 700- Identification and Emergency Information, LIC 627- Consent for Medical Treatment, and LIC 995A Notification of Parents’ Rights.

Licensee records were reviewed for approved Pediatric First Aid and CPR certification for Licensee and Assistant dated for 9/2023, LIC-501: Personnel Record, LIC 508-Criminal Record Statement, LIC 9052- Employee Rights, Proof of immunizations against measles, pertussis and influenza or influenza declination, TB clearance or risk assessment, LIC 9108- Statement Acknowledging Requirement to Report Child Abuse and current Mandated Reporter Training Certificate (3/15/2023) for Licensee and Assistant.

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.

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

Licensee was reminded that all adults 18 and over living or working in the home, 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 licensed Family Child Care Home. A civil penalty of $100.00 minimum/day up to $500.00 maximum per day/per person will be assessed if this regulation is violated.

To improve the quality and value of the new inspection process, a survey will be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or tools, please send them by email to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/inspection-process.

Based on the LPA's observations and records review no deficiencies were cited at this time. A notice of site visit was given and must remain posted for 30 days.

Exit interview conducted and report was reviewed with the facility representative, Yolanda Sandoval.

SUPERVISOR'S NAME: Valarie Cook	TELEPHONE: (323) 513-3858
LICENSING EVALUATOR NAME: Franchesca White	TELEPHONE: 323-981-3350
LICENSING EVALUATOR SIGNATURE:	DATE: 05/26/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/26/2023

LIC809 (FAS) - (06/04)

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