198011139-8-5-2021-54-CC-KCHE-C5LTXM-20210805150723

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 198011139
Report Date: 08/05/2021
Date Signed: 08/05/2021 03:07:39 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:	MATEOS FAMILY CHILD CARE		FACILITY NUMBER:	198011139
ADMINISTRATOR:	MATEOS, LUCILA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(323) 752-3914
CITY:	LOS ANGELES	STATE: CA	ZIP CODE:	90003
CAPACITY:	14	CENSUS: 3	DATE:	08/05/2021
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	01:20 PM
MET WITH:	Licensee, Lucila Mateos		TIME COMPLETED:	03:15 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)Katrina Chicote conducted an Unannounced Required Annual inspection to the above facility on 08/05/2021 at 1:30 PM. LPA conducted COVID-19 screening call prior to entry of the home. Upon arrival, LPA disclosed the purpose of the inspection and met with Licensee, Lucila Mateos, who guided the LPA on a tour of the facility. Also present were two adults who live in the home and who have criminal record clearance. There are four people living in the home and all have criminal record clearance. There were three day care children napping present during today’s inspection. Licensee states that there are currently four children enrolled. The children's roster was reviewed and is current. Per licensee, the facility’s hours of operation are 6am to 6pm, 5 days a week. 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 07/2021. This is a single story home which consists of three bedrooms and two bathrooms, kitchen, dining room, living room, back covered patio, and backyard. Areas used by the children include the living room used for napping, one restroom located through hallway in front of living room, kitchen used for eating, back covered patio, and backyard. Per Licensee, areas off limits to children and parents include three bedrooms. Per licensee, off limit areas are locked during operating hours, LPA observed doors to be 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 fans all through out home and windows open. There is a working telephone maintained in the home. At 1:25 PM, LPA observed living room area which Licensee states is used for napping to be free of hazards at time of inspection. At 1:26 PM, LPA observed Kitchen area, towards the rear of the home, to be well maintained, counter tops to be free of clutter, and to have operable child safety locks on all cabinets. At 1:41 PM, LPA observed knives and other Report continues- Page 1 of 4

SUPERVISOR'S NAME: Trevino Cochran	TELEPHONE: (323) 981-3385
LICENSING EVALUATOR NAME: Katrina Chicote	TELEPHONE: (323) 629-7658
LICENSING EVALUATOR SIGNATURE:	DATE: 08/05/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/05/2021

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
CCLD Regional Office, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME: MATEOS FAMILY CHILD CARE	FACILITY NUMBER: 198011139
	VISIT DATE: 08/05/2021

NARRATIVE

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hazardous items to be kept in cabinet that has operable child safety locks at time of inspection. At 1:26 PM, LPA observed restroom used by the children to have adequate handwashing supplies available, step stool for children by sink, locks on under bathroom sink, and bathroom floor and counters to be free of hazards at time of inspection. Children will have access to Main Care Area, back covered patio, through a back door in the Kitchen. At 1:28 PM, LPA observed back covered patio to have carpet on floor, cubbies for children's belongings, child size tables and chairs, cubbies with wooden blocks, puzzles, book shelf, play kitchen, and other age appropriate toys, free of loose and sharp parts. LPA observed electrical cover outlets all through the home. LPA observed, detergents, cleaning compounds kept in a locked cabinet in kitchen at time of inspection. Licensee understands that medications, and other items which can pose a danger to children have to be inaccessible. 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 backyard area. At 1:28 PM, LPA observed backyard has black soft cushioning material all through out, dome climbing apparatus, and adequate perimeter fencing through-out the yard. LPA observed age appropriate toys such as blocks and plastic play structure free of loose and sharp parts available for the children in the backyard and all trees, shrubs, and plants are maintained. LPA observed handwashing station in backyard. At 1:29 PM, LPA observed small dog kept in backyard of home separated by a gate.

The valve on the required 2A 10BC fire extinguisher indicates fully charged. Smoke and carbon monoxide detectors are in operable condition. Per Licensee, First Aid kit is kept in the bathroom and outside play area, 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: 03/2023
—Fire Extinguisher was last serviced on: Jan., 11, 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 4

SUPERVISOR'S NAME: Trevino Cochran	TELEPHONE: (323) 981-3385
LICENSING EVALUATOR NAME: Katrina Chicote	TELEPHONE: (323) 629-7658
LICENSING EVALUATOR SIGNATURE:	DATE: 08/05/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/05/2021

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 CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME: MATEOS FAMILY CHILD CARE	FACILITY NUMBER: 198011139
	VISIT DATE: 08/05/2021

NARRATIVE

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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 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

LPA discussed updated sick policy with Licensee, and Licensee states that she has updated her sick policy to notify parents to screen for symptoms prior to drop off. LPA observed document with parent signatures updating sick policy. Licensee states if child gets sick while in her care she will notify parents to pick up immediately and isolate child in living room, where she will be able to supervise while keeping child isolated from other children, until parents come to pick up.

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.

Report Continues - Page 3 of 4

SUPERVISOR'S NAME: Trevino Cochran	TELEPHONE: (323) 981-3385
LICENSING EVALUATOR NAME: Katrina Chicote	TELEPHONE: (323) 629-7658
LICENSING EVALUATOR SIGNATURE:	DATE: 08/05/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/05/2021

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 CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME: MATEOS FAMILY CHILD CARE	FACILITY NUMBER: 198011139
	VISIT DATE: 08/05/2021

NARRATIVE

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The Licensee was advised that inaccessibility of hazards must be constantly reassessed depending on the children in care. A hard copy of A Child Care Provider’s Guide to Safe Sleep, Form LIC 9227, PIN 20-24-CCP Safe, and Lead Handout.

The Licensee was advised how to access forms and Regulations online at www.ccld.ca.gov. Licensee was made aware that it is his/her responsibility to know the regulations as well as anyone who assists in providing care.

AB 1207: Beginning on January 1, 2018, this law requires all licensed providers, applicants, directors and employees to complete training as specified on their mandated reporter duties and to renew their training every two years. Volunteers are encouraged but not required to take the training. Website: http://www.mandatedreporterca.com/www.mandatedreporterca.com

Senate Bill 792: this bill, commencing September 1, 2016, prohibits a person from being employed or volunteering at a child care facility or family day care if he or she has not been immunized against influenza, pertussis and measles. LPA discussed the influenza waiver during the visit.

The facility was found in compliance per Title 22 regulations, there will be no deficiencies cited today 08/05/2021

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, Lucila Mateos.

SUPERVISOR'S NAME: Trevino Cochran	TELEPHONE: (323) 981-3385
LICENSING EVALUATOR NAME: Katrina Chicote	TELEPHONE: (323) 629-7658
LICENSING EVALUATOR SIGNATURE:	DATE: 08/05/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/05/2021

LIC809 (FAS) - (06/04)

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