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Department of
SOCIAL SERVICES
Community Care Licensing
FACILITY EVALUATION REPORT
Facility Number:
198004419
Report Date:
08/11/2022
Date Signed:
08/11/2022 03:16:53 PM
Document Has Been Signed on
08/11/2022 03:16 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
,
1000 CORPORATE CENTER DR 200B
MONTEREY PARK
,
CA
91754
FACILITY NAME:
PINEDA FAMILY CHILD CARE
FACILITY NUMBER:
198004419
ADMINISTRATOR:
PINEDA, ELVIA
FACILITY TYPE:
810
ADDRESS:
TELEPHONE:
(323) 562-7847
CITY:
MAYWOOD
STATE:
CA
ZIP CODE:
90270
CAPACITY:
14
CENSUS:
1
DATE:
08/11/2022
TYPE OF VISIT:
Required - 1 Year
UNANNOUNCED
TIME BEGAN:
09:44 AM
MET WITH:
Licensee Elvia Pineda
TIME COMPLETED:
03:30 PM
NARRATIVE
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On 8/11/22 Licensing Program Analysts (LPAs) Jeanette Estrada and Austin Estrada conducted an unannounced required 1 year inspection at the above facility. LPAs met with the Licensee Elvia Pineda and informed her of the purpose for the visit. LPAs provided Licensee with a copy of the Facility Entrance Checklist. Licensee guided LPAs on a tour of the facility. There was 1 child present during the inspection. All residents were noted and verified.
Also present was Staff 1- Licensee's spouse who is the Assistant.
Facility provides care to children ages 0 to 12. Facility is open Monday to Friday 6 AM to 6 PM.
This is a one story, 2 bedroom, 2 bathroom home, with a living room (daycare area), dining room, kitchen, back yard, detached garage with an additional dwelling unit (ADU) with one bedroom attached and a fenced front yard.
Per Licensee areas on limits to children are:
living room, dining room, hallway bathroom, kitchen and front yard.
Per Licensee areas off limits to children are:
2 bedrooms, entire back yard and detached garage including ADU.
Licensee was advised to submit an updated facility sketch which indicates clearly off limit areas. A previous report dated 5/16/2018 identified the front yard and garage as off limits.
All areas that are accessible to children were inspected for safety, comfort, and cleanliness. The following was observed and reviewed during this inspection: LPA discussed required posted documentation with Licensee and advised the following shall be posted in a Licensed facility. Facility license, Publication (PUB) 394- Notification of Parent Rights and Licensing Form (LIC) 9148- Earthquake Preparedness form. LPAs did not observe those forms posted at the facility. LPAs did not observe a disaster drill log or a children's roster. Per Licensee, the last disaster drill took place in May 2022.
There is an operable carbon monoxide detector and a smoke detector in the facility. LPAs observed a 2A10BC Fire Extinguisher in the facility which was serviced in April 2022.
The home maintains telephone service
(Land line and cell phone). Food is provided by Licensee. Licensee was reminded if children bring food from home it must be labeled with the child’s name and properly stored or refrigerated.
SUPERVISOR'S NAME:
Valarie Cook
TELEPHONE:
(323) 513-3828
LICENSING EVALUATOR NAME:
Jeanette Estrada
TELEPHONE:
(323) 229-6521
LICENSING EVALUATOR SIGNATURE:
DATE:
08/11/2022
I acknowledge receipt of this form and understand my
licensing
appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
08/11/2022
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
12
Document Has Been Signed on
08/11/2022 03:16 PM
- It Cannot Be Edited
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 CENTER DR 200B
MONTEREY PARK
,
CA
91754
FACILITY NAME:
PINEDA FAMILY CHILD CARE
FACILITY NUMBER:
198004419
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE:
08/11/2022
DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
102417(g)(4)
Operation of A Family Child Care Home
(g) The home shall be free from defects or conditions which might endanger a child. Safety precautions shall include but not limited to: (4) Poisons, detergents, cleaning compounds, medicines, firearms and other items which could pose a danger if readily available to children shall be stored where they are inaccessible to children.
This requirement is not met as evidenced by:
Deficient Practice Statement
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2
3
4
Based on observation the licensee did not comply with the section cited above. LPAs observed accessible prescription medication in the kitchen, knives on the kitchen counter, cleaning products in a cabinet under the sink which did not have a latch installed and a container of laundry detergent on the counter which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date:
08/12/2022
Plan of Correction
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4
Licensee removed the medication and placed it in an off limits bedroom, the knives were placed in a container and placed in an upper kitchen cabinet and the laundry detergent was moved to the laundry room which is maintained locked. Licensee stated a safety latch will be installed on the lower kitchen cabinet containing the cleaning products. Licensee closed kitchen door and stated it will be kept locked during operating hours until a safety gate is installed.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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4
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:
Valarie Cook
TELEPHONE:
(323) 513-3828
LICENSING EVALUATOR NAME:
Jeanette Estrada
TELEPHONE:
(323) 229-6521
LICENSING EVALUATOR SIGNATURE:
DATE:
08/11/2022
I acknowledge receipt of this form and understand my
appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
08/11/2022
LIC809
(FAS) - (06/04)
Page:
2
of
12
Document Has Been Signed on
08/11/2022 03:16 PM
- It Cannot Be Edited
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 CENTER DR 200B
MONTEREY PARK
,
CA
91754
FACILITY NAME:
PINEDA FAMILY CHILD CARE
FACILITY NUMBER:
198004419
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE:
08/11/2022
DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102417(g)
Operation of A Family Child Care Home
(g) The home shall be free from defects or conditions which might endanger a child. Safety precautions shall include but not limited to:
This requirement is not met as evidenced by:
Deficient Practice Statement
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2
3
4
Based on observation and interview, the licensee did not comply with the section cited above. LPAs observed the backyard to contain a large amount of toys and materials for children that are not in good condition and in the front yard LPAs observed materials such as a recliner couch and a pair of blinds which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date:
08/22/2022
Plan of Correction
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Licensee stated back yard will be off limits while it is being cleaned up. Licensee will submit an updated faciilty sketch labeling off /on limit areas. Licensee was advised notification shall be made to the Department prior to backyard being accessible to children. Front yard will be cleaned up/potentially hazardous items will be removed and pictures will be submitted to LPA by due date.
Type B
Section Cited
CCR
102417(g)(9)
Operation of A Family Child Care Home
(g) The home shall be free from defects or conditions which might endanger a child. Safety precautions shall include but not limited to: (9) Each family child care home shall have a written disaster plan of action prepared on a form approved by the Department. All children, age and ability permitting, and the provider, the assistant provider, and other members of the household, shall be instructed in their duties under the disaster plan. As their age and ability permit, newly enrolled children shall be informed promptly of their duties as required in the plan.
This requirement is not met as evidenced by:
Deficient Practice Statement
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3
4
Based on interview, the licensee did not comply with the section cited above. Licensee did not have a completed LIC 610A Emergency Disaster Plan available at the facility which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date:
08/22/2022
Plan of Correction
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4
Licensee will submit a completed LIC 610A via picture by due date.
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:
Valarie Cook
TELEPHONE:
(323) 513-3828
LICENSING EVALUATOR NAME:
Jeanette Estrada
TELEPHONE:
(323) 229-6521
LICENSING EVALUATOR SIGNATURE:
DATE:
08/11/2022
I acknowledge receipt of this form and understand my
appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
08/11/2022
LIC809
(FAS) - (06/04)
Page:
3
of
12
Document Has Been Signed on
08/11/2022 03:16 PM
- It Cannot Be Edited
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 CENTER DR 200B
MONTEREY PARK
,
CA
91754
FACILITY NAME:
PINEDA FAMILY CHILD CARE
FACILITY NUMBER:
198004419
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE:
08/11/2022
DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102417(g)(9)(A)1
Operation of A Family Child Care Home
(g) The home shall be free from defects or conditions which might endanger a child. Safety precautions shall include but not limited to: (9) Each family child care home shall have a written disaster plan of action prepared on a form approved by the Department. All children, age and ability permitting, and the provider, the assistant provider, and other members of the household, shall be instructed in their duties under the disaster plan. As their age and ability permit, newly enrolled children shall be informed promptly of their duties as required in the plan. (A) Each family child care home shall conduct fire drills and disaster drills at least once every six months. 1. The licensee shall document the drills, including the date and time of each drill. This documentation shall kept at the family child care home.
This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on interview, the licensee did not comply with the section cited above. Per Licensee, there is no documentation of the required disaster drills which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date:
08/22/2022
Plan of Correction
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Licensee will conduct and document a disaster drill. Licensee will provide proof of documentation via picture.
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:
Valarie Cook
TELEPHONE:
(323) 513-3828
LICENSING EVALUATOR NAME:
Jeanette Estrada
TELEPHONE:
(323) 229-6521
LICENSING EVALUATOR SIGNATURE:
DATE:
08/11/2022
I acknowledge receipt of this form and understand my
appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
08/11/2022
LIC809
(FAS) - (06/04)
Page:
4
of
12
Document Has Been Signed on
08/11/2022 03:16 PM
- It Cannot Be Edited
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 CENTER DR 200B
MONTEREY PARK
,
CA
91754
FACILITY NAME:
PINEDA FAMILY CHILD CARE
FACILITY NUMBER:
198004419
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE:
08/11/2022
DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
HSC
1596.8662(b)(1)
Administration of Child Day Care Licensing
(1) On or before March 30, 2018, a person who, on January 1, 2018, is a licensed child day care provider, administrator, or employee of a licensed child day care facility shall complete the mandated reporter training provided pursuant to paragraphs (2) and (3) of subdivision (a), and shall complete renewal mandated reporter training every two years following the date on which he or she completed the initial mandated reporter training.
This requirement is not met as evidenced by:
Deficient Practice Statement
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2
3
4
Based on interview, the licensee did not comply with the section cited above in 2 out of 2 staff (Licensee and Assistant) who did not have Mandated Reporter training completed which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date:
09/12/2022
Plan of Correction
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Licensee and Staff 1 will complete Mandated Reporter training -general training and child care provider training- and will submit proof of certificates via picture. Licensee was advised training can be accessed in Spanish on www.mandatedreporterca.com
Type B
Section Cited
CCR
102416.3(a)(1)
Alterations to Existing Building or Grounds
(a) Prior to making alterations or additions to a family child care home or grounds, the licensee shall notify the Department of the proposed changed, including, but not limited to, the following: (1) Conversion of a garage (either attached or detached) into a "child care" room.
This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on observation and interview, the licensee did not comply with the section cited above. Per Licensee, the garage has been used for day care activities which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date:
08/19/2022
Plan of Correction
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3
4
Licensee stated garage will be off limits to children and will submit an updated facility sketch that labels all off limit areas via picture. Licensee was advised that if she wishes to use the garage as a day care room, notification must be given to the department prior to use.
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:
Valarie Cook
TELEPHONE:
(323) 513-3828
LICENSING EVALUATOR NAME:
Jeanette Estrada
TELEPHONE:
(323) 229-6521
LICENSING EVALUATOR SIGNATURE:
DATE:
08/11/2022
I acknowledge receipt of this form and understand my
appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
08/11/2022
LIC809
(FAS) - (06/04)
Page:
5
of
12
Document Has Been Signed on
08/11/2022 03:16 PM
- It Cannot Be Edited
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 CENTER DR 200B
MONTEREY PARK
,
CA
91754
FACILITY NAME:
PINEDA FAMILY CHILD CARE
FACILITY NUMBER:
198004419
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE:
08/11/2022
DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102416.3(a)(6)
Alterations to Existing Building or Grounds
(a) Prior to making alterations or additions to a family child care home or grounds, the licensee shall notify the Department of the proposed changed, including, but not limited to, the following: (6) Any change from an area of the family child care home previously identified as "off limits" to an area where care and supervision will be provided to children in care.
This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on interview, record review and observation, the licensee did not comply with the section cited above. The front yard has been noted as off limits in previous reports, Licensee did not rerport changes that area is now accessible to children prior to this inspection which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date:
08/19/2022
Plan of Correction
1
2
3
4
Licensee will submit an updated facility sketch labeling off limit and on limit areas via picture. Licensee was advised that any changes to accessible areas shall be reported to the Department prior to use.
Type B
Section Cited
CCR
102419(b)
Admission Procedures and Authorized Representatives Rights
(b) The licensee shall post the PUB 394 (8/02), Family Child Care Home Notification of Parents’ Rights Poster in a prominent, publicly accessible area in the family child care home at all times children are in care.
This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on observation and interview, the licensee did not comply with the section cited above. PUB 394 was not posted at the facility which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date:
08/19/2022
Plan of Correction
1
2
3
4
Licensee will submit picture of PUB posted in a prominent publicly accessible area. Per Licensee, she will place it on a poster board that hangs at the entrance of the home. Licensee will submit picture of poster board to LPA.
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:
Valarie Cook
TELEPHONE:
(323) 513-3828
LICENSING EVALUATOR NAME:
Jeanette Estrada
TELEPHONE:
(323) 229-6521
LICENSING EVALUATOR SIGNATURE:
DATE:
08/11/2022
I acknowledge receipt of this form and understand my
appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
08/11/2022
LIC809
(FAS) - (06/04)
Page:
6
of
12
Document Has Been Signed on
08/11/2022 03:16 PM
- It Cannot Be Edited
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 CENTER DR 200B
MONTEREY PARK
,
CA
91754
FACILITY NAME:
PINEDA FAMILY CHILD CARE
FACILITY NUMBER:
198004419
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE:
08/11/2022
DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
HSC
1597.622(a)(1)
General Provisions and Definitions
(1) Commencing September 1, 2016, a person shall not be employed or volunteer at a family day care home if he or she has not been immunized against influenza, pertussis, and measles. Each employee and volunteer shall receive an influenza vaccination between August 1 and December 1 of each year.
This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on interview, the licensee did not comply with the section cited above. Licensee and Staff 1 did not have proof of requried immunizations on file which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date:
09/12/2022
Plan of Correction
1
2
3
4
Licensee will obtain proof of required immunizations for herself and Assistant 1 -MEASLES, PERTUSSIS and FLU (or a written declination for the flu vaccine only) and will submit via picture or email.
Type B
Section Cited
CCR
102417(g)(7)
Operation of A Family Child Care Home
(7) An emergency information card shall be maintained for each child and shall include the child's full name, telephone number and location of a parent or other responsible adult to be contacted in an emergency, the name and telephone number of the child's physician and the parent's authorization for the licensee or registrant to consent to emergency medical care.
This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on interview, the licensee did not comply with the section cited above. A file for Child 1 was not available. LIC 700 was not available which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date:
08/26/2022
Plan of Correction
1
2
3
4
Licensee will obtain a completed LIC 700 for child 1 and will submit proof via picture or email.
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:
Valarie Cook
TELEPHONE:
(323) 513-3828
LICENSING EVALUATOR NAME:
Jeanette Estrada
TELEPHONE:
(323) 229-6521
LICENSING EVALUATOR SIGNATURE:
DATE:
08/11/2022
I acknowledge receipt of this form and understand my
appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
08/11/2022
LIC809
(FAS) - (06/04)
Page:
7
of
12
Document Has Been Signed on
08/11/2022 03:16 PM
- It Cannot Be Edited
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 CENTER DR 200B
MONTEREY PARK
,
CA
91754
FACILITY NAME:
PINEDA FAMILY CHILD CARE
FACILITY NUMBER:
198004419
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE:
08/11/2022
DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102419(d)
Admission Procedures and Parental and Authorized Representative's Rights
(d) At the time of acceptance of each child into care, the licensee shall provide the child's parent or authorized representative with a copy of the notice Family Child Care Home Notification of Parent's Rights, LIC 995A (8/06), the Caregiver Background Check Process, LIC 995E (6/05), and the Family child Care Consumer Awareness Information, LIC 9212 (10/05).
This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on interview, the licensee did not comply with the section cited above. A file for Child 1 was not available. A signed LIC 995 was not available which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date:
08/26/2022
Plan of Correction
1
2
3
4
Licensee will provide the required forms to parent of Child 1 and will obtain a signed LIC 995. Licensee will submit proof of signed LIC 995 to LPA via picture or email.
Type B
Section Cited
CCR
102417(g)(8)
Operation of A Family Child Care Home
(8) Each family child care home shall have a current roster of children as specified in Health and Safety Code Section 1596.841.
This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on interview, the licensee did not comply with the section cited above. Licensee did not have a current roster available at the faclility which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date:
08/18/2022
Plan of Correction
1
2
3
4
Licensee will submit picture of completed facility roster LIC 9040 by due date.
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:
Valarie Cook
TELEPHONE:
(323) 513-3828
LICENSING EVALUATOR NAME:
Jeanette Estrada
TELEPHONE:
(323) 229-6521
LICENSING EVALUATOR SIGNATURE:
DATE:
08/11/2022
I acknowledge receipt of this form and understand my
appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
08/11/2022
LIC809
(FAS) - (06/04)
Page:
8
of
12
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 CENTER DR 200B
MONTEREY PARK
,
CA
91754
FACILITY NAME:
PINEDA FAMILY CHILD CARE
FACILITY NUMBER:
198004419
VISIT DATE:
08/11/2022
NARRATIVE
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Page 2
There are toys and other age appropriate materials available for children. Sharp objects, detergents and cleaning compounds were not inaccessible to children in care. LPAs observed knives on the kitchen counter, accessible to children in care. Licensee removed the knives, placed them in a container and placed the container in an upper cabinet in the kitchen. Cleaning products are kept in the cabinet under the kitchen sink. Licensee installed a latch on the cabinet. LPAs observed a container of laundry detergent on the kitchen counter. Licensee removed the detergent and placed it in the locked laundry room. LPAs observed two containers with prescription medication on the kitchen counters and a container of Tylenol in the living room. Per Licensee no children enrolled require medication. At the time of arrival, Child 1 was present in the kitchen. LPA observed Licensee remove the prescription medication and place it in an off limits bedroom. LPA discussed with Licensee the importance of maintaining the kitchen inaccessible to children due to the hazards observed. Licensee stated the kitchen will only be accessible from now on in passing to the back yard when the back yard is on limits and children will be escorted through. Licensee stated she will place a safety gate at the entrance of the kitchen. Licensee asked Child 1 to move to the living room during the inspection.
There is an air conditioning unit in the living room. There is a wall heater in the living room which has a safety gate installed. Children use the restroom in the hallway. LPA observed cleaning products are contained in a latched cabinet under the sink.
Per Licensee the children use the back yard and the front yard for outdoor play. LPAs observed the back yard which contained a large amount of toys, furniture and equipment for children. The majority of the items observed were not in good condition. Per the Licensee, she is in the process of cleaning and getting rid of items which cannot be used anymore. Licensee also stated the detached garage is used by children for activities. LPAs observed a section of the garage set up for day care. During this inspection LPA discussed use of the backyard with Licensee. Per Licensee, the backyard was previously accessible to children but children have been using the front yard for outdoor play. Licensee stated the back yard will be off limits while it is being cleaned. Licensee was advised to notify the Department when before back yard is made accessible. LPAs observed some items in the front yard that per Licensee will be removed, such as a recliner couch and a set of blinds. The front yard is fenced and per Licensee, the children are supervised when they are outside.
Per Licensee, there are no poisons in the home. Licensee understands that all poisons must be locked, not only inaccessible to children. Isolation area for sick children waiting to be picked up is in the children's living room. Per Licensee, there are no firearms or weapons stored in the home. LPA did not observe pools or spas, or other bodies of water.
SUPERVISOR'S NAME:
Valarie Cook
TELEPHONE:
(323) 513-3828
LICENSING EVALUATOR NAME:
Jeanette Estrada
TELEPHONE:
(323) 229-6521
LICENSING EVALUATOR SIGNATURE:
DATE:
08/11/2022
I acknowledge receipt of this form and understand my licensing appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
08/11/2022
LIC809
(FAS) - (06/04)
Page:
12
of
12
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 CENTER DR 200B
MONTEREY PARK
,
CA
91754
FACILITY NAME:
PINEDA FAMILY CHILD CARE
FACILITY NUMBER:
198004419
VISIT DATE:
08/11/2022
NARRATIVE
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Infant Care
:
Currently licensee has no infants enrolled. Licensee was advised that napping equipment should not block entrances or exits. Infant mattresses should be firm with tightly fitted sheets. LPA discussed that each infant enrolled must have their own crib/ napping mat and bedding. LPA informed licensee of the new Safe sleep regulations, including LIC 9227 Infant Sleep Plan for infants under 12 months, 15-minute sleep check documentation for infants 0-24 months, LPA provided PIN 20-24-CCP.
Overnight Care
: There is no overnight care provided at the moment. LPA discussed the following: Licensee is aware that they must remain awake while children are awake. If children sleep in separate area from licensee, the door must remain open. If licensee cannot hear children when they wake up, video or audio device can be used.
Children's records were discussed.
There was no record for Child 1 available at the facility. LPAs advised Licensee that Children's records shall contain (LIC) 282- Affidavit Regarding Liability Insurance, Immunization Records, LIC 700- Identification and Emergency Information, LIC 627- Consent for Medical Treatment, LIC 995A Notification of Parents’ Rights.
Licensee's and Staff 1s records were reviewed.
Licensee's and Staff 1's Pediatric CPR/First Aid expires 3/2024. Licensee and Staff 1 did not have proof of required immunizations (measles, pertussis, flu), proof of TB clearance or Mandated Reporter Training certificate.
During inspection the child present was observed to be treated with dignity and respect, and free from corporal and/or unusual punishment. Issues with safe and comfortable accommodations were cited on LIC 809-D.
Incidental Medical Services (IMS)
:
Incidental Medical Services (IMS) policy was discussed. Per Licensee, no children enrolled require medication. 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 Center 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.
SUPERVISOR'S NAME:
Valarie Cook
TELEPHONE:
(323) 513-3828
LICENSING EVALUATOR NAME:
Jeanette Estrada
TELEPHONE:
(323) 229-6521
LICENSING EVALUATOR SIGNATURE:
DATE:
08/11/2022
I acknowledge receipt of this form and understand my licensing appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
08/11/2022
LIC809
(FAS) - (06/04)
Page:
11
of
12
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 CENTER DR 200B
MONTEREY PARK
,
CA
91754
FACILITY NAME:
PINEDA FAMILY CHILD CARE
FACILITY NUMBER:
198004419
VISIT DATE:
08/11/2022
NARRATIVE
1
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3
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5
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Page 4
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
https://www.cdss.ca.gov/inforesources/child-care-licensing/
public -information-and-resources/safe-sleep as an additional resource. 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.
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/process
.
The deficiencies listed on the following page were observed by the LPA and are being cited in accordance with California Code of Regulations Title 22. One type A citation was issued today for CCR
102417(g)(4)
Operation of a family child care home regarding the hazards that were observed in the kitchen: accessible medication, knives and cleaning products. Please see attached LIC 809-D for all citations.
Deficiencies that are being cited need to be cleared to protect the children’s health & safety.
The notice of site visit was posted where the parent/guardian of children enter and exit the facility. A copy of this report shall also be posted where the parent/guardian of children enter and exit the facility.
Both the notice of site visit and licensing report shall remain posted for 30 consecutive days. Failure to maintain posting as required will result in a $100.00 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 their return.
A copy of this report shall also be provided to the parent/guardian of any newly enrolled child for the next 12 months. A signed Acknowledgement of Receipt (LIC9224) shall be in each child’s file, acknowledging receipt.
Exit interview conducted and report was reviewed with the Licensee, Elvia Pineda. A notice of site visit was given and must remain posted for 30 days.
SUPERVISOR'S NAME:
Valarie Cook
TELEPHONE:
(323) 513-3828
LICENSING EVALUATOR NAME:
Jeanette Estrada
TELEPHONE:
(323) 229-6521
LICENSING EVALUATOR SIGNATURE:
DATE:
08/11/2022
I acknowledge receipt of this form and understand my licensing appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
08/11/2022
LIC809
(FAS) - (06/04)
Page:
10
of
12
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 CENTER DR 200B
MONTEREY PARK
,
CA
91754
FACILITY NAME:
PINEDA FAMILY CHILD CARE
FACILITY NUMBER:
198004419
VISIT DATE:
08/11/2022
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
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24
25
26
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29
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Page 5
The deficiencies listed on the following page were observed by the LPA and are being cited in accordance with California Code of Regulations Title 22. One type A citation was issued today for CCR
102417(g)(4)
Operation of a family child care home regarding the hazards that were observed in the kitchen: accessible medication, knives and cleaning products. Please see attached LIC 809-D for all citations.
Deficiencies that are being cited need to be cleared to protect the children’s health & safety.
The notice of site visit was posted where the parent/guardian of children enter and exit the facility.
A copy of this report shall also be posted where the parent/guardian of children enter and exit the facility.
Both the notice of site visit and licensing report shall remain posted for 30 consecutive days. Failure to maintain posting as required will result in a $100.00 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 their return.
A copy of this report shall also be provided to the parent/guardian of any newly enrolled child for the next 12 months. A signed Acknowledgement of Receipt (LIC9224) shall be in each child’s file, acknowledging receipt.
Exit interview conducted and report was reviewed with the Licensee, Elvia Pineda. A notice of site visit was given and must remain posted for 30 days.
SUPERVISOR'S NAME:
Valarie Cook
TELEPHONE:
(323) 513-3828
LICENSING EVALUATOR NAME:
Jeanette Estrada
TELEPHONE:
(323) 229-6521
LICENSING EVALUATOR SIGNATURE:
DATE:
08/11/2022
I acknowledge receipt of this form and understand my licensing appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
08/11/2022
LIC809
(FAS) - (06/04)
Page:
9
of
12