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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198007267
Report Date: 08/20/2024
Date Signed: 08/20/2024 11:55:34 AM


Document Has Been Signed on 08/20/2024 11:55 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
MONTEREY PARK SW RO, 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) 627-2141
CITY:MAYWOODSTATE: CAZIP CODE:
90270
CAPACITY:14CENSUS: 1DATE:
08/20/2024
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
09:40 AM
MET WITH:Facility Represenative Johanna TejenaTIME COMPLETED:
12:15 PM
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Licensing Program Analysts (LPA) Anthony Padilla conducted an unannounced annual inspection at the above facility on 08/20/24. 9:40 AM arrived at the facility and was granted access by Field Representative 1 (FR1) Johanna Tejena licensee adult daughter). LPA provided FR1 LIC 126 Entrance Checklist and business card. FR informed LPA that licensee was currently at a doctor appointment an will return shortly. Present during inspection was 1 child with FR1 and FR2 licensee adult son. FR1 stated that hours of operation are Monday through Friday open 24 hours FR1 stated that care for children from 6 months to 10 years of age is provided.

All areas identified on the facility sketch were inspected. This is a single-story home which consists of five bedrooms, two bathrooms, Laundry Room, kitchen, dining room, living room, front yard (fenced), side yard and detached garage.

Areas used by children include: Living room, dining room, bathroom, front yard, and 1 bedroom, bedroom used for sleeping. Areas off limits include: 4 bedrooms, 1 bathroom, kitchen, laundry room, side yard and garage.



The home was inspected for safety, comfort, cleanliness, telephone service is available via cell phone, heating and ventilation. Wall heater is barricaded with a safety gate mounted . There is no accessibility to poisons, detergents, cleaning compounds, medicines, sharp objects, and hazardous items that can pose a danger to children. There are toys and other age-appropriate materials available for children. Isolation area for sick children waiting to be picked up is the nap room separate and away from the other children in care.

At 10:20 AM Licensee Aura Tejena arrived at the facility and continued inspection with LPA. Individuals residing in the home have been discussed and noted. All adults present in the home have obtained a criminal record clearance or exemption. .

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SUPERVISOR'S NAME: Karen ChambersTELEPHONE: (323) 981-3368
LICENSING EVALUATOR NAME: Anthony PadillaTELEPHONE: 323-981-3350
LICENSING EVALUATOR SIGNATURE:
DATE: 08/20/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/20/2024
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
MONTEREY PARK SW RO, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME: TEJENA FAMILY CHILD CARE
FACILITY NUMBER: 198007267
VISIT DATE: 08/20/2024
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Medications that are used by licensee are kept in her bedroom that is off limits to the children with a door blocking the hallway to several bedrooms making them inaccessible to children in care. At the moment there are no children enrolled who require medications or Incidental medical services.

The following was observed and reviewed during this inspection: LPA reviewed required posted documentation for Facility License, Publication (PUB) 394- Notification of Parent Rights and Licensing Form (LIC) 9148- Earthquake Preparedness form, LIC 9040- Facility Roster, LIC 610- Facility Disaster Plan and Disaster drill log. Last drill conducted on 8/9/24.



Food is provided by Licensee. Licensee was reminded if children bring food from home it must be labeled with the child’s name and properly stored or refrigerated. 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.
LPA observed the Fire extinguisher (3A40BC) in the kitchen indicating fully charge, serviced 3/4/24. Smoke detector and carbon monoxide detector located in the dinning room are in operable condition. Per Licensee there are no weapons, firearms in the facility. LPA did not observe any weapons or fire arms at facility during time of inspection. The kitchen has a door blocking entrance for the children as the kitchen is off limits to the children. LPA observed knives are kept on top of the counter away from children. Smoking is prohibited in a family child care home and per licensee there is no one who smokes in the home.

Children and Staff records must be maintained and updated as needed and must be available for review by the Department. Children’s records were reviewed for (LIC) 282- Affidavit Regarding Liability Insurance, Immunization Records, LIC 700- Identification and Emergency Information, LIC 627- Consent for Medical Treatment, LIC 995A Notification of Parents’ Rights, LIC 9227. During insoection LPA reviewed 1 child file and observed file to be complete with required licensing forms.

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SUPERVISOR'S NAME: Karen ChambersTELEPHONE: (323) 981-3368
LICENSING EVALUATOR NAME: Anthony PadillaTELEPHONE: 323-981-3350
LICENSING EVALUATOR SIGNATURE:

DATE: 08/20/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/20/2024
LIC809 (FAS) - (06/04)
Page: 2 of 4
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MONTEREY PARK SW RO, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME: TEJENA FAMILY CHILD CARE
FACILITY NUMBER: 198007267
VISIT DATE: 08/20/2024
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Staff records were reviewed for approved Pediatric First Aid and CPR certification, LIC-501: Personnel Record, LIC 508-Criminal Record Statement, LIC 9052- Employee Rights, Proof of immunizations against measles, pertussis and influenza or influenza declination, TB clearance or risk assessment, LIC 9108- Statement of Child and Mandated Reporter Training Certificate, Licensee's CPR/First Aid expires on 3/2/26, Mandated Reporter certificate expires on 2/8/26. At 11:00 AM LPA issued a Technical Violation (TV) for FR1 not having proof of current mandated reporter training certificate.

Licensee stated that currently the outdoor yard is not being used to play for outdoors due to construction being completed at facility. Licensee stated outdoors play area is having new flooring and fenced be installed for outdoor yard. LPA observed no tools, dust, equipment, or any other items that may be hazardous to children in care in the outdoor yard. Licensee stated that completion of construction at facility should be done by 8/30/24. Licensee will inform LPA of completion date via cell phone. Licensee states facility is currently going to local park(Freedom Park) for outdoor play.

During inspection all children were observed to be treated with dignity and respect, they were observed to be receiving safe, healthful and comfortable accommodations, furnishings and equipment, and free from corporal and/or unusual punishment.

To improve the quality and value of the new inspection process, a survey may 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 CARE tools, please send email inquiries 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.

Licensee was reminded that all adults 18 and over living or working in the home, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, 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 for a maximum of 5 days or, if the penalty is for a repeat violation, for a maximum of 30 days per person will be assessed if this regulation is violated.

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SUPERVISOR'S NAME: Karen ChambersTELEPHONE: (323) 981-3368
LICENSING EVALUATOR NAME: Anthony PadillaTELEPHONE: 323-981-3350
LICENSING EVALUATOR SIGNATURE:

DATE: 08/20/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/20/2024
LIC809 (FAS) - (06/04)
Page: 3 of 4
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MONTEREY PARK SW RO, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME: TEJENA FAMILY CHILD CARE
FACILITY NUMBER: 198007267
VISIT DATE: 08/20/2024
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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-andresources/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 PIN 22-02- CCP. 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: https://www.ada.gov/resources/child-care-centers/.

Licensee was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain child care by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.

During the exit interview, the LICENSEE AURA TEJENA, confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS.

At this time, the licensee is in compliance with California Title 22 Regulations. Therefore, there are no citations being issued today.

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

Exit interview conducted and report was reviewed with the licensee Aura Tejena

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SUPERVISOR'S NAME: Karen ChambersTELEPHONE: (323) 981-3368
LICENSING EVALUATOR NAME: Anthony PadillaTELEPHONE: 323-981-3350
LICENSING EVALUATOR SIGNATURE:

DATE: 08/20/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/20/2024
LIC809 (FAS) - (06/04)
Page: 4 of 4