198005637-2-25-2022-33-CC-LGOZ-CBYRF7-20220225115840

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 198005637
Report Date: 02/25/2022
Date Signed: 02/25/2022 11:58:59 AM

Document Has Been Signed on 02/25/2022 11:58 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
CCLD Regional Office, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME:	FLORES FAMILY CHILD CARE		FACILITY NUMBER:	198005637
ADMINISTRATOR:	FLORES,MONICA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(323) 728-7119
CITY:	LOS ANGELES	STATE: CA	ZIP CODE:	90022
CAPACITY:	14	CENSUS: 4	DATE:	02/25/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	08:46 AM
MET WITH:	Maria Flores, Lincensee		TIME COMPLETED:	12:19 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 inspection to the above facility on 02/25/2022. LPA arrived at the facility at 8:47AM and met with Monica Flores, Licensee who guided analyst on a tour of the facility. Per Licensee, operation hours are 6:00AM to 8:00PM. There are eight (08) children enrolled, one (01) being an infant. A current children’s roster was available for review. There were four (04) children present upon arrival. This is a two home which consists of 5 bedrooms, 2 bathrooms, kitchen, dining room, living room, garage and backyard (fenced). The children use the one front bedroom, bathroom in the hallway, living room, dining room and kitchen area. Per licensee, areas off limits to children and parents include: 4 bedrooms, upstairs bathroom and detached garage. Licensee provides food to children in care. Individuals who reside in the home were noted and discussed. Licensee [or facility representative] 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 Licensee states that there are no firearms stored in the home. All areas identified on the facility sketch that are accessible for children to use were inspected for safety, comfort, and cleanliness. There is telephone service via a landline. There is ventilation and heating via central air/heating. Safe toys play equipment and materials were observed. REPORT CONTINUES ON NEXT PAGE: 1 OF 4

SUPERVISOR'S NAME: Christina Gabelman	TELEPHONE: (323) 981-3383
LICENSING EVALUATOR NAME: Lissete Gonzalez	TELEPHONE: (323) 981-3383
LICENSING EVALUATOR SIGNATURE:	DATE: 02/25/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/25/2022

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
CCLD Regional Office, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME: FLORES FAMILY CHILD CARE	FACILITY NUMBER: 198005637
	VISIT DATE: 02/25/2022

NARRATIVE

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Detergents, cleaning compounds, medications, and other items which could pose a danger to children were observed to be inaccessible to children. The licensee states there are no poisons in the home and understands that storage areas for poisons must be locked with a key or combination lock. The restroom that children use was observed to be safe and sanitary.

At 9:15AM, LPA observed the home to be equipped with a 1A-10BC fire extinguisher. The facility does not have the required 2A 10BC fire extinguisher. LPA observed smoke detectors that were tested and are operable. At 9:19Am LPA observed the facility currently does not have a carbon monoxide detector.

Licensee states she is currently caring for one (01) infant. Licensee states the infant sleeps in the front bedroom where they will be constantly supervised. Appropriate sleeping arrangements and play yards were observed. The play yards did not hinder the entrance or exit from the sleeping space, mattresses shall be firm and covered with a fitted sheet that overlaps the underside so it cannot be dislodged. Play yards were observed to be free of loose articles and objects. No objects were observed to be hanging above or attached to the side. LPA did not observe any infants swaddled while in care. LPA advised the Licensee that infants shall be placed on their backs for sleeping and shall be supervised. Infants shall be checked on every 15 minutes and the time of each 15-minute check shall be documented with child’s name and date. The LIC 9227 Individual Infant Sleeping Plan shall be completed for each infant up to 12 months of age. A copy of the LIC 9227 was provided to Licensee. a copy of the Provider Information Notice (PIN) 20-24 CCP: Recently Approved Safe Sleep Regulations in Effect.

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 [facility representative] 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.

Currently, children are using the back yard for outdoor play time. The outdoor play area was observed to be fenced. LPA observed that the outdoor yard has toys and other materials for children to play with. LPA did not
REPORT CONTINUES ON NEXT PAGE: 2 OF 4

SUPERVISOR'S NAME: Christina Gabelman	TELEPHONE: (323) 981-3383
LICENSING EVALUATOR NAME: Lissete Gonzalez	TELEPHONE: (323) 981-3383
LICENSING EVALUATOR SIGNATURE:	DATE: 02/25/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/25/2022

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
CCLD Regional Office, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME: FLORES FAMILY CHILD CARE	FACILITY NUMBER: 198005637
	VISIT DATE: 02/25/2022

NARRATIVE

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observe any objects that can pose a danger to children on the outdoor yard. The licensee states that supervision is always provided.

The licensee is observed to be operating within the license capacity limitations. LPA did not observe any children left in parked vehicles. Car seats shall only be used for transportation. LPA did not observe any children sleeping in car seats.

At 9:25AM, LPA observed the Licensee’s training on preventive health practices including Pediatric First Aid and CPR to have an expiration date of 3/23/2021. There are first aid supplies available. LPA advised that if a child shows signs of illness he/she/they shall be separated from other children.

Children’s records were reviewed, including emergency information and were observed to be complete.

The licensee does/does not have proof of immunization against influenza, pertussis, and measles.

LPA observed that the Licensee has proof of the Mandated Reporter AB 1207 compliant Child Care Training Certificate on file.
LPA issued a Confidential Names List (LIC 811) to the licensee which documents staff and children’s files reviewed during this inspection.

All homes shall conduct fire and disaster drills at least once every six months, and document the date and time of each drill. Last drill documented was conducted on 02/01/22.

There are two dogs on the premises. The dogs are kept on the side yard (fenced) during operating hours.

LPA did not observe any pools, spas, hot tubs, fish ponds, or similar bodies of water during the inspection.

Emergency Disaster Plan, Parent’s Rights Poster and the Facility License were observed to be posted.
LPA did not observe the following items during the inspection: Infant Walkers, Johnny Jumpers, Saucer Chairs, Trampolines and/or any other item that fall into these categories are not permitted in a family child care facility.

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SUPERVISOR'S NAME: Christina Gabelman	TELEPHONE: (323) 981-3383
LICENSING EVALUATOR NAME: Lissete Gonzalez	TELEPHONE: (323) 981-3383
LICENSING EVALUATOR SIGNATURE:	DATE: 02/25/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/25/2022

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
CCLD Regional Office, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME: FLORES FAMILY CHILD CARE	FACILITY NUMBER: 198005637
	VISIT DATE: 02/25/2022

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Smoking is prohibited in a licensed Family Child Care Home. Per Licensee, no one smokes in the home.

Incidental Medical Services (IMS):
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.

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 following deficiencies listed on the attached LIC 809 (deficiency page) 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.

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

Exit interview conducted and report was reviewed with the licensee, Monica Flores.

END OF REPORT PAGE: 4 OF 4

SUPERVISOR'S NAME: Christina Gabelman	TELEPHONE: (323) 981-3383
LICENSING EVALUATOR NAME: Lissete Gonzalez	TELEPHONE: (323) 981-3383
LICENSING EVALUATOR SIGNATURE:	DATE: 02/25/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/25/2022

LIC809 (FAS) - (06/04)

Page: 4 of 6

Document Has Been Signed on 02/25/2022 11:58 AM - 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 CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME: FLORES FAMILY CHILD CARE	FACILITY NUMBER: 198005637
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 02/25/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

HSC

1597.543

Licensure Requirements

Every family day care home for children shall have one or more carbon monoxide detectors in the facility that meet the standards established in Chapter 8 (commencing with Section 13260) of Part 2 Division 12. The department shall account for the presence of these detectors during inspections. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation, the licensee did not comply with the section cited above in that there was no carbon monoxide detector available at the facility which poses a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 03/11/2022
	Plan of Correction
1 2 3 4	Licensee states she will purchase and install an operational carbon monoxide detector. A photograph of the installed carbon monoxide detector will be sent to LPA as proof of correction.

Type B

Section Cited

CCR

102417(g)(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: (1) Fireplaces and open face heaters shall be screened to prevent access by children. The home shall contain a fire extinguisher and smoke detector device which meet standards established by the State Fire Marshall. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation, the licensee did not comply with the section cited above in that the required 2A 10BC fire extinguisher model was not available at the facility which poses a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 03/11/2022
	Plan of Correction
1 2 3 4	Licensee states she will purchase the required 2A 10BC Fire Extinguisher. A photograph of the fire extinguisher and receipt will be sent to LPA as proof of correction.

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) 981-3383
LICENSING EVALUATOR NAME: Lissete Gonzalez	TELEPHONE: (323) 981-3383
LICENSING EVALUATOR SIGNATURE:	DATE: 02/25/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/25/2022

LIC809 (FAS) - (06/04)

Page: 5 of 6

Document Has Been Signed on 02/25/2022 11:58 AM - 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 CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME: FLORES FAMILY CHILD CARE	FACILITY NUMBER: 198005637
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 02/25/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

102416(c)

Personnel Requirements

(c) The licensee and other personnel as specified shall complete training on preventive health practices, including pediatric cardiopulmonary resuscitation and pediatric first aid, pursuant to Health and Safety Code Section 1596.866. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation, the licensee did not comply with the section cited above in that the Pediactric First Aid/CPR certification for Licensee has an expiration date of 03/23/2021 which poses a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 03/25/2022
	Plan of Correction
1 2 3 4	Licensee states she will enroll in a Pediatric First Aid/CPR course and submit an udpated copy of the certification to LPA as proof of correction.

Section Cited


	Deficient Practice Statement
1 2 3 4
	POC Due Date:
	Plan of Correction
1 2 3 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: Christina Gabelman	TELEPHONE: (323) 981-3383
LICENSING EVALUATOR NAME: Lissete Gonzalez	TELEPHONE: (323) 981-3383
LICENSING EVALUATOR SIGNATURE:	DATE: 02/25/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/25/2022

LIC809 (FAS) - (06/04)

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