198011175-9-19-2019-54-CC-DGIS-BG6U7W-20190919152036

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 198011175
Report Date: 09/19/2019
Date Signed: 09/19/2019 03:20:54 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:	LARDIZABAL FAMILY CHILD CARE		FACILITY NUMBER:	198011175
ADMINISTRATOR:	LARDIZABAL, LUISA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(323) 234-2628
CITY:	LOS ANGELES	STATE: CA	ZIP CODE:	90037
CAPACITY:	14	CENSUS: 6	DATE:	09/19/2019
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	10:40 AM
MET WITH:	Luisa Lardizabal, Licensee		TIME COMPLETED:	12:30 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) Denise Gibbs conducted an unannounced annual random inspection to the above facility. LPA met with Luisa Lardizabal, Licensee who guided analyst on a tour of the facility. Also present during this inspection, was Maricela Montiel and Guadalupe Guevara, Licensee’s Assistants. Per Licensee, there are 14 children that are currently enrolled. A Children’s Roster was available for review. There were 6 children present upon arrival. This is a two-story home which consists of 4 bedrooms, 3 bathrooms, kitchen, dining room, living room, den, detached back house, front yard and backyard (fenced). Main care is provided in the den and backyard. The children use the bathroom adjacent to the den. Per Licensee, areas off limits to children and parents include: upstairs, living room, kitchen, dining room (baby gate make all areas off limits), 2 bathrooms, back house and front yard. The licensee provides food for children in care. LPA observed food available in the refrigerator. Hours of operation are Mon-Fri 7am-7pm. The licensee states that 1 adult and 1 child currently live in the home. Per Licensee, she currently has two assistants. All adults present in the home have obtained a criminal record clearance or exemption prior to working, residing or volunteering in the licensed child care home. Licensee states that there are no firearms or weapons stored in the home. All areas identified on the facility sketch that are accessible for children to use were inspected for safety, comfort, and cleanliness. There is telephone service via a landline that is used at the facility during operation hours. There is ventilation and heating (fans). The following was observed and reviewed during this inspection: Detergents, cleaning compounds, medications, and other items which could pose a danger to children. ------------------Page 1

SUPERVISOR'S NAME: Trevino Cochran	TELEPHONE: (323) 981-3385
LICENSING EVALUATOR NAME: Denise Gibbs	TELEPHONE: (323) 558-2794
LICENSING EVALUATOR SIGNATURE:	DATE: 09/19/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/19/2019

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: LARDIZABAL FAMILY CHILD CARE	FACILITY NUMBER: 198011175
	VISIT DATE: 09/19/2019

NARRATIVE

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LPA did not observe the following items during the inspection: Infant Walkers, Johnny Jumpers, Saucer Chairs, Trampolines and/or any other item that fall into these categories are not permitted in a family child care facility.

Smoking is prohibited in a licensed Family Child Care Home. LPA did not observe anyone smoking in the home.

LPA provided the licensee with a copy of the Child Care Provider’s Guide to Safe Sleep, by American Academy of Pediatrics and Helping you to reduce the risk of SIDS, updated Parent’s Rights Poster with Complaint Hotline information, Capacity Handout (Small & Large) and Never Shake a Baby pamphlet.

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: www.mandatedreporterca.com

Incidental Medical Services (IMS):
The licensee states that she will provide IMS. Per licensee, there are no children enrolled that require IMS at this time. 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 advised the licensee to access forms, regulations and quarterly updates on line at: www.ccld.ca.gov

Based on the LPA’s observations and records review, the following deficiencies listed on the attached LIC 809 (deficiency page) are being cited in accordance with California Code of Regulations Title 22. Deficiencies that are being cited need to be cleared to protect the children’s health & safety.

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SUPERVISOR'S NAME: Trevino Cochran	TELEPHONE: (323) 981-3385
LICENSING EVALUATOR NAME: Denise Gibbs	TELEPHONE: (323) 558-2794
LICENSING EVALUATOR SIGNATURE:	DATE: 09/19/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/19/2019

LIC809 (FAS) - (06/04)

Page: 3 of 5

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: LARDIZABAL FAMILY CHILD CARE	FACILITY NUMBER: 198011175
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 09/19/2019

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 10/18/2019 Section Cited	1 2 3 4 5 6 7	Availability of information regarding detecting and reporting child abuse and neglect; training for mandated reporter who is licensed day care provider, administrator, or employee of a licensed child day care facility; proof of completion On and after January 1, 2018, a person
	8 9 10 11 12 13 14	who becomes an administrator or employee of a licensed child day care facility shall complete the mandated reporter training...and shall complete renewal mandated reporter training every two years following the date on which he or she completed the initial mandated reporter training. This requirement was not met as evidenced by LPA failing to provide proof of mandated reporter training for staff #1, #2, #3. This poses a potential health and safety risk to children in care.	8 9 10 11 12 13 14
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	1 2 3 4 5 6 7

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: Trevino Cochran	TELEPHONE: (323) 981-3385
LICENSING EVALUATOR NAME: Denise Gibbs	TELEPHONE: (323) 558-2794
LICENSING EVALUATOR SIGNATURE:	DATE: 09/19/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/19/2019

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: LARDIZABAL FAMILY CHILD CARE	FACILITY NUMBER: 198011175
	VISIT DATE: 09/19/2019

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 26 27 28 29 30 31 32	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 Luisa Lardizabal, Licensee, including, but not limited to Appeal Procedures and Appeal Rights.

SUPERVISOR'S NAME: Trevino Cochran	TELEPHONE: (323) 981-3385
LICENSING EVALUATOR NAME: Denise Gibbs	TELEPHONE: (323) 558-2794
LICENSING EVALUATOR SIGNATURE:	DATE: 09/19/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/19/2019

LIC809 (FAS) - (06/04)

Page: 5 of 5

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: LARDIZABAL FAMILY CHILD CARE	FACILITY NUMBER: 198011175
	VISIT DATE: 09/19/2019

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were observed to be inaccessible to children. Poisons are locked in the kitchen(off limit area). The restroom that children use was observed to be clean and free of hazards.

The valve on the required 2A 10BC fire extinguisher indicates fully charged and was last serviced on 08/2019, as indicated on service tag. Smoke and carbon monoxide detectors were tested and are operable.

The home is observed to be clean and orderly. Where children less than five years old are in care, stairs are fenced or barricaded. There is a child safety gate which keeps stairs inaccessible to children. There are toys and other age appropriate material available for children. Children nap on mats/cots in the main care area. Licensee has 1 older infant in care who naps on a mat/cot. Safe sleep was discussed.

Currently, children are using the back yard for outdoor play. The outdoor play area was observed to be fenced. LPA observed that the outdoor yard has toys and other materials for children to play with. LPA did not observe any objects that can pose a danger to children on the outdoor yard. There are no pools or spas, or other bodies of water. Licensee has 1 dog that is kept in the off limit areas during operating hours.

The licensee and other personnel have completed training on preventive health practices including Pediatric First Aid and CPR. The licensee's and assistant's Pediatric First Aid and CPR expires on 4/2020. There are first aid supplies available.

Children’s records were reviewed, including emergency information and were observed to be complete.

The licensee and assistant's do have proof of immunization against influenza, pertussis, and measles. LPA observed that the Licensee and assistant do not have proof of the Mandated Reporter AB 1207 compliant Child Care Training Certificate on file.

LPA issued a Confidential Names List (LIC 811) to the licensee which documents staff and children’s files reviewed 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 documented was conducted on 8/2019.
Emergency Disaster Plan, Parent’s Rights Poster and the Facility License were observed to be posted.------Page 2

SUPERVISOR'S NAME: Trevino Cochran	TELEPHONE: (323) 981-3385
LICENSING EVALUATOR NAME: Denise Gibbs	TELEPHONE: (323) 558-2794
LICENSING EVALUATOR SIGNATURE:	DATE: 09/19/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/19/2019

LIC809 (FAS) - (06/04)

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