198012738-11-5-2019-33-CC-CGRN-BHN38F-20191105170127

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 198012738
Report Date: 11/05/2019
Date Signed: 11/05/2019 05:01:33 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 CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME:	CARRILLO FAMILY CHILD CARE		FACILITY NUMBER:	198012738
ADMINISTRATOR:	CARRILLO, BLANCA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(626) 791-4952
CITY:	ALTADENA	STATE: CA	ZIP CODE:	91001
CAPACITY:	14	CENSUS: 11	DATE:	11/05/2019
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	03:31 PM
MET WITH:	Blanca Carrillo		TIME COMPLETED:	05:10 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 Analysts (LPAs) Crystal Green and Bardo Baluyot conducted an unannounced annual inspection. LPA met with Licensee Assistant, Aurys Hernandez, who assisted licensing staff until Licensee, Blanca Carrillo arrived during this inspection. There were 11 children present during this inspection. Per Licensee, there are 20 children enrolled. A current children roster was available. This is a single- story home which consists (4) bedrooms, (3) bathrooms, office, main day care room, living room, dining room, kitchen, and outdoor play area. The area used by children was inspected for safety, comfort, cleanliness, ventilation, and telephone service (land line). The children use main day care room, outdoor play area, (1) bathroom, and the living room. Per licensee, areas off limits to children are all four (4) bedrooms, (2) bathrooms near the bedrooms, dining room, and kitchen. The licensee provides food for children in care. Currently residing in the home are Licensee, her spouse, her daughter, one (1) female adult, and one (1) male minor child. All individuals have obtained a criminal record clearance or exemption prior to working, residing or volunteering in a licensed home. Detergents, cleaning compounds, medications, and other items which could pose a danger, were inaccessible to children during this inspection. Per licensee assistant, there are no pets, weapons, firearms or bodies of water on the premises. There were safe toys, play equipment, and materials observed for children. Emergency Disaster Plan, Parent’s Rights Poster, and the Facility License are observed to be posted. Children’s records were reviewed to ensure that each child has an Identification and Emergency form, Consent for Medical Treatment, and Immunization's records on file.

SUPERVISOR'S NAME: Christina Gabelman	TELEPHONE: (323) 854-8930
LICENSING EVALUATOR NAME: Crystal Green	TELEPHONE: (323) 980-4930
LICENSING EVALUATOR SIGNATURE:	DATE: 11/05/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/05/2019

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 CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME: CARRILLO FAMILY CHILD CARE	FACILITY NUMBER: 198012738
	VISIT DATE: 11/05/2019

NARRATIVE

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Smoke detector and carbon monoxide detector were tested and are in operable condition. The valve on the required 2A10BC fire extinguisher indicates fully charged, last service date of 10/2019. All homes shall conduct fire and disaster drills at least once every six months and document the date and time of each drill. LPAs observed last drill documented was conducted on 10/28/2019. The licensee and licensee’s assistant have current Pediatric First Aid and CPR, which will expire 04/2021.

AB1207 Mandated Child Abuse Reporting – Licensee and Licensee’s Assistant have completed the required mandated training.

This facility provides Incidental Medical Services – IMS. Per Licensee, there are currently no children enrolled requiring IMS. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226.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

Infant Care: Licensee states that she is currently caring for infants. LPA advised the licensee to sleep infants where they can be directly supervised. The licensee stated the following as a supervision plan for infants: Licensee states that infants always sleep in the living room.

At this time, the licensee is in compliance with California Title 22 Regulations. Therefore, there are no citations being issued today.

The exit interview was conducted with Licensee. The Licensee was provided a copy of their appeal rights (LIC 9058) and their signature on this form acknowledges receipt of these forms.

The Notice of Site Visit (LIC 9213) – must remain posted for 30 days during the hours of operation after each site visit by a licensing representative. Failure to maintain posting as required will result in a civil penalty of $100.00.

SUPERVISOR'S NAME: Christina Gabelman	TELEPHONE: (323) 854-8930
LICENSING EVALUATOR NAME: Crystal Green	TELEPHONE: (323) 980-4930
LICENSING EVALUATOR SIGNATURE:	DATE: 11/05/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/05/2019

LIC809 (FAS) - (06/04)

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