198002467-11-22-2019-33-CC-LGOZ-BJ6V53-20191122150715

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 198002467
Report Date: 11/22/2019
Date Signed: 11/22/2019 03:07:28 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME:	LUIS, MELINDA FAMILY DAY CARE		FACILITY NUMBER:	198002467
ADMINISTRATOR:	LUIS, MELINDA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(323) 258-5330
CITY:	LOS ANGELES	STATE: CA	ZIP CODE:	90065
CAPACITY:	14	CENSUS: 4	DATE:	11/22/2019
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	12:51 PM
MET WITH:	Melinda Luis		TIME COMPLETED:	03:21 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	Licensing Program Analyst (LPA) Lissete Gonzalez conducted an unannounced annual random site inspection to ensure the health & safety standards as required by regulations governing family child care homes. Upon arrival, LPA met with Licensee, Melissa Luis, who guided LPA on a tour of the facility. Also present during today’s visit was the Licensee’s husband (fingerprint clearance on file). Additional individuals residing in the home include Licensee’s adult son (fingerprint clearance on file). There were 4 children present. Per Licensee, there are 5 children enrolled. The facility roster was reviewed and is current. Licensee’s operating hours are from 6:00 a.m. to 5:00 a.m. from Monday through Friday. This is a two story home which consists of 3 bedrooms, 2 bathrooms, kitchen, dining room, living room, garage and backyard (fenced). The children use one bathroom, living room and dining room. The Licensee states that she takes the children to the park to play. Licensee states she supervises children at all times. Per licensee, areas off limits to children and parents include: 3 bedrooms, licensee's bathroom, kitchen and detached garage. The LPA toured all areas used by children during this visit. There are no firearms or poisons on the premises as stated by Licensee. LPA observed a water fountain in the front yard which is barricaded and inaccessible to children in care. LPA inspected the living room used by children. There are adequate age appropriate toys, books, and games. No hazards or violations were observed. There is proper ventilation through the home. The dining room used by the children was inspected. No hazards of violations were observed. Knives, sharp objects, detergents, and cleaning compounds are stored in the kitchen which is inaccessible. LPA observed a child safety gate barricading the entrance to the kitchen. LPA inspected the bathroom used by the children. No hazards or violations observed. There are electrical outlet covers throughout and a First Aid kit is available. Licensee has the Parent’s Rights poster and other appropriate forms posted on a board in the living room. REPORT CONTINUES ON NEXT PAGE: 1 OF 3

SUPERVISOR'S NAME: Christina Gabelman	TELEPHONE: (323) 981-3380
LICENSING EVALUATOR NAME: Lissete Gonzalez	TELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:	DATE: 11/22/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/22/2019

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)

Page: 1 of 4

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME: LUIS, MELINDA FAMILY DAY CARE	FACILITY NUMBER: 198002467
	VISIT DATE: 11/22/2019

NARRATIVE

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Licensee, Melinda Luis’ First Aid/Infant CPR certificates are valid through 01/27/2020. Licensee's disaster drill log notes last drill conducted on 9/24/19. Licensee has a working telephone.

LPA observed the 2A10BC fire extinguisher located in the hallway to be fully charged and was last serviced on 4/18/2019. There is an operational smoke detector and an operational carbon monoxide detector in the home. Licensee states there are not pets.

Staff file was reviewed and found to be complete. Children’s files were reviewed for proper documentation. Child #2, Child #3, and Child #5 did not have the required LIC 9224 for licensing report dated 07/02/19.

The following were discussed: Individuals who are 18 years of age or older living in the home must be finger print cleared prior to being in the presence of the children in care. Individuals within one month of their 18th birthday must be fingerprinted immediately. No smoking, No infant walkers, No baby bouncers, No Johnny jumpers, No exersaucers and any other item that falls into that category. LPA discussed disaster drills, posting requirements, children records requirements, mandated child abuse and injury/death reporting. LPA reviewed LIC 311D with licensee, reminding her of required forms. LPA reviewed SIDs, Never Shake A Baby, and safe sleeping practices. Infants should sleep mouth up, on their backs, free of clutter surrounding their sleeping space.

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

A qualified Assistant must be present and actively involved in caring for children whenever nine (9) or more children are present at the facility in a large family child care home.

LPA advised the licensee how to access forms, regulations and quarterly updates on the Child Care Licensing
REPORT CONTINUES ON NEXT PAGE: 2 OF 3

SUPERVISOR'S NAME: Christina Gabelman	TELEPHONE: (323) 981-3380
LICENSING EVALUATOR NAME: Lissete Gonzalez	TELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:	DATE: 11/22/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/22/2019

LIC809 (FAS) - (06/04)

Page: 2 of 4

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME: LUIS, MELINDA FAMILY DAY CARE	FACILITY NUMBER: 198002467
	VISIT DATE: 11/22/2019

NARRATIVE

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website at: www.ccld.ca.gov

Based on this information, the following deficiencies listed on the attached LIC 809d are being cited in accordance with California Code of Regulations Title 22. Deficiencies that are being cited need to be cleared to protect the children’s health & safety.

Exit interview was conducted with Licensee, Melinda Luis. The Licensee was provided a copy of the appeal rights (LIC 9058) and their signature on this form acknowledges receipt of these forms.

A copy of the LIC 9213 was given to licensee—Notice of Site Visit. The Notice of Site Visit (LIC 9213) – must
remain posted for 30 days during the hours of operation after each site visit by a licensing representative.
Failure to maintain posting as required will result in a civil penalty of $100.00.

END OF REPORT: PAGE 3 OF 3

SUPERVISOR'S NAME: Christina Gabelman	TELEPHONE: (323) 981-3380
LICENSING EVALUATOR NAME: Lissete Gonzalez	TELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:	DATE: 11/22/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/22/2019

LIC809 (FAS) - (06/04)

Page: 3 of 4

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME: LUIS, MELINDA FAMILY DAY CARE	FACILITY NUMBER: 198002467
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 11/22/2019

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 11/27/2019 Section Cited	1 2 3 4 5 6 7	A licensed child day care facility shall provide to the parents or guardians of each child receiving services in the facility copies of any licensing report that documents any Type A citation...Upon enrollment of a new child in a facility, the licensee shall provide to the parents or legal guardians of the newly enrolling child copies of any licensing report
	8 9 10 11 12 13 14	that the licensee has received during the prior 12-month period that documents any Type A citation...This requirement was not met as evidence by: Child #2, #3, and #5 did not have the required LIC 9224 for the report dated 07/02/19. This poses a potenial risk to the health and safety of children in care.	8 9 10 11 12 13 14
	1 2 3 4 5 6 7
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

SUPERVISOR'S NAME: Christina Gabelman	TELEPHONE: (323) 981-3380
LICENSING EVALUATOR NAME: Lissete Gonzalez	TELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:	DATE: 11/22/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/22/2019

LIC809 (FAS) - (06/04)

Page: 4 of 4