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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198004419
Report Date: 09/05/2024
Date Signed: 09/05/2024 02:57:01 PM


Document Has Been Signed on 09/05/2024 02:57 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
MONTEREY PARK SW RO, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754



FACILITY NAME:PINEDA FAMILY CHILD CAREFACILITY NUMBER:
198004419
ADMINISTRATOR:PINEDA, ELVIAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(323) 562-7847
CITY:MAYWOODSTATE: CAZIP CODE:
90270
CAPACITY:14CENSUS: 0DATE:
09/05/2024
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
12:50 PM
MET WITH:Licensee Elvia PinedaTIME COMPLETED:
03:15 PM
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On 9/5/24 Licensing Program Analyst(LPA) Anthony Padilla conducted an unannounced required 1 year inspection at the above facility. LPA met with the Licensee Elvia Pineda and informed her of the purpose for the visit. LPA provided Licensee with a copy of the Facility Entrance Checklist. Licensee guided LPA on a tour of the facility. There was 0 child present during the inspection. Per licensee there are no infant children enrolled and currently school age children are enrolled. All residents were noted and verified. Also present was Staff 1- Licensee's spouse who is the Assistant. Facility provides care to children ages 4 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.

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. LPA observed licensing forms posted in the living room which is used as main care space. LPA observed a disaster drill log drill conducted 7/6/24. There is an operable carbon monoxide detector and a smoke detector in the facility. LPA observed a 2A10BC Fire Extinguisher in the facility which was serviced on 3/5/24. The home maintains telephone service (Land line and cell phone) LPA obtained new landline number from licensee. 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. PAGE 1

SUPERVISOR'S NAME: Karen ChambersTELEPHONE: (323) 981-3368
LICENSING EVALUATOR NAME: Anthony PadillaTELEPHONE: 323-981-3350
LICENSING EVALUATOR SIGNATURE:
DATE: 07/23/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/23/2024
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
MONTEREY PARK SW RO, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME: PINEDA FAMILY CHILD CARE
FACILITY NUMBER: 198004419
VISIT DATE: 09/05/2024
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There are toys and other age appropriate materials available for children. Sharp objects, detergents and cleaning compounds were inaccessible to children in care. LPA observed knives on the kitchen counter in a locked container inaccessible to children in care. Cleaning products are kept in the cabinet under the kitchen sink with a safety latch making the cleaning compounds inaccessible to children. Per Licensee Children only have access to kitchen area to eat. LPA observed a small child size table and chairs in the kitchen area. During inspection LPA did not observe any items in the kitchen area that are hazardous or dangerous to children in care.
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 currently use the front yard for outdoor play. LPA observed the front yard to have adequate shade with trees and a covered patio area, toys, furniture and equipment for children. The front yard is fenced and per Licensee, the children are supervised when they are outside at all times. LPA did not observe any items in the front yard that could pose a hazard or danger to children in care.
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 facility living room. Per Licensee, there are no firearms or weapons stored in the home. Per licensee there are no pools or bodies of water at the facility. LPA did not observe any fire arms or weapons, pools or spas, or other bodies of water during time of inspection.
At 2:10 Licensee stated she had to leave to pick up school age children and will return around 3:00 PM. Licensee assistant was able to continue annual inspection process with LPA.
Infant Care: Currently licensee has no infants enrolled. Licensee stated she does not want to provide care for infants at the moment. LPA provided consultation with licensee for Infant safe sleep regulations with and reminded licensee if care is provided for infants the 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 LIC 9227 Infant Sleep Plan for infants under 12 months, 15-minute sleep check documentation for infants 0-24 months.
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.
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SUPERVISOR'S NAME: Karen ChambersTELEPHONE: (323) 981-3368
LICENSING EVALUATOR NAME: Anthony PadillaTELEPHONE: 323-981-3350
LICENSING EVALUATOR SIGNATURE:

DATE: 09/05/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/05/2024
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
MONTEREY PARK SW RO, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME: PINEDA FAMILY CHILD CARE
FACILITY NUMBER: 198004419
VISIT DATE: 09/05/2024
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Children's records were discussed. LPA observed 1 of 1 children for Children's records (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. File was reviewed and complete
Licensee's and Staff 1s records were reviewed. Licensee's and Staff 1's Pediatric CPR/First Aid expires 5/2026. Licensee and Staff 1 have proof of required immunizations (measles, pertussis, flu), proof of TB clearance. At 2:00 PM LPA observed licensee mandated reporter training certificate to be expired on 9/2/24 LPA issued a Technical Violation (TV) . At 2:36 PM Licensee returned to facility and continued inspection with LPA.

To improve the quality and value of the new inspection process, a survey may 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 CARE tools, please send email inquiries 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.

Licensee was reminded that all adults 18 and over living or working in the home, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, 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 for a maximum of 5 days or, if the penalty is for a repeat violation, for a maximum of 30 days per person will be assessed if this regulation is violated.

LPA discussed the safe sleep regulations with licensee [or facility representative] 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 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.

Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02-CCP. 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: https://www.ada.gov/resources/child-care-centers/. PAGE 3

SUPERVISOR'S NAME: Karen ChambersTELEPHONE: (323) 981-3368
LICENSING EVALUATOR NAME: Anthony PadillaTELEPHONE: 323-981-3350
LICENSING EVALUATOR SIGNATURE:

DATE: 09/05/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/05/2024
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
MONTEREY PARK SW RO, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME: PINEDA FAMILY CHILD CARE
FACILITY NUMBER: 198004419
VISIT DATE: 09/05/2024
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Licensee was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain child care by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.

During the exit interview, the LICENSEE Elvia Pineda, confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS.

At this time, the licensee is in compliance with California Title 22 Regulations. Therefore, there are no citations being issued today.

A notice of site visit was given and must remain posted for 30 days.

Exit interview conducted and report was reviewed with the licensee Elvia Pineda.

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SUPERVISOR'S NAME: Karen ChambersTELEPHONE: (323) 981-3368
LICENSING EVALUATOR NAME: Anthony PadillaTELEPHONE: 323-981-3350
LICENSING EVALUATOR SIGNATURE:

DATE: 09/05/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/05/2024
LIC809 (FAS) - (06/04)
Page: 4 of 4