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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198007147
Report Date: 10/25/2022
Date Signed: 10/25/2022 02:48:37 PM


Document Has Been Signed on 10/25/2022 02:48 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:GUERRA FAMILY CHILD CAREFACILITY NUMBER:
198007147
ADMINISTRATOR:GUERRA, THELMAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
2135365179
CITY:LOS ANGELESSTATE: CAZIP CODE:
90011
CAPACITY:14CENSUS: 4DATE:
10/25/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:31 AM
MET WITH:Thelma Guerra, LicenseeTIME COMPLETED:
03:46 PM
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On Tuesday, October 25, 2022 at 10:31 a.m., Licensing Program Analyst (LPA) Mayra Rivera conducted an unannounced annual inspection and met with Licensee Thelma Guerra who guided LPA Rivera on a tour of the facility.

During the inspection, 3 infants and one preschool child were present and assistant. Family members residing in the home has been discussed with licensee and have obtained a criminal record clearance or exemption. Operating hours are Monday to Friday, 6:00 a.m. to 7:00 p.m and care for children ages 0 to 13 years.

This facility is a one-story home that consists of three bedrooms, one full and half bathroom, kitchen, living room, and front yard and backyard (fenced and gated). Areas that are accessible to children and identified on the facility sketch were inspected by LPA Rivera; living room, daycare bedroom (by living room), kitchen, and backyard. Areas off limits to children include- front yard, master bedroom, computer room, full bathroom, outdoor sheds and garage.

At approximately 10:46 a.m., LPA Rivera inspected the facility for safety, comfort, cleanliness, ventilation and working phone (land line and cell phone). For ventilation, LPA Rivera observed AC wall unit and wall heater with screen protector, ocated in the living room. LPA observed the furniture and children materials to be in good condition and age appropriate.

At approximately 11:01 a.m, LPA Rivera entered the restroom and observed a toilet, toilet paper and the hand washing sink, hand soap and paper towels outside of the restroom . LPA did not observe any hazards and observed the restroom and hand washing sink area to be in good condition.

SUPERVISOR'S NAME: Karen ChambersTELEPHONE: (323) 981-3368
LICENSING EVALUATOR NAME: Mayra RiveraTELEPHONE: (323) 629-7782
LICENSING EVALUATOR SIGNATURE:
DATE: 10/25/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/25/2022
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 CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME: GUERRA FAMILY CHILD CARE
FACILITY NUMBER: 198007147
VISIT DATE: 10/25/2022
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At approximately 11:17 a.m., LPA observed cleaning compounds items stored inside the storage cabinet located in the diapering area with a child proof lock making it inaccessible for children to open. Knives and sharp objects, LPA observed the items stored inside the kitchen cabinet with child proof lock making it inaccessible for children to open. For drinking water, LPA observed water dispensers and disposable cups. Licensee is currently enrolled with California Adult Child Care Food Program. Currently the facility does not have any children with food allergies.

LPA Rivera asked if there are any pets, poisons, firearms, weapons or bodies of water. Licensee stated she has one dog, no body of waters, no firearms, no weapons or poisons. LPA did not observe, firearms, weapons, poisons nor bodies of water. Licensee was advised that if any poisons (ex; drano, rat poison or items with skull hazard symbol), firearms and weapons are purchased, it is required to be locked with a key or combination lock and firearm and ammunition must be stored separately.



At approximately 11:29 a.m., LPA Rivera observed the 2A10BC fire extinguisher located in the kitchen and the valve not on the green area and serviced on 3/29/22. LPA informed Licensee that the fire extinguisher needs to be replaced or refilled. LPA observed the combo smoke/carbon detector in the living room. The detector was tested and is operable. LPA observed the first Aid complete with band aids, gauzes, adhesive bandages and antiseptic wipes and located in the diapering room. LPA observed the fire/earthquake drill log and last drill conducted on 6/1/22.

At approximately 11:45 a.m., LPA Rivera inspected the outdoor area used by children for safety, comfort and cleanliness. LPA observed the equipment to be age appropriate, and good condition and free of sharp, no loose or pointed parts. LPA observed two swings, and a slide with no soft padding that observes a fall. LPA advised to add soft padding the supports a fall from the swings or recommended to remove the swings to avoid an injury. Also, LPA informed to add soft padding below the exit of the slide. LPA observed a unit (second floor) and a gate closed and locked with a keypad lock below the stairs that leads to the second floor (tenant). LPA observed two sheds closed and with keypad locks. LPA observed a garage and per licensee, the garage is occupied by a family member. LPA observed 3 propane tanks, BBQ materials, chairs and other personal items located in the side yard. LPA observed the side yard fenced, gated, and closed with a self-latch lock.

SUPERVISOR'S NAME: Karen ChambersTELEPHONE: (323) 981-3368
LICENSING EVALUATOR NAME: Mayra RiveraTELEPHONE: (323) 629-7782
LICENSING EVALUATOR SIGNATURE:

DATE: 10/25/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/25/2022
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 CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME: GUERRA FAMILY CHILD CARE
FACILITY NUMBER: 198007147
VISIT DATE: 10/25/2022
NARRATIVE
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LPA observed licensee Pediatric First Aid/ CPR certification dated 11/21/22 , missing Health and Safety (8 hour) certification and the AB 1207 Child Abuse Mandated Reporting training expired on 7/30/2020. Licensee has proof of immunization against Pertussis, MMR and Influenza. Licensee was advised that the mandated reporter training must be completed every 2 years, and is available at www.mandatedreporterca.com

At approximately 12:25 p.m., LPA reviewed child #1 file. LPA observed child #1 file to be incomplete; missing Safe Sleep Plan LIC 9227, Safe Sleep Log, and LIC 627 Emergency Medical Treatment. LPA also reviewed licensee and staff files and observed the files to be incomplete. Licensee and assistant AB 1207 Child Abuse Mandated Reporting training expired on 7/30/2020


Safe Sleep: LPA discussed the safe sleep regulations with assistant Viridiana Becerra 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 assistant Viridiana of the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at also explained to licensee that car seat, stroller are only and only for https://www.cpsc.gov/ and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment.

LPA Rivera also reviewed Sudden Infant Death Syndrome (SIDS), Never Shake A Baby, and Lead Exposure information with licensee. LPA informed car seats are only for transportation, highchair is only and only for feeding and stated items cannot be misused. No smoking, No infant walkers, No Johnny jumpers, No saucer chairs and any other item that falls into this category are not permitted in a family child care facility.



Medication: Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Family Child Care Homes Section 102417. When any IMS is provided, a Plan for Providing IMS must be submitted to the Department. The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice)/ (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: http://www.ada.gov/childqanda.htm

Currently the facility has not children with or on medication.

SUPERVISOR'S NAME: Karen ChambersTELEPHONE: (323) 981-3368
LICENSING EVALUATOR NAME: Mayra RiveraTELEPHONE: (323) 629-7782
LICENSING EVALUATOR SIGNATURE:

DATE: 10/25/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/25/2022
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 CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME: GUERRA FAMILY CHILD CARE
FACILITY NUMBER: 198007147
VISIT DATE: 10/25/2022
NARRATIVE
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Criminal Record Statement: Assistant Viridiana Becerra 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.

LPA provided guidance in how to obtain required licensing forms and how enroll to receive Provider Information Notices (PINs)

Licensee has been given three Type B violations and three Technical Violations with due date 11/25/22.

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

Exit interview conducted and report was reviewed with assistant Viridiana Becerra.

SUPERVISOR'S NAME: Karen ChambersTELEPHONE: (323) 981-3368
LICENSING EVALUATOR NAME: Mayra RiveraTELEPHONE: (323) 629-7782
LICENSING EVALUATOR SIGNATURE:

DATE: 10/25/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/25/2022
LIC809 (FAS) - (06/04)
Page: 4 of 6
Document Has Been Signed on 10/25/2022 02:48 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: GUERRA FAMILY CHILD CARE
FACILITY NUMBER: 198007147

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/25/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102425(j)(2)
Infant Safe Sleep
The provider shall supervise infants while they are sleeping and adhere to the following requirements: The provider shall check and document the following:

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, the licensee did not comply with the section cited above for not having documentation of the safe sleep log for child 1which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 11/25/2022
Plan of Correction
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Licensee will be creating a safe sleep log starting today 10/25/22 and document date, times and initials of when Licensee is checking the infant.
Type B
Section Cited
CCR
102425(c)
Infant Safe Sleep
An Individual Infant Sleeping Plan [LIC 9227 (3/20)] shall be completed for each infant up to 12 months of age the provider has in care and included in the infant's file at the facility.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review) the licensee did not comply with the section cited above in not having the LIC 9227 Sleeping Plan signed by the parent or Licensee which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 10/25/2022
Plan of Correction
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Licensee will give the parent the LIC 9227 Slepping Plan to parent during pick up time to complete today.

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: Karen ChambersTELEPHONE: (323) 981-3368
LICENSING EVALUATOR NAME: Mayra RiveraTELEPHONE: (323) 629-7782
LICENSING EVALUATOR SIGNATURE:
DATE: 10/25/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/25/2022
LIC809 (FAS) - (06/04)
Page: 5 of 6


Document Has Been Signed on 10/25/2022 02:48 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: GUERRA FAMILY CHILD CARE
FACILITY NUMBER: 198007147

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/25/2022

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
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Based on record review the licensee did not comply with the section cited above in not having the required LIC 9227 Sleep Plan or Safe Sleep documentation which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 11/25/2022
Plan of Correction
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Licensee will have the paraent of child #1 complete LIC 9227 Safe Sleep Plan and begin documenting the 15 min sleep checks.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Karen ChambersTELEPHONE: (323) 981-3368
LICENSING EVALUATOR NAME: Mayra RiveraTELEPHONE: (323) 629-7782
LICENSING EVALUATOR SIGNATURE:
DATE: 10/25/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/25/2022
LIC809 (FAS) - (06/04)
Page: 6 of 6