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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198003557
Report Date: 09/26/2019
Date Signed: 09/26/2019 11:10:07 AM

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:RODRIGUEZ FAMILY CHILD CAREFACILITY NUMBER:
198003557
ADMINISTRATOR:RODRIGUEZ, INGRIDFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(818) 802-6015
CITY:GLENDALESTATE: CAZIP CODE:
91202
CAPACITY:14CENSUS: 9DATE:
09/26/2019
TYPE OF VISIT:Required - 3 YearUNANNOUNCEDTIME BEGAN:
08:05 AM
MET WITH:Ingrid Rodriguez, LIcenseeTIME COMPLETED:
11:20 AM
NARRATIVE
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Licensing Program Analysts (LPA) Anomeh Eivazian and Alanna Gontarek conducted an unannounced required 3 year inspection. LPAs met with licensee, Ingried Rodriguez who guided analyst on a tour of the facility. Also present was Jocelyne Rodriguez, licensee's assistant/daughter. There were 9 children present during this inspection, 3 being infants. Ms. Rodriguez states that there are currently 9 children enrolled, children's roster was reviewed but it was not current. Disaster drill log was not available.

This is a one story home which consists of 2 bedrooms, 1 bathroom, kitchen, dining room, living room, converted garage in the backyard, front yard and back yard (fenced). The children use the living room, 1 bathroom in the main house, 1 bedroom, detached converted garage, and backyard yard (fenced). Per licensee, areas off limits to children and parents include: 1 bedroom and front yard. Parents enter the facility through back door which leads to the backyard.

Upon LPAs arrival to the facility, LPAs observed children in the detached converted garage, LPAs observed children's napping cots in converted garage. Per licensee, children currently eat either inside the converted garage or in the backyard and sleep in converted garage. Per licensee, children have free access to the main house to use the bathroom. Licensee was advised that the converted garage cannot be used as a primary area to care for children. Converted garage can only and only being used to limited activity only. Children are required to eat and sleep in the main home.

Per licensee, converted garage will be used for limited activity only from 8:00 a.m. to 10:30 a.m. and in the afternoon from 3:0 p.m. to 6:00 p.m.. Per licensee children will sleep in the living room and eat either inside the home or backyard. A written declaration submitted during this inspection.
REPORT CONTINUES ON NEXT PAGE 1 of 4
SUPERVISOR'S NAME: Christina GabelmanTELEPHONE: (323) 854-8930
LICENSING EVALUATOR NAME: Anomeh EivazianTELEPHONE: (323) 981-3391
LICENSING EVALUATOR SIGNATURE:

DATE: 09/26/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/26/2019
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 6
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: RODRIGUEZ FAMILY CHILD CARE
FACILITY NUMBER: 198003557
VISIT DATE: 09/26/2019
NARRATIVE
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Family members residing in the home are 4 adults who have clearances on file and 1 child.

All areas used by children were inspected for safety, comfort, cleanliness, telephone, ventilation and heating. The licensee states that there are no poisons in the home. The licensee understands that any poisons must be locked with a key or combination lock. Detergents, cleaning compounds, medicines, sharp objects and hazardous items that can pose a danger to children are accessible in some areas in the home. During the tour of the facility LPAs observed shampoos and conditioners on the floor in the bathroom that children use, also, LPAs observed detergents in laundry room on the floor. (Pictures were taken).



Per licensee, there are no weapons, firearms or bodies of water on the premises. There is one dog on premises. There were toys observed for children. Posting requirements were observed to be posted at the time of inspection. Children’s records were reviewed. The valve on the required 2A 10BC fire extinguisher indicates fully charged and was purchased on 07/01/19, as indicated on receipt. Smoke detector in the converted garage was tested, and is in operable condition. Carbon monoxide detector was not available in the facility during this inspection. There are emergency supplies on the premises.

The licensee was observed to be operating within the licensed capacity and is not exceeding the required limitations. All adults present have obtained a criminal record clearance. The licensee has proof of current pediatric first aid and CPR (expires: 04/2020).

H&S 1596.8662: Commencing January 1, 2018 all the licensed providers, applicants, directors and employees are required to complete training as specified on the mandated reporter duties and to renew their training every two years. Volunteers are encouraged but not required to take the training. Licensee and her assistants do not have required mandated reporter training.

Medication: 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

REPORT CONTINUES ON NEXT PAGE 2 of 4
SUPERVISOR'S NAME: Christina GabelmanTELEPHONE: (323) 854-8930
LICENSING EVALUATOR NAME: Anomeh EivazianTELEPHONE: (323) 981-3391
LICENSING EVALUATOR SIGNATURE:

DATE: 09/26/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/26/2019
LIC809 (FAS) - (06/04)
Page: 5 of 6
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: RODRIGUEZ FAMILY CHILD CARE
FACILITY NUMBER: 198003557
VISIT DATE: 09/26/2019
NARRATIVE
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The following was discussed:
INFANT CARE: Licensee states that she does care for infants. LPA discussed the licensee’s plan for supervising sleeping infants.
Licensee states the following: Any infants in care will stay in the area where the licensee or assistant are. LPA advised the licensee to sleep infants where the infant can be directly supervised and advised against sleeping infants in a separate room. The licensee states that she will not sleep infants in a separate room. 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. Safe sleep concepts were provided.

No smoking, No infant walkers, No Johnny jumpers, No saucer chairs, No trampolines and any other item that falls into this category are not permitted in a family child care facility.

LPA reviewed and issued the LIC 311 - Forms/Records to Keep in Your Family Child Care Home.
LPA advised the licensee how to access forms, regulations and quarterly updates and provider information notices (PIN) on line at: www.ccld.ca.gov
LPA consulted and explained Child Abuse Reporting, Updated Patent’s Rights Poster with Complaint Hotline information, Never Shake a Baby, Sudden Infant Death Syndrome (SIDS), and Safe Sleeping practices which always Baby is sleeping on his/her back. Capacity Handout (Small & Large) was provided during this inspection. Any unusual incidents or injuries must be reported to the Department within 24 hours via telephone and within seven (7) days in writing. (use LIC624B for written report).

LPA issued the Confidential Names List (LIC 811) to the licensee during this inspection. The Confidential Names List documents the children’s files that were reviewed during this inspection.

The deficiencies listed on the following pages were observed by the LPA and are being cited in accordance with California Code of Regulations Title 22. Please see attached LIC 809d. Deficiencies that are being cited need to be cleared to protect the children’s health & safety.
REPORT CONTINUES ON NEXT PAGE 3 of 4
SUPERVISOR'S NAME: Christina GabelmanTELEPHONE: (323) 854-8930
LICENSING EVALUATOR NAME: Anomeh EivazianTELEPHONE: (323) 981-3391
LICENSING EVALUATOR SIGNATURE:

DATE: 09/26/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/26/2019
LIC809 (FAS) - (06/04)
Page: 2 of 6
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: RODRIGUEZ FAMILY CHILD CARE
FACILITY NUMBER: 198003557
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/26/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
10/25/2019
Section Cited

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Operation of a Family Child Care Home. All homes shall have a current roster of the children.
This requirement is not met as evidenced by file review. Children’s roster was available but not current during this inspection.
This poses a potential risk to the health and safety of children in care.
Type B
10/25/2019
Section Cited

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Operation of a Family Child Care Home. Poisons, detergents, cleaning compounds, medicines, firearms and other items which could pose a danger to children shall be stored where they are inaccessible to children.
This requirements not met as evidence by LPAs tour of the facility.
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During the tour of the facility LPAs observed accessible shampoos, conditioners in the children's bathroom and detergents in the laundry room. (Pictures were taken).
This poses a potential risk to the health and safety of children in care.
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Type B
10/25/2019
Section Cited

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On or before March 30, 2018, a person who, on January 1, 2018, is a licensed
child care provider, administrator, or employee of a licensed child day care facility shall complete the mandated reporter training
Licensee and her assistants do not have mandate reporter certificate. The requirement is not met as evidenced by personal observation. This poses a potential risk to the health and safety of children in care.
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 GabelmanTELEPHONE: (323) 854-8930
LICENSING EVALUATOR NAME: Anomeh EivazianTELEPHONE: (323) 981-3391
LICENSING EVALUATOR SIGNATURE:
DATE: 09/26/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/26/2019
LIC809 (FAS) - (06/04)
Page: 3 of 6
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: RODRIGUEZ FAMILY CHILD CARE
FACILITY NUMBER: 198003557
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/26/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
09/27/2019
Section Cited

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Carbon monoxide detectors required; inspection
Every licensed child day care center shall have one or more carbon monoxide detectors in the facility
This requirement has not been met as evidenced by LPAs observation that there is no
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carbon monoxide detector in the facility.
This poses an immediate risk to the health and safety of children in care.
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Type A
09/27/2019
Section Cited

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Public policy to provide home environment; restriction governing real property
It is the intent of the Legislature that family day care homes for children should be situated in normal residential surroundings so as to give children the home environment which is conducive to healthy and safe development.
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This requirement has not been met as evidenced by LPAs personal observations.
LPAs observed and per licensee children eat and sleep in converted detached garage.
This poses an immediate risk to the health and safety of children in care.
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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 GabelmanTELEPHONE: (323) 854-8930
LICENSING EVALUATOR NAME: Anomeh EivazianTELEPHONE: (323) 981-3391
LICENSING EVALUATOR SIGNATURE:
DATE: 09/26/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/26/2019
LIC809 (FAS) - (06/04)
Page: 4 of 6
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: RODRIGUEZ FAMILY CHILD CARE
FACILITY NUMBER: 198003557
VISIT DATE: 09/26/2019
NARRATIVE
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Upon receipt of this report, the Licensee shall post the Notice of Site visit and any licensing report documenting a type “A” deficiency. The report and the Notice of Site visit shall be posted for 30 consecutive days. Failure to maintain posting as required, will result in an immediate $100 civil penalty. A copy of this report shall be provided to the parent/guardian of children currently enrolled by the next business day or immediately upon return. A copy of this report shall also be provided to the parent/guardian of any newly enrolled children for the next 12 months (1 year). The Acknowledgement form must be maintained in each child’s file immediately upon receipt from parent. Licensee was provided with a copy of the parent Acknowledgement of Receipt of Licensing Reports Form during this inspection. A copy of the Parent Notification Requirements was also provided to the licensee.

Exit interview was conducted with Ingrid Rodriguez, Licensee, Appeal rights explained & provided.

REPORT END 4 of 4
SUPERVISOR'S NAME: Christina GabelmanTELEPHONE: (323) 854-8930
LICENSING EVALUATOR NAME: Anomeh EivazianTELEPHONE: (323) 981-3391
LICENSING EVALUATOR SIGNATURE:

DATE: 09/26/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/26/2019
LIC809 (FAS) - (06/04)
Page: 6 of 6