198010489-8-12-2021-54-CC-KCHE-C5TQXE-20210812123324

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 198010489
Report Date: 08/12/2021
Date Signed: 08/12/2021 12:33:30 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:	CHAVARRIA FAMILY CHILD CARE		FACILITY NUMBER:	198010489
ADMINISTRATOR:	CHAVARRIA, ROSA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(323) 753-3644
CITY:	LOS ANGELES	STATE: CA	ZIP CODE:	90003
CAPACITY:	14	CENSUS: 6	DATE:	08/12/2021
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	11:30 AM
MET WITH:	Rosa Chavarria, Licensee		TIME COMPLETED:	12:45 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)Katrina Chicote conducted an Unannounced Required Annual inspection to the above facility on 08/12/2021 at 11:30 AM. LPA conducted COVID-19 screening call prior to entering facility. Upon arrival, LPA disclosed the purpose of the inspection and met with Licensee, Rosa Chavarria, who guided the LPA on a tour of the facility. There are two adults living in the home and all have criminal record clearance. There were six day care children present during today’s inspection. Licensee states that there are currently ten children enrolled. The children's roster was reviewed and is current. Emergency Disaster Plan, License, and Parents’ Rights were posted at the time of inspection. Disaster drill log was also available during today’s inspection, last disaster drill conducted on 08/06/2021. LPA observed COVID-19 posters posted through out home and hand sanitizers and thermometer by front door. This is a single story home which consists of two bedrooms and one bathroom, kitchen, living room, dining room, and covered patio. Areas used by the children include the living room, dining room, and covered patio. Per Licensee, areas off limits to children and parents include Bedroom 1, Bedroom 2, and kitchen. LPA observed that there is an operable baby gate separating kitchen and areas used by children making it off-limits at time of inspection. Per licensee, off limit bedrooms locked during operating hours, LPA observed doors to be closed and locked. All areas identified on the facility sketch as accessible to children were inspected to ensure that they are clean and orderly with ventilation and heating for the safety of the children. LPA observed ceiling fans in Main Care Areas. There is a working telephone maintained in the home. Main Care Areas used by the children is the living room/dining room and covered patio. At 11:40 AM, LPA observed covered patio to have carpet, cubbies with children's belongings, magna tiles, books, wooden blocks, and age appropriate toys, free of loose and sharp parts. At 11:42 AM, LPA observed living room/dining room area upon entry of the home, to have a large Report continues- Page 1 of 3

SUPERVISOR'S NAME: Trevino Cochran	TELEPHONE: (323) 981-3385
LICENSING EVALUATOR NAME: Katrina Chicote	TELEPHONE: (323) 629-7658
LICENSING EVALUATOR SIGNATURE:	DATE: 08/12/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/12/2021

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 3

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: CHAVARRIA FAMILY CHILD CARE	FACILITY NUMBER: 198010489
	VISIT DATE: 08/12/2021

NARRATIVE

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sectional sofa, dining table and chairs, child size table and chairs, low high chairs, and television. At 11:45 AM, LPA observed bathroom used by the children located to the right upon entry through a hallway. LPA observed diaper changing table stocked with wipes and diapers in hallway next to bathroom. LPA observed bathroom to be free of hazards and adequately stocked with handwashing supplies and handwashing poster posted next to sink. LPA observed electrical cover outlets all through the home. Per licensee, there are no pets and LPA did not observe any pets. Detergents, cleaning compounds, medications, and other items which can pose a danger to children are inaccessible. LPA observed these items in cabinets with child safety lock in off limits Kitchen area making it inaccessible to children in care. At 11:47 AM, LPA observed knives and other sharp objects kept in high cabinet with child safety locks in off limit Kitchen area making it inaccessible to children in care. 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 lock.

Per licensee, the children will have access to front yard area for outdoor play. LPA observed front yard has turf grass and adequate perimeter fencing through-out the yard. LPA observed bicycles, small plastic play structure with slide, doll houses, chairs, and other age appropriate toys free of loose and sharp parts available for the children in the backyard and all trees, shrubs, and plants are maintained.

Per Licensee, there are no weapons, firearms in the home and there are no bodies of water around the premises. LPA observation did not see any bodies of water around the premises. Per licensee, they provide food for children in care.

The valve on the required 2A 10BC fire extinguisher indicates fully charged. At 11:48 AM, LPA observed Smoke and carbon monoxide detectors are in operable condition at time of inspection. Per Licensee, First Aid kit is kept in Bedroom and LPA observed for supplies. The Licensee has current Pediatric First Aid and CPR. Proof of immunization against influenza, pertussis, and measles was readily available during today’s inspection. The Licensee has also taken the Mandated Reporter Training
—CPR Card valid until: 02/2023
—Fire Extinguisher was last serviced on: 05/12/2021
—Mandated Reporter AB1207 Completed: 05/09/2021
—Children records and required licensing forms were discussed as well as mandated child abuse reporting and criminal record clearance requirement.

Report continues- Page 2 of 3

SUPERVISOR'S NAME: Trevino Cochran	TELEPHONE: (323) 981-3385
LICENSING EVALUATOR NAME: Katrina Chicote	TELEPHONE: (323) 629-7658
LICENSING EVALUATOR SIGNATURE:	DATE: 08/12/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/12/2021

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: CHAVARRIA FAMILY CHILD CARE	FACILITY NUMBER: 198010489
	VISIT DATE: 08/12/2021

NARRATIVE

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The following were discussed:
Incidental Medical Services (IMS)
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 Centers and the ADA, available at: http://www.ada.gov/childqanda.htm

Licensee (or facility representative) 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.

Rooms that are off-limits need to be made inaccessible during operating hours. NO smoking, NO infant walkers, NO Johnny jumpers, NO saucer chairs, NO incline sleepers and any other item that falls into that category are permitted in the facility.

The Licensee was advised that inaccessibility of hazards must be constantly reassessed depending on the children in care. Sudden Infant Death Syndrome (SIDS) and Never-Shake-a-Baby were discussed. A hard copy of A Child Care Provider’s Guide to Safe Sleep, Lead Handout, LIC 9227, and PIN 21-19-CCP, and PIN 20-24-CCP.

The facility was found in compliance per Title 22 regulations, there will be no deficiencies cited today 08/12/201

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 and report was reviewed with the Licensee, Rosa Chavarria. Report ends- Page 3 of 3

SUPERVISOR'S NAME: Trevino Cochran	TELEPHONE: (323) 981-3385
LICENSING EVALUATOR NAME: Katrina Chicote	TELEPHONE: (323) 629-7658
LICENSING EVALUATOR SIGNATURE:	DATE: 08/12/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/12/2021

LIC809 (FAS) - (06/04)

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