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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198007267
Report Date: 11/14/2019
Date Signed: 11/14/2019 05:22:32 PM

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:TEJENA FAMILY CHILD CAREFACILITY NUMBER:
198007267
ADMINISTRATOR:TEJENA, AURA & CARLOSFACILITY TYPE:
810
ADDRESS:TELEPHONE:
3232779964
CITY:MAYWOODSTATE: CAZIP CODE:
90270
CAPACITY:14CENSUS: 8DATE:
11/14/2019
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
01:05 PM
MET WITH:Aura TejenaTIME COMPLETED:
05:30 PM
NARRATIVE
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Conducted in Spanish
An unannounced Annual Random Inspection was conducted by Licensing Program Analyst (LPA) Fabiola Vasquez and Licensing Program Manager (LPM) Claudia Guangorena who met with licensee Aura Tejena.
This is a single story home. Currently residing in the home are 5 adults and 1 minor. No other adults were present at the time of inspection. Upon arrival, Licensing staff observed 1 child sleeping in an off limit bedroom. Per licensee he is her biological grandson and 3 children napping in the dinning room. Total of four children in care. Days and hours of operation Monday- Friday 6:00AM.-6:00PM.

Licensee was reluctant to guide licensing staff on a tour of the facility. Licensee stated that she was not going to open her daughters and sons bedroom doors (Maryorie Tejena, Johanna Tejana, Jonathan Tejena). Licesning staff asked Licensee if they live in the home she stated yes. Licensing staff observed a for rent sign for 1 bedroom. When asked Licensee stated it is not for this house it is for a room in South Gate where her daughter's friend lives. Licensing staff observed a facility advertisement banner missing the facility number in the front yard. During the inspection 4 school age children arrived and the Licensee (carlos Aura).

Areas accessible to children were inspected as follows: Living room, dining room, bathroom, front yard, and 1 bedroom, bed room used for eating.

Areas off limits include: 4 bedrooms, 1 bathroom, kitchen, laundry room, side yard and garage.

All areas used by children were inspected for safety, comfort, cleanliness, ventilation and heating Detergents, cleaning compounds, medicines, sharp objects, hazardous items that can pose a danger to children are inaccessible. The licensee understands that any poisons must be locked with a key or combination lock.
SUPERVISOR'S NAME: Brandi VanOostenTELEPHONE: (323) 981-3439
LICENSING EVALUATOR NAME: Fabiola VasquezTELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:

DATE: 11/14/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/14/2019
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: TEJENA FAMILY CHILD CARE
FACILITY NUMBER: 198007267
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/14/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
12/02/2019
Section Cited

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Employess or Volunteers at family day care home: 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 recieve an
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influenza vaccination between August 1 and December 1 of each year. The requirement is not met as evidenced by Licensee does not have any proof of vaccinations, This is a potential risk to the health and safety of children in care.
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Type B
12/02/2019
Section Cited

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Advertisements and License Number

Licensees shall reveal each facility license number in all advertisements, publications, or announcements made with the intent to attract clients.
Type B
12/02/2019
Section Cited

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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.The requirement is not met medication was out avaliable not stored. This is a potential risk to the health and safety of children in care.
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: Brandi VanOostenTELEPHONE: (323) 981-3439
LICENSING EVALUATOR NAME: Fabiola VasquezTELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:
DATE: 11/14/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/14/2019
LIC809 (FAS) - (06/04)
Page: 2 of 6
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: TEJENA FAMILY CHILD CARE
FACILITY NUMBER: 198007267
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/14/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
12/02/2019
Section Cited

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The home shall be free from defects or conditions which might endanger a child. Safety precautions shall include but not be limited to a child was sleeping an an off limit area unsupervised. The requirement is not met as evidenced This poses a potential risk to the health and safety of children in care.
Type B
12/02/2019
Section Cited

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The home shall be free from defects or conditions which might endanger a child. Safety precautions shall include but not be limited to the requirement is not met as evidenced the side of the front yardwhere children play has jagged edges This is a potential risk to the health and safety of children in care.

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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: Brandi VanOostenTELEPHONE: (323) 981-3439
LICENSING EVALUATOR NAME: Fabiola VasquezTELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:
DATE: 11/14/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/14/2019
LIC809 (FAS) - (06/04)
Page: 5 of 6
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: TEJENA FAMILY CHILD CARE
FACILITY NUMBER: 198007267
VISIT DATE: 11/14/2019
NARRATIVE
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All adults living and working in the home shall be made of aware of the Departments right to inspection authority, which includes but not limited to the right to enter the home when children are being cared for, interview children and adults and review documentation.

LPA advised the licensee how to access forms, regulations and quarterly updates on line at: www.ccld.ca.gov.

The following deficiencies are being cited in accordance to Title 22 Regulations. The Notice of Site Visit (LIC 9213) – must remain posted for 30 days during the hours of operation after each site inspection by a licensing representative. Failure to maintain posting as required will result in a civil penalty of $100.00. Exit interview was conducted with Aura Tejena. Appeal Rights were issued and discussed.

SUPERVISOR'S NAME: Brandi VanOostenTELEPHONE: (323) 981-3439
LICENSING EVALUATOR NAME: Fabiola VasquezTELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:

DATE: 11/14/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/14/2019
LIC809 (FAS) - (06/04)
Page: 6 of 6
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: TEJENA FAMILY CHILD CARE
FACILITY NUMBER: 198007267
VISIT DATE: 11/14/2019
NARRATIVE
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Per licensee, there are no weapons or firearms or bodies of water on the premises. Licensing staff did not observe swimming pools or spas on the premises. The front yard is adequately fenced. There are age appropriate toys. The smoke detectors and carbon monoxide detectors are present and in operational condition. The required 2A-10BC fire extinguisher has been serviced on October 2019.

There are emergency supplies on the premises and a first aid kit. The fire extinguisher type 2A-10BC must be serviced annually or as often as necessary. Smoke and Carbon Monoxide detectors should be checked and batteries replaced as needed.

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

CPR Card valid until: 3/09/2021 (Aura Tejena), CPR Card valid until: 2/17/2020 (Carlos Tejena)


Child Care Roster, Disaster Plan, and Children's Records were reviewed and discussed.
Children records and required licensing forms were discussed as well as mandated child abuse reporting and criminal record clearance requirement.

The following was discussed with the Licensee:

Jonathan Tejena conditional criminal exemption has been granted and approved with the following conditions:
1. Does not transport children.
2. The individual does not violate any licensing laws or regulations.
3. The individual does not engage in conduct that indicate that he/she may pose a risk to the health and
Safety of any individuals who is or may be a client.
4. The individual does not fail to disclose a conviction even if it occurred before the exemption was granted.
5 The individual is not convicted of a subsequent crime.
SUPERVISOR'S NAME: Brandi VanOostenTELEPHONE: (323) 981-3439
LICENSING EVALUATOR NAME: Fabiola VasquezTELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:

DATE: 11/14/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/14/2019
LIC809 (FAS) - (06/04)
Page: 3 of 6
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: TEJENA FAMILY CHILD CARE
FACILITY NUMBER: 198007267
VISIT DATE: 11/14/2019
NARRATIVE
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Individuals who are 18 years of age or older living in the home must obtain a criminal record clearance. Individuals within one month of their 18th birthday must be fingerprinted immediately. Failure to obtain a criminal record background check clearance prior to initial presence in the home will result in an immediate $100.00 dollar or more per day Civil Penalty.

In the absence of the Licensee, a qualified adult must be present supervising the children; a qualified adult is an individual who has a valid and current adult/infant CPR & Pediatric First Aid certification and a valid criminal record clearance associated to the facility license.

All forms of children and staff enrolled must be available and maintained for a period of three years, even after children no longer are attending the facility. Annual fees must be paid promptly and by the due date or a late fee shall be assessed and/or the License shall be terminated.

Changes should be reported to the Department as soon as they occur such as construction, remodeling, telephone number changes and/or if you move from your home.

Any unusual incidents or injuries must be reported to the Department within 24 hours via telephone and within seven (7) days in writing. Fire and safety drills must be performed every six months and documented for review by the Department. Smoking is prohibited in a family child care home. Children and Staff records must be maintained and updated as needed and must be available for review by the Department.


POSTING REQUIREMENTS: Parent’s Rights Poster, Earthquake and fire drill log, Emergency Disaster plan posted and License posted.

Infant Care: Baby walkers, saucer chairs, bouncers, Johnny Jumpers or any similar items are prohibited.

LPA provided a Safe Sleep Awareness Campaign (PIN) 19-02-CCP dated February 20, 2019 packet, Never Shake a Baby (Pub 271), A Child Care Providers Guide to Safe Sleep (SIDS) American Academy of Pediatrics and California Child Passenger Safety Law during today’s inspection.
SUPERVISOR'S NAME: Brandi VanOostenTELEPHONE: (323) 981-3439
LICENSING EVALUATOR NAME: Fabiola VasquezTELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:

DATE: 11/14/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/14/2019
LIC809 (FAS) - (06/04)
Page: 4 of 6