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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198009860
Report Date: 05/17/2019
Date Signed: 05/17/2019 10:33:06 AM

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 CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME:DIAZ FAMILY CHILD CAREFACILITY NUMBER:
198009860
ADMINISTRATOR:LAURA DIAZFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(626) 815-5925
CITY:AZUSASTATE: CAZIP CODE:
91702
CAPACITY:14CENSUS: 7DATE:
05/17/2019
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Laura DiazTIME COMPLETED:
10:15 AM
NARRATIVE
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 Licensing program Analyst (LPA), Ana Chico, conducted an unannounced Case Management inspection for the purpose of ensuring that the licensee is in compliance. The inspection was conducted in Spanish. LPA met with licensee, Laura Diaz, licensee, who guided analyst on a tour of the facility. Licensee's adult daughter Christina Zamora, was also present assisting with the care. According to licensee she has (12) children enrolled. LPA observed (6) preschool age children and (2) infants at the time of the inspection.

Areas designated for care were inspected for safety, comfort, cleanliness, telephone service, ventilation and heating. This is a single story home which consists of 2 bedrooms, 1 full bathroom and one half bathroom. There is also a kitchen, dinning room, living room and adjacent day care room. Children have access to all areas of the home with the exception of licensee's daughter's bedroom and half bathroom. The wall heater was observed to be barricaded and an air conditioner unit which is used during the summer months or when the temperature rises.

Criminal record clearance has been granted for all adults living in the home. According to Mrs. Diaz there are (2) adults who live in the home (licensee and adult daughter) and (1) minor child (granddaughter). Cleaning compounds, medicines, sharp objects and hazardous items that can pose a danger to children are inaccessible. Children use the back patio, which is fully gated, for outdoor play. There are plenty of toys and materials available for children and sleeping mats are used for napping. According to licensee she prepares meals daily for day care children. The licensee states that there are no poisons in the home. The licensee does understand that poison must be locked with a key or combination. Per licensee, there are no weapons/ firearms or bodies of water. Posting requirements were observed. Mrs. Diaz states that transportation is offered to children in care. According to licensee her adult daughter Christina transports children as needed.
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SUPERVISOR'S NAME: Katherine HarewoodTELEPHONE: (323) 981-2956
LICENSING EVALUATOR NAME: Ana ChicoTELEPHONE: (323) 981-3374
LICENSING EVALUATOR SIGNATURE:

DATE: 05/17/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/17/2019
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC809 (FAS) - (06/04)
Page: 1 of 4
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 CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME: DIAZ FAMILY CHILD CARE
FACILITY NUMBER: 198009860
VISIT DATE: 05/17/2019
NARRATIVE
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Incidental Medical Services (IMS): Incidental Medical Services (IMS) policy was discussed. According to licensee, there are no children requiring IMS at this time. 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 Homes and the ADA, available at: http://www.ada.gov/childqanda.ht

Based on LPAs observations, the following deficiency is being cited in accordance with California Code of Regulations Title 22. Deficiency cited needs to be cleared to protect the children’s health & safety and are being documented on the attached LIC 809D. LPA advised licensee of an Office Visit scheduled on May 29, 2019 at 2:30 PM at the Monterey Park Regional Office A letter will mailed as confirmation of the agreed to meeting with the licensee.

The Notice of Site Visit (LIC 9213) – must remain posted for 30 days during the hours of operation after each site visit made by a licensing representative. Failure to maintain posting as required will result in a civil penalty of $100.00. Exit interview was conducted with licensee, including, but not limited to Provider Rights, Appeal Procedures and Agencies Consultative Role.


REPORT END - 3 OF 3
SUPERVISOR'S NAME: Katherine HarewoodTELEPHONE: (323) 981-2956
LICENSING EVALUATOR NAME: Ana ChicoTELEPHONE: (323) 981-3374
LICENSING EVALUATOR SIGNATURE:

DATE: 05/17/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/17/2019
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
CCLD Regional Office, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME: DIAZ FAMILY CHILD CARE
FACILITY NUMBER: 198009860
VISIT DATE: 05/17/2019
NARRATIVE
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LPA reviewed the record of one chid which recently enrolled. All other children's records were reviewed during a random inspection conducted in January of 2019. A current children’s roster was available and observed to be current. LPA issued a Children's Record Review List (LIC 857) to the licensee during this visit. The list documents the children’s files that were reviewed during this visit.


The following items were also discussed with licensee during this inspection.
  • All homes shall conduct fire and disaster drills at least once every six months, and document the date and time of each drill. Last drill was conducted (4/2019).
  • POSTING REQUIREMENTS: Emergency Disaster Plan, Parent’s Rights Poster and the Facility License were observed to be posted.
  • Infant Walkers, Johnny Jumpers, Saucer Chairs, Trampolines and/or any other item that falls into these categories are not permitted in a family child care facility. SMOKING IS PROHIBITED IN A LICENSED FAMILY CHILD CARE HOME.
Infant Care: Infants use the licensee's bedroom to sleep in. Per licensee she will ensure that infants are supervised at all times. Doors were observed to be open during the inspection. LPA provided the licensee with a copy of the Child Care Provider’s Guide to Safe Sleep, by American Academy of Pediatrics.

The required 2A 10BC fire extinguisher was available and received service in May of 2019. Smoke detector and carbon monoxide detectors were tested and observed in operable condition. Pediatric First Aid and for licensee remains current. Licensee's assistant's First Aid/ CPR, expires 3/2021. Mandated Reporter training was discussed as well as new immunization requirements for all adults working or volunteering at the day care. Training must be renewed every two years and can be found at: http:/www.mandatedreporterca.com/training /training.htm. Mandated Reporter Certificate is on file. Immunization was not up to date for assistant.


REPORT CONTINUES ON THE NEXT PAGE - 2 OF 3
SUPERVISOR'S NAME: Katherine HarewoodTELEPHONE: (323) 981-2956
LICENSING EVALUATOR NAME: Ana ChicoTELEPHONE: (323) 981-3374
LICENSING EVALUATOR SIGNATURE:

DATE: 05/17/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/17/2019
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
CCLD Regional Office, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME: DIAZ FAMILY CHILD CARE
FACILITY NUMBER: 198009860
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/17/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
06/17/2019
Section Cited
HSC
1596.7995(a)(1)
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Commencing September 1, 2016, a person shall not be employed or volunteer at a day care center if he or she has not been immunized against influenza, pertussis, and measles. Each employee and volunteer shall receive an influenza vaccination between August 1 and December 1 of each year.
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Per licensee's daughter she will obtain her immunization record and provide a copy by POC date.
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The requirement is not met as evidenced by a records review. This poses 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: Katherine HarewoodTELEPHONE: (323) 981-2956
LICENSING EVALUATOR NAME: Ana ChicoTELEPHONE: (323) 981-3374
LICENSING EVALUATOR SIGNATURE:

DATE: 05/17/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/17/2019
LIC809 (FAS) - (06/04)
Page: 4 of 4