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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198007267
Report Date: 02/15/2023
Date Signed: 02/15/2023 06:23:53 PM


Document Has Been Signed on 02/15/2023 06:23 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
MONTEREY PARK S WEST, 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: DATE:
02/15/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
02:10 PM
MET WITH:'Aura TejenaTIME COMPLETED:
06:30 PM
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Licensing Program Analysts (LPA) Patricia Medel and Licensing Program Manager (LPM) Karen Chambers conducted an unannounced joint annual required inspection at the above facility on 02/15/23. This visit was conducted in Spanish. LPA met with Licensee Aura Tejana who guided analyst on a tour of the facility. There were 5 children and 3 staff present when LPA arrived. Licensee states that her hours of operation are Monday through Friday. 6AM to 6:00PM. Licensee states that she will care for children from 6 months to 10 years of age.

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 (cell phone), heating and ventilation. Wall heater is barricaded and after 15 mins, of being turned on there was no heat to the touch. There is no accessibility to poisons, detergents, cleaning compounds, medicines, sharp objects, and hazardous items that can pose a danger to children. However, in the sleep room there are objects such as books, boxes and video equipment on shelves above that can pose threat to sleeping children during an earthquake. There are toys and other age-appropriate materials available for children. Isolation area for sick children waiting to be picked up is play room number 2 away from the other children..
SUPERVISOR'S NAME: Karen ChambersTELEPHONE: (323) 981-3368
LICENSING EVALUATOR NAME: Patricia MedelTELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:
DATE: 02/15/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/15/2023
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 S WEST, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME: TEJENA FAMILY CHILD CARE
FACILITY NUMBER: 198007267
VISIT DATE: 02/15/2023
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Medicines 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. 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 Center and the ADA, available at: http://www.ada.gov/childqanda.htm

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.



Individuals residing in the home have been discussed and noted. All adults present in the home have obtained a criminal record clearance or exemption. Per Licensee, they currently have one assistant. Licensee 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

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.

Facility records were reviewed for LIC 9040- Facility Roster, LIC 610- Facility Disaster Plan and Disaster drill log. Last drill conducted on December 30, 2022.
SUPERVISOR'S NAME: Karen ChambersTELEPHONE: (323) 981-3368
LICENSING EVALUATOR NAME: Patricia MedelTELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:

DATE: 02/15/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/15/2023
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 S WEST, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME: TEJENA FAMILY CHILD CARE
FACILITY NUMBER: 198007267
VISIT DATE: 02/15/2023
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LPA observed the Fire extinguisher (3A40BC) in the kitchen indicating fully charge, serviced April 2, 2022. Smoke detector and carbon monoxide detector located in the living are in operable condition. Per Licensee there are no weapons, firearms in the facility. First Aid and emergency kits are available in the kitchen. LPA observed knives are kept on top of the counter away from children. The kitchen has a door blocking entrance for the children as the kitchen is off limits to the children. Fire and earthquake drills must be performed every six months and documented for review by the Department.. LPA observed on the drill forms that The last fire and earthquake drill was conducted on December 26th. 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.

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 1/13/24, Mandated Reporter certificate expires on 3/22/24.

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.

LPA reminded licensee of the new Safe sleep regulations, including LIC 9227 Infant Sleep Plan for infants under 12 months, 15-minute sleep check documentation for infants 0-24 months, provided PIN 20-24-CCP and discussed the Child Care Licensing Safe Sleep webpage athttps://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleephttps://www.cdss.ca.gov/inforesources/child-care-licensing/ https://www.cdss.ca.gov/ inforesources/ child-care-licensing/ public-information-and-resources/safe-sleep. Licensee states the following sleep supervision plan for infants: Infants nap during nap time and are supervised by a staff member.

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

DATE: 02/15/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/15/2023
LIC809 (FAS) - (06/04)
Page: 4 of 5
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MONTEREY PARK S WEST, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME: TEJENA FAMILY CHILD CARE
FACILITY NUMBER: 198007267
VISIT DATE: 02/15/2023
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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.

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/process

Based on the LPA's observations and records review two deficiencies will be cited today 02/15/23. They are for the following:


-Materials and equipment stored unsecured in book shelves above that could easily fall upon children in sleep room.
-Holes in the playground cushioning is hazardous to children when they are running in the yard.

Exit interview conducted and report was reviewed with the Licensee, Aura Tejana. A notice of site visit was given and must remain posted for 30 days. Appeal Rights was also provided.
SUPERVISOR'S NAME: Karen ChambersTELEPHONE: (323) 981-3368
LICENSING EVALUATOR NAME: Patricia MedelTELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:

DATE: 02/15/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/15/2023
LIC809 (FAS) - (06/04)
Page: 5 of 5
Document Has Been Signed on 02/15/2023 06:23 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
MONTEREY PARK S WEST, 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: 02/15/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102417(g)
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:

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 there were several areas observed in the outoor play area where there were several cracks and uneven ground that is creating a tripping hazard which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 03/17/2023
Plan of Correction
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Licensee will use a special glue and mateials to temporarially cover the exposed holes and areas of this type of playground cushining.
Section Cited
Deficient Practice Statement
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Based on observation the licensee did not comply with the section cited above as there were several areas observed in the outoor play area where there were several cracks and uneven ground that is creating a tripping hazard which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 03/17/2023
Plan of Correction
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Licensee will take down all the books, boxes and video equipment stored in shelves above that are not secure and place in boxes and store in her garage.
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: Patricia MedelTELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:
DATE: 02/15/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/15/2023
LIC809 (FAS) - (06/04)
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