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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198007267
Report Date: 02/13/2020
Date Signed: 02/13/2020 05:03:59 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:
(323) 277-9964
CITY:MAYWOODSTATE: CAZIP CODE:
90270
CAPACITY:14CENSUS: 10DATE:
02/13/2020
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
03:15 PM
MET WITH:Licensee, Aura TejenaTIME COMPLETED:
05:00 PM
NARRATIVE
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3:10 PM Fabiola Vasquez, LPA arrived at the facility, observed Co-Licensee walking away from the facility into a vehicle turned the ignition on. LPA conducted an Unannounced Case Management- Other Inspection. Upon arrival 3:12 PM there were 10 children in care with Licensee's daughter Johanna Tejena. 3:23 PM Co-Licensee, Carlos Tejena walked in to the facility. Aura Tejena arrived at 4:00PM.

Johanna Tejena stated " My mom is picking up her medicine. LPA asked is she far a little in South gate, My dad was going to pick her up but he came back. I called her an uber. So he can be here.(Carlos Tejena)."

LPA reviewed : Deficiencies issued on 11/14/19. Licensee removed the for rent poster on the window.

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.

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

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. A copy of this report and appeal rights were provided.

Licensee Refuse to sign.

SUPERVISOR'S NAME: Brandi VanOostenTELEPHONE: (323) 981-3365
LICENSING EVALUATOR NAME: Fabiola VasquezTELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:

DATE: 02/13/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/13/2020
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: 02/13/2020
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
02/14/2020
Section Cited

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For a Large Family Child Care Home, the maximum number of children for whom care may be provided at any one time when there is an assistant provider in the home, including children under age 10 who reside at the licensee's home and the assistant provider's children under age 10, shall be either:This requirement was not met as evidenced by:
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LPA observed 10 children in care with Licensee's daughter.

This poses an immediate 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) 981-3365
LICENSING EVALUATOR NAME: Fabiola VasquezTELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:
DATE: 02/13/2020
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/13/2020
LIC809 (FAS) - (06/04)
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