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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198010667
Report Date: 10/08/2021
Date Signed: 10/08/2021 11:12:57 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 CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME:ROSA FAMILY CHILD CAREFACILITY NUMBER:
198010667
ADMINISTRATOR:ROSA, ROSAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(323) 582-2577
CITY:LOS ANGELESSTATE: CAZIP CODE:
90002
CAPACITY:14CENSUS: 3DATE:
10/08/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:25 AM
MET WITH:Rosa Rosa, LicenseeTIME COMPLETED:
11:30 AM
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Licensing Program Analyst (LPA)Katrina Chicote conducted an Unannounced Required Annual inspection to the above facility on 10/08/2021 at 9:25 AM. LPA conducted a COVID-19 screening call prior to entering the home. Upon arrival, LPA disclosed the purpose of the inspection and met with Licensee, Rosa Rosa, who guided the LPA on a tour of the facility. Adults in the home were discussed and all have criminal record clearance. There were three napping day care children present during today’s inspection. Licensee states that there are currently twelve children enrolled. The children's roster was reviewed and is current. Per Licensee, the facility’s hours of operation are 24 hours, 7 days a week. Overnight care plan was discussed with Licensee, Licensee states she provides air mattresses for children sleeping and she stays in the same room with children. Licensee states she currently has no overnight care children enrolled. Licensee understands that she cannot provide care to child more than 23 hours. 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 04/1/2021.

This is a two-story home which consists of five bedrooms, three bathrooms, kitchen, living room, dining room, and den. Main Care Areas used by the children include the living room (located upon entry), Bathroom 1 (located downstairs through a doorway in between Living Room and Kitchen), Dining Room (next to Living Room), and Licensee states Kitchen is accessible only for access to drinking water (located up a step next to Dining Room). Per Licensee, areas off limits to children and parents include entire upstairs which contains five bedrooms and two bathrooms and back patio. LPA observed that there is an operable baby gate at the bottom of the steps, making this area off limits to children in care at time of inspection.

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. At 9:42 AM, LPA observed A/C window unit hanging in window to the rear of the home in Dining Room. There is a working telephone maintained
Report continues- Page 1 of 3
SUPERVISOR'S NAME: Trevino CochranTELEPHONE: (323) 981-3385
LICENSING EVALUATOR NAME: Katrina ChicoteTELEPHONE: (323) 629-7658
LICENSING EVALUATOR SIGNATURE:

DATE: 10/08/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/08/2021
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: ROSA FAMILY CHILD CARE
FACILITY NUMBER: 198010667
VISIT DATE: 10/08/2021
NARRATIVE
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in the home. LPA observed large couches and entertainment center in Living Room, dining room table with eight chairs and child size table and chairs in Dining Room. At 9:40 AM, LPA observed GRACO pack-n-play used for infant sleep. LPA observed electrical cover outlets all through the home. At 9:42 AM, LPA observed dog carrier through sliding glass door leading to patio, Licensee states she has a dog kept in patio that children do not have access to. LPA observed sliding glass door to be closed and locked making area inaccessible to children in care at time of inspection. At 9:45 AM, LPA observed Kitchen to have operable child safety locks on bottom cabinets. Detergents, cleaning compounds, medications, and other items which can pose a danger to children are inaccessible. At 9:46 AM, LPA observed sharp knives to be kept in high cabinet and detergents and cleaning solutions to be kept in under cabinet sink in the kitchen with operable child safety lock, making these items inaccessible to children in care at time of inspection. 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. At 9:50 AM, LPA observed Bathroom 1, which will be used by the children, to have operable toilet and sink, adequate hand washing supplies, and floor maintained and free of hazards at time of inspection.

Per Licensee, the children will not have access to an outdoor play area at this time. Licensee states that has she changed this policy due to COVID-19 and to limit their exposure.

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 or firearms at time of inspection. Per Licensee, they provide food for children in care.

The valve on the required 2A 10BC fire extinguisher indicates fully charged, Licensee states that fire department has called and made an appointment next week for fire extinguisher to be serviced. Smoke and carbon monoxide detectors are in operable condition. At 9:47 AM, LPA observed First Aid kit is kept hanging next to Bathroom 1 entry way, LPA observed First Aid kit and was inventoried for necessary 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: 01/12/2022
—Fire Extinguisher was last serviced on: 10/26/2020
—Mandated Reporter AB1207 Completed: 06/16/2021
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SUPERVISOR'S NAME: Trevino CochranTELEPHONE: (323) 981-3385
LICENSING EVALUATOR NAME: Katrina ChicoteTELEPHONE: (323) 629-7658
LICENSING EVALUATOR SIGNATURE:

DATE: 10/08/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/08/2021
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
CCLD Regional Office, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME: ROSA FAMILY CHILD CARE
FACILITY NUMBER: 198010667
VISIT DATE: 10/08/2021
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The following were discussed:
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. Effective January 1, 2010, licensees of family child care homes are required to ensure that at least one staff member with current training in pediatric first aid and pediatric CPR is on site at all times when children are present.



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 PIN 20-24-CCP
Safe Sleep Regulations in Effect, PIN 21-25-CCP Care Tools, and LIC 9227 provided at time of inspection.

The facility was found in compliance per Title 22 regulations, there will be no deficiencies cited today 10/8/21.

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 (or facility representative), Rosa Rosa.
Report Ends - Page 3 of 3
SUPERVISOR'S NAME: Trevino CochranTELEPHONE: (323) 981-3385
LICENSING EVALUATOR NAME: Katrina ChicoteTELEPHONE: (323) 629-7658
LICENSING EVALUATOR SIGNATURE:

DATE: 10/08/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/08/2021
LIC809 (FAS) - (06/04)
Page: 3 of 3