198008836-8-2-2023-33-CC-CRES-CUBQK9-20230802121357

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 198008836
Report Date: 08/02/2023
Date Signed: 08/02/2023 12:14:19 PM

Document Has Been Signed on 08/02/2023 12:14 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
L.A. DAY CARE-EAST, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME:	MITRA FAMILY CHILD CARE		FACILITY NUMBER:	198008836
ADMINISTRATOR:	MITRA, SWETA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(626) 393-5122
CITY:	GLENDORA	STATE: CA	ZIP CODE:	91741
CAPACITY:	14	CENSUS: 4	DATE:	08/02/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	08:30 AM
MET WITH:	Mitra Sweta		TIME COMPLETED:	12:15 PM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	Licensing Program Analyst (LPA) Cynthia Reyes conducted an unannounced annual required inspection on this date. A COVID-19 risk assessment was conducted prior to entering the facility. Licensing staff met with Mitra Sweta, Licensee, who guided the LPA on a tour of the home. There was 4 children in care & licensee adult renter and assistant Diana was also present on this date. This is a single story home. Residing in the home are 3 Adults and 0 Children. Hours of operation are Monday through Friday 6:30 AM to 6PM. 23 hour Areas used by children were inspected as follows: Living room w/fire place covered, Den (day care room), one restroom (Next to day care room), Kitchen, Dining area and fenced backyard There are No weapons, firearms, swimming pool, spas or bodies of water on the premises. The backyard is adequately fenced. Smoke and carbon monoxide detectors were tested and are operable. Fire extinguisher indicates fully charged, serviced 03/29/22. Licensee CPR/First Aid Exp. 04/09/2024. Assistant Diane, Exp.11/19/2024. Areas off limits* include: Master bedroom with office, another room (guest room), front yard, Hallway with 2 bedrooms (2 Renters), bathroom and Garage Rooms that are off-limits need to be made inaccessible during operating hours The home was inspected for safety, comfort, cleanliness, ventilation, and telephone service (land line). The home has central air and heat. There are age appropriate toys & Napping equipment available for children. Detergents, cleaning compounds, medications, and other items which can pose a danger to children are inaccessible. The department has On Duty Workers available for questions Monday through Friday at (323) 981-3350 from 8:00 AM - 5:00 PM.

SUPERVISOR'S NAME: Christina Gabelman	TELEPHONE: (323) 981-3380
LICENSING EVALUATOR NAME: Cynthia Reyes	TELEPHONE: (323) 981-3369
LICENSING EVALUATOR SIGNATURE:	DATE: 08/02/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/02/2023

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
L.A. DAY CARE-EAST, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME: MITRA FAMILY CHILD CARE	FACILITY NUMBER: 198008836
	VISIT DATE: 08/02/2023

NARRATIVE

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Licensing staff observed the following required posted documentation in the playroom: Facility License, Publication (PUB) 394- Notification of Parent Rights and Licensing Form. LPA reviewed facility records for LIC 9040- Facility Roster, LIC 610- Facility Disaster Plan and Disaster drill log, last drill documented was 06/03/2023. Licensee states and per LPA review of the children roster there are currently 07 children enrolled.

Licensee states that there are no poisons stored in the home and understands that all poisons must be lock, and made inaccessible to children. Isolation area for sick children waiting to be picked up is in the day care room, and other children if necessary, will be away from the other children in the living room.

Infant Care: The facility has No infants enrolled at this time.

Children’s records were reviewed for (LIC) 282- Affidavit Regarding Liability Insurance, LIC 700- Identification and Emergency Information, LIC 627- Consent for Medical Treatment, LIC 995A Notification of Parents’ Rights,

Staff records were reviewed, Licensee and staff are not current with mandated reporter.LPA reviewed the LIC 508- Criminal Record Statement. Licensee has No Proof of immunization's against measles. Influenza or influenza declination on file, TB clearance or risk assessment, LIC 9108- Statement Acknowledging Requirement to Report Child Abuse and current Mandated Reporter Training Certificate are not on file.

Incidental Medical Services (IMS) policy was discussed. Per Licensee, there are no children on medications. 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

Report continues on next page

SUPERVISOR'S NAME: Christina Gabelman	TELEPHONE: (323) 981-3380
LICENSING EVALUATOR NAME: Cynthia Reyes	TELEPHONE: (323) 981-3369
LICENSING EVALUATOR SIGNATURE:	DATE: 08/02/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/02/2023

LIC809 (FAS) - (06/04)

Page: 2 of 3

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
L.A. DAY CARE-EAST, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME: MITRA FAMILY CHILD CARE	FACILITY NUMBER: 198008836
	VISIT DATE: 08/02/2023

NARRATIVE

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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.

AB1207 Mandated Child Abuse Reporting – Implementation was discussed with Licensee. Website provided: http://mandatedreporterca.com. The Licensee will complete the training.

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.

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-and-resources/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.

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

There are no deficiencies being cited, however technical assistant was provided on this date. LPA provided consultation during this inspection.

A notice of site visit was given and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

Exit interview conducted and report was reviewed with the Licensee Mitra Sweta. *END OF REPORT

SUPERVISOR'S NAME: Christina Gabelman	TELEPHONE: (323) 981-3380
LICENSING EVALUATOR NAME: Cynthia Reyes	TELEPHONE: (323) 981-3369
LICENSING EVALUATOR SIGNATURE:	DATE: 08/02/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/02/2023

LIC809 (FAS) - (06/04)

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