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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198006142
Report Date: 12/21/2022
Date Signed: 12/21/2022 05:45:25 PM

Document Has Been Signed on 12/21/2022 05:45 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:CENTANNI FAMILY CHILD CAREFACILITY NUMBER:
198006142
ADMINISTRATOR:CENTANNI, KATHRYNFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(562) 920-0385
CITY:LAKEWOODSTATE: CAZIP CODE:
90713
CAPACITY: 14TOTAL ENROLLED CHILDREN: 10CENSUS: 6DATE:
12/21/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:15 PM
MET WITH:Licensee, Kathryn CentanniTIME COMPLETED:
06:00 PM
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On December 21, 2022 at 12:15 PM, Licensing Program Analyst (LPA) Monique Ayala conducted an unannounced inspection at the facility noted above and met with Licensee, Kathryn Centanni. The purpose of the inspection was to conduct the Required - 1 Year inspection. The operating hours of the facility is Monday through Friday from 8:00 AM to 5:00 PM. Entrance Checklist (LIC 126) was provided to the Licensee upon arrival. Individuals residing in the home were discussed and noted. At the time of the inspection, the Licensee and six (6) children were present.

All areas identified on the facility sketch were inspected. This facility is a single family home that consists of four (4) bedrooms, two (2) bathrooms, living room, kitchen, den, detached garage, and fenced backyard.

Upon arrival, LPA observed the children inside the detached garage with the garage door opened and within a gated area in the backyard that is located in front of the garage door. Per Licensee, child care is taken place outside, in the detached garage. Licensee also disclosed that children nap in the detached garage while Licensee or an Assistant is present.

Licensee stated that she did not submit an updated Facility Sketch (LIC 999A) to the Department. The current LIC 999A on record has the garage listed as off-limits to children in care. Per Licensee, children utilize one (1) bathroom that is located inside the house, which is adjacent to the den. Licensee also stated that the children currently utilize the gated area in the backyard that is located in front of the garage for outdoor activity.

Per Licensee, areas off-limits to children include: 4 bedrooms, 1 bathroom, living room, kitchen, den and part of the fenced backyard. Per Licensee, children enter and exit the facility through the front door accompanied by their parent/legal guardian and are walked to the garage. Based on record review conducted at the Monterey Park Child Care Regional Office by LPA on November 8, 2022, the Department does not have an updated LIC 999A with the disclosed off-limit areas and/or areas currently used by children in care.
SUPERVISORS NAME: Valarie Cook
LICENSING EVALUATOR NAME: Monique Ayala
LICENSING EVALUATOR SIGNATURE: DATE: 11/14/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/14/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.

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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 CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME: CENTANNI FAMILY CHILD CARE
FACILITY NUMBER: 198006142
VISIT DATE: 12/21/2022
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The current LIC 999A on record lists 4 bedrooms, 1 bathroom, and detached garage as off-limits to children in care. LPA observed the doors to the off-limit bedrooms and bathroom open, making the areas accessible to children in care. Licensee was advised that off-limit areas must be made inaccessible during operating hours or while children in care are present. LPA informed Licensee that care would need to resume within the areas noted on the original LIC 999A as these areas were granted a fire clearance. LPA informed the Licensee that an updated LIC 999A and fire clearance must be granted to provide child care in the detached garage in order to be used for care. LPA also informed the Licensee that the use of the detached garage for napping would be under the discretion of the Fire Department and/or fire clearance.

Based on record review, the facility was granted a fire clearance on November 3, 2012. Per Licensee, the Fire Department has not conducted an inspection at the facility since the initial inspection for the fire clearance. Licensee confirmed that no further inspections have been conducted at the facility by the Fire Department.

The following documents were posted inside the garage: Facility License and Notification of Parents' Rights (PUB 394). Licensee did not have the Earthquake Preparedness (LIC 9148) available or posted in a prominent, publicly accessible area at the facility. Licensee has an Emergency Disaster Plan (LIC 610A) and Facility Roster (LIC 9040) available for review. Licensee has verification of Disaster and Fire Drills available for review. The last drill was conducted on November 11, 2022.

Areas currently used by children were inspected for safety, comfort, heating, cleanliness and telephone service. Licensee stated that she has 2 cats. LPA also observed a dog at the home, which Licensee stated belongs to her daughter that is only visiting during the holidays. LPA advised the Licensee that best practice is to keep pets isolated from children in care. At 12:30 PM, LPA observed food, clothes, shoes, toys, and other miscellaneous items scattered on the floor inside the garage. LPA observed 2 infant rockers (not in use) inside the garage. LPA observed 3 infant rocking bassinets (not in use) within the gated area that is located near the garage door. LPA took multiple photographs of the noted observations.
SUPERVISORS NAME: Valarie Cook
LICENSING EVALUATOR NAME: Monique Ayala
LICENSING EVALUATOR SIGNATURE:

DATE: 12/21/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/21/2022
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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 CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME: CENTANNI FAMILY CHILD CARE
FACILITY NUMBER: 198006142
VISIT DATE: 12/21/2022
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LPA did not observe any wall heaters at the facility. LPA observed a fireplace (not in use) located in the den that may be closed with a glass door fitted for the fireplace. LPA informed the Licensee that the glass door attached to the fireplace could get hot while the fireplace is in-use and should be screened to make the fireplace inaccessible to children in care per licensing regulations.

Detergents, cleaning compounds, and medicines were made inaccessible to children. Per Licensee, there are no poisons kept in the home. Licensee was advised that if any poisons are purchased, it is required to be locked with a key or combination lock. Per Licensee, there are no firearms and/or weapons on the premises. Licensee disclosed that children use fabric nap mats that have an attached pillow for napping. LPA did not observe any other napping equipment other than 1 play pen.

At 12:47 PM, LPA observed a small water well/water fountain located in the flower bed that is in the backyard. Per Licensee, the area of the backyard is not used by children in care. During the inspection, LPA observed children walking through the "off-limit" area of the backyard to enter the inside of the home while Licensee was with LPA in the den with the back sliding door open. LPA observed the water well/water fountain not in-use however, water was accumulated inside the well/fountain and the well/fountain is not barricaded. During the inspection, LPA took photographs of the noted observation.

LPA observed the required fire extinguisher (2-A:10-B:C or larger) that is fully charged. LPA observed the fire extinguisher stored under the kitchen sink that is located inside the home. Licensee did not have a receipt available for the fire extinguisher or documentation of when the fire extinguisher was last serviced. Licensee was reminded to have the fire extinguisher serviced yearly.

Licensee tested the smoke detector located inside the garage, which was inoperable. Licensee also tested the smoke detector that is located inside the home near the restroom used by children in care, which was operable. During the inspection, Licensee did not have a carbon monoxide detector available. Licensee had a First Aid kit available. Licensee was reminded that food that is brought from the child's home shall be labeled with the child’s name and properly stored or refrigerated.
SUPERVISORS NAME: Valarie Cook
LICENSING EVALUATOR NAME: Monique Ayala
LICENSING EVALUATOR SIGNATURE:

DATE: 12/21/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/21/2022
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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 CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME: CENTANNI FAMILY CHILD CARE
FACILITY NUMBER: 198006142
VISIT DATE: 12/21/2022
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LPA conducted a record review of six (6) children's records and the Licensee's record. Based on the children's record review, 4 children's records (C2, C3, C4, and C5) did not have the Consent for Emergency Medical Treatment (LIC 627) available for review. C2's record also did not have documentation of the 15-minute physical checks for when the child is napping available for review.

Based on Licensee's record review, Licensee has proof of immunization against measles, pertussis, influenza, and a TB clearance. Licensee has a current Pediatric First Aid and CPR certification (expires July 2023). Licensee completed the Preventative Health and Safety Practices (EMSA-approved) training on March 28, 1999 and Mandated Reporter Training (AB 1207) on November 14, 2022. Licensee was advised that the Mandated Reporter training (AB 1207) must be completed every 2 years and is available at www.mandatedreporterca.com. Licensee did not have the Criminal Record Statement (LIC 508) available for review.

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 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 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.
SUPERVISORS NAME: Valarie Cook
LICENSING EVALUATOR NAME: Monique Ayala
LICENSING EVALUATOR SIGNATURE:

DATE: 12/21/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/21/2022
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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 CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME: CENTANNI FAMILY CHILD CARE
FACILITY NUMBER: 198006142
VISIT DATE: 12/21/2022
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Licensee was reminded that all adults 18 and over living in the home, persons who provide care and supervision to children, and staff who have contact with children, 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.

Community Care Licensing Division (CCLD) regularly sends information to licensed facilities, providers, and stakeholders by way of Provider Information Notices (PINs), Program Quarterly Update Newsletters and other important information communication platforms.

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/inspection-process.

Deficiencies were cited during today's inspection (refer to deficiency pages). During the inspection, LPA provided in-depth technical assistance regarding Title 22 regulations. LPA provided information to the Licensee regarding the Technical Support Program (TSP). Per Licensee, she will determine an agreement to participate with TSP at a later time.

A Notice of Site Visit (LIC 9213) was given and must remain posted for 30 days.

Exit interview conducted and report was reviewed with Licensee, Kathryn Centanni.
SUPERVISORS NAME: Valarie Cook
LICENSING EVALUATOR NAME: Monique Ayala
LICENSING EVALUATOR SIGNATURE:

DATE: 12/21/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/21/2022
LIC809 (FAS) - (06/04)
Page: 5 of 11
Document Has Been Signed on 12/21/2022 05:45 PM - It Cannot Be Edited


Created By: Monique Ayala On 12/21/2022 at 04:15 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME: CENTANNI FAMILY CHILD CARE
FACILITY NUMBER: 198006142

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/21/2022

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 as the facility did not have a carbon monoxide detector which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 01/23/2023
Plan of Correction
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Licensee will install an operable carbon monoxide inside the facility by the POC due date. During the inspection, Licensee was able to obtain 2 new carbon monoxide detectors that were installed inside the home and detached garage. The carbon monoxide detectors were tested and are operable.
Type B
Section Cited
CCR
102417(b)
Operation of A Family Child Care Home
(b) The home shall be kept clean and orderly, with heating and ventilation for safety and comfort.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, the licensee did not comply with the section cited above as the detached garage (child care area) was not kept clean or orderly which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 01/23/2023
Plan of Correction
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Licensee will ensure that the child care areas are kept clean and orderly while children are in care. During the inspection, the area used by children in care was cleaned by the Licensee. LPA will conduct an unannounced inspection to the facility by January 23, 2023 to ensure compliance.
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
LICENSING EVALUATOR NAME:Monique Ayala
LICENSING EVALUATOR SIGNATURE:
DATE: 12/21/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/21/2022


LIC809 (FAS) - (06/04)
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Document Has Been Signed on 12/21/2022 05:45 PM - It Cannot Be Edited


Created By: Monique Ayala On 12/21/2022 at 04:15 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME: CENTANNI FAMILY CHILD CARE
FACILITY NUMBER: 198006142

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/21/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102417(d)
Operation of A Family Child Care Home
(d) The home shall provide safe toys, play equipment and materials.

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 as LPA observed prohibited devices (not in-use) inside the child care area (infant rockers and infant rocking bassinets) which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 01/23/2023
Plan of Correction
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Licensee removed the prohibited devices from the child care area. LPA will conduct an unannounced inspection to the facility by January 23, 2023 to ensure compliance.
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
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Based on observation, the licensee did not comply with the section cited above as the facility has a fireplace that is screened with a fitted glass door that may become hot while the fireplace is in-use, the Licensee did not have documentation available for the fire extinguisher as to when it was purchased or last serviced, and the facility did not have an operable smoke detector inside the detached garage (child care area) which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 01/23/2023
Plan of Correction
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Licensee will install a screen or barricade to the fireplace to make the fireplace inaccessible and safe while children are in care. Licensee will submit a photograph of the installation to LPA via e-mail by January 23, 2023. During the inspection, Licensee was able to have a new fire extinguisher purchased and presented to LPA the receipt. Licensee also replaced the battery to the smoke detector located inside the detached garage, which was then made operable.
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
LICENSING EVALUATOR NAME:Monique Ayala
LICENSING EVALUATOR SIGNATURE:
DATE: 12/21/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/21/2022


LIC809 (FAS) - (06/04)
Page: 7 of 11
Document Has Been Signed on 12/21/2022 05:45 PM - It Cannot Be Edited


Created By: Monique Ayala On 12/21/2022 at 04:15 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME: CENTANNI FAMILY CHILD CARE
FACILITY NUMBER: 198006142

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/21/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102417(g)(5)
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: (5) All licensees shall ensure the inaccessibility of pools (in-ground and above-ground), fixed-in-place wading pools, hot tubs, spas, fish ponds and similar bodies of water through a pool cover or by surrounding the pool with a fence.

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 as LPA observed a small water well/water fountain located in the off-limit portion of the backyard that was made accessible to children in care which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 01/23/2023
Plan of Correction
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2
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4
Licensee will have the water well/water fountain barricaded or removed to ensure the safety of children in care. Licensee will submit a photograph as proof of correction to LPA via e-mail by January 23, 2023.
Type B
Section Cited
CCR
102416.1(a)(11)
Personnel Records
(a) Personnel records shall be maintained on each employee and shall contain the following information: (11) A signed statement regarding their criminal record history as required by Section 102370(c).

This requirement is not met as evidenced by:
Deficient Practice Statement
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4
Based on record review, the licensee did not comply with the section cited above as Licensee did not have the Criminal Record Statement (LIC 508) available for review which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 01/23/2023
Plan of Correction
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2
3
4
Licensee will submit the completed LIC 508 to LPA via e-mail by January 23, 2023.
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
LICENSING EVALUATOR NAME:Monique Ayala
LICENSING EVALUATOR SIGNATURE:
DATE: 12/21/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/21/2022


LIC809 (FAS) - (06/04)
Page: 8 of 11
Document Has Been Signed on 12/21/2022 05:45 PM - It Cannot Be Edited


Created By: Monique Ayala On 12/21/2022 at 04:15 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME: CENTANNI FAMILY CHILD CARE
FACILITY NUMBER: 198006142

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/21/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102416.2(a)(2)
Reporting Requirements
(a) The licensee shall report the following information the Department by telephone or fax within the Department's next business day and during normal working hours (8am to 5pm). (2) Any change in household composition including adults moving in or out of the home and anyone living in the home who reaches his or her 18th birthday.

This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on interview and record review, the licensee did not comply with the section cited above as Licensee disclosed that two of her adult children are no longer residing in the home/facility and did report this information to the Department which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 01/23/2023
Plan of Correction
1
2
3
4
Licensee will submit an updated Application for a Family Child Care Home License (LIC 279) and Current Children in your Home (LIC 279B) to the Monterey Park Child Care Regional Office to reflect the individuals that currently reside in the home/facility by January 23, 2023.
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 as LPA observed the off-limit detached garage currently being used for child care and the Licensee disclosing that she did not notify the Department of this change which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 01/23/2023
Plan of Correction
1
2
3
4
Licensee will submit an updated Facility Sketch (LIC 999A) to the Department in order for the Department to issue a fire inspection request to the Fire Department. Licensee was informed that the detached garage can not be used until an updated fire clearance is granted. LPA will also conduct an unannounced inspection to the facility by January 23, 2023 to ensure compliance.
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
LICENSING EVALUATOR NAME:Monique Ayala
LICENSING EVALUATOR SIGNATURE:
DATE: 12/21/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/21/2022


LIC809 (FAS) - (06/04)
Page: 9 of 11
Document Has Been Signed on 12/21/2022 05:45 PM - It Cannot Be Edited


Created By: Monique Ayala On 12/21/2022 at 04:15 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME: CENTANNI FAMILY CHILD CARE
FACILITY NUMBER: 198006142

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/21/2022

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 observation and interview, the licensee did not comply with the section cited above as LPA observed the children inside the "off-limit" detached garage and the Licensee disclosed that the inside of the home is currently off-limits to children in care other than 1 bathroom which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 01/23/2023
Plan of Correction
1
2
3
4
Licensee will submit an updated Facility Sketch (LIC 999A) to the Department by January 23, 2023 for further review. LPA will also conduct an unannounced inspection to the facility by January 23, 2023 to ensure compliance.
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 record review, the licensee did not comply with the section cited above in four (4) children's records (C2, C3, C4, and C5) did not have the Consent for Emergency Medical Treatment (LIC 627) available for review which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 01/23/2023
Plan of Correction
1
2
3
4
Licensee will submit the completed LIC 627 for C2, C3, C4, and C5 to LPA via e-mail by January 23, 2023.
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
LICENSING EVALUATOR NAME:Monique Ayala
LICENSING EVALUATOR SIGNATURE:
DATE: 12/21/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/21/2022


LIC809 (FAS) - (06/04)
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Document Has Been Signed on 12/21/2022 05:45 PM - It Cannot Be Edited


Created By: Monique Ayala On 12/21/2022 at 04:15 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME: CENTANNI FAMILY CHILD CARE
FACILITY NUMBER: 198006142

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/21/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102425(j)(2)(D)
Infant Safe Sleep
Documentation shall be maintained in the infant’s file and be available to the Department for review. Documentation shall include the following:

This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on record review, the licensee did not comply with the section cited above in 1 child's record (C2) did not have verification of the 15-minute physical checks for when the child is napping available for review which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 01/23/2023
Plan of Correction
1
2
3
4
Licensee will conduct 15-minute physical checks for infants while they are napping. Licensee will submit documentation of the 15-minute physical checks for C2 for the duration of one week to LPA via e-mail by January 23, 2023.
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:Valarie Cook
LICENSING EVALUATOR NAME:Monique Ayala
LICENSING EVALUATOR SIGNATURE:
DATE: 12/21/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/21/2022


LIC809 (FAS) - (06/04)
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