198012589-10-1-2019-54-CC-WBIS-BGJQM6-20191001121700

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 198012589
Report Date: 10/01/2019
Date Signed: 10/01/2019 12:17:19 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:	PEREZ FAMILY CHILD CARE		FACILITY NUMBER:	198012589
ADMINISTRATOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY:	8	CENSUS: 2	DATE:	10/01/2019
TYPE OF VISIT:	Case Management - Licensee Initiated	UNANNOUNCED	TIME BEGAN:	10:02 AM
MET WITH:	Angelica Perez		TIME COMPLETED:	12:25 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	VISIT CONDUCTED IN ENGLISH AND SPANISH TRANSLATED BY LPA Licensing Program Analysts (LPAs) Warren Birks and Alicia Mooberry conducted an unannounced case management inspection for the purpose of inspecting the facility for a capacity increase. LPA met with Licensee and cleared assistant who were caring for two preschool children. The Licensee is requesting to increase to a Large Family Child Care with a capacity of 12-14 children. Family members residing in the home are the Licensee, one cleared adult and a minor child. Licensee is in compliance with with license capacity limitations. There is a unit next door with a separate address (127 Home). All areas identified on the facility sketch were inspected. This is a unit within a duplex consisting of 2 bedrooms, 1 bathroom, living room, kitchen, dining area, backyard and an outdoor back room (occupied by cleared relative). The children use the living room, kitchen, bathroom, one bedroom and the front yard for childcare. Off-limits areas are the backyard and the Licensee's bedroom. Home was inspected for comfort, cleanliness, ventilation, and telephone service. LPA observed age appropriate toys and equipment for children. LPA observed cabinets in the Licensee's kitchen to be locked preventing access to hazardous items. The Licensee's 2A 10BC fires extinguisher is fully charged with an inspection due of date of June 26, 2020. Smoke and carbon monoxide detectors in the home were tested and are in operable condition. There are emergency supplies on the premises and a first aid kit. LPA observed no accessible medicines, cleaners or hazardous items that can pose a danger to children. Per Licensee, states there are no firearms or weapons or bodies of water at the facility. Per applicant, there are no dual licenses at this address. Napping equipment for infants is available. All posting requirements were observed to be posted at the time of visit. The backyard is off limits. One adult resident resides in the outdoor unit in the backyard. LPAs observed weights and a grill in accessible to the outdoor play area that must be made inaccessible.

SUPERVISOR'S NAME: Karen Chambers	TELEPHONE: (323) 980-4934
LICENSING EVALUATOR NAME: Warren Birks	TELEPHONE: 323-981-3373
LICENSING EVALUATOR SIGNATURE:	DATE: 10/01/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/01/2019

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: PEREZ FAMILY CHILD CARE	FACILITY NUMBER: 198012589
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 10/01/2019

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 10/01/2019 Section Cited	1 2 3 4 5 6 7	Operation of a Family Child Care Home: The home shall be free from defects or conditions which might endanger a child: This requirement was not met as evidenced by: LPA observed an accesssible grill and weights near the outdoor play area. This is an potential immediate risk to children in care.
	1 2 3 4 5 6 7
	1 2 3 4 5 6 7
	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: Karen Chambers	TELEPHONE: (323) 980-4934
LICENSING EVALUATOR NAME: Warren Birks	TELEPHONE: 323-981-3373
LICENSING EVALUATOR SIGNATURE:	DATE: 10/01/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/01/2019

LIC809 (FAS) - (06/04)

Page: 3 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: PEREZ FAMILY CHILD CARE	FACILITY NUMBER: 198012589
	VISIT DATE: 10/01/2019

NARRATIVE

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Note: A qualified assistant must be present and actively involved in caring for children whenever nine (9) or more children are present at the facility. This includes outdoor activity and activity away from the child care facility.

There is a small rabbit caged in the backyard. The licensee was strongly advised to provide 100% supervision for all outdoor play. Note: LPA provided Licensee with a form listing the possible capacity and ratio scenarios approved under Title 22. Licensee was also advised to organize loose items in the additional bedroom for children. LPA also reminded Licensee of the following:

1. All adults working with the children, residing in the home or having initial presence in the facility (during operating hours) must be fingerprint cleared.

2. The capacity and ratio requirements for a small family child care home resume when no assistants are present.

3. All medications, cleaners, chemicals and hazardous items (such as knives, sharp objects etc.) must be inaccessible.

4. The following are not allowed in a family child care home: Baby bouncers, saucer chairs, johnny jumpers, baby walkers, car seats, rockers and trampolines as they may be an immediate risk to children in care.

Note: Licensee has an approved July 17, 2019 Fire Clearance (14 children). Note: The following items must be corrected before LPA will request approval for a Large family License:

Make grill and weights near the front yard driveway inaccessible. The Licensee submitted a declaration that the driveway is not used for vehicles.

Upon receipt the Licensee shall post the Notice of Site Visit and the Licensing Report. This report and the Notice of Site Visit shall be posted for 30 consecutive days. Failure to maintain posting as required will result in a $100.00 civil penalty. Exit interview conducted with Licensee Perez.

SUPERVISOR'S NAME: Karen Chambers	TELEPHONE: (323) 980-4934
LICENSING EVALUATOR NAME: Warren Birks	TELEPHONE: 323-981-3373
LICENSING EVALUATOR SIGNATURE:	DATE: 10/01/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/01/2019

LIC809 (FAS) - (06/04)

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