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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198012910
Report Date: 01/28/2020
Date Signed: 01/28/2020 01:37:07 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:JIMENEZ FAMILY CHILD CAREFACILITY NUMBER:
198012910
ADMINISTRATOR:JIMENEZ, VERONICAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(626) 633-2083
CITY:DUARTESTATE: CAZIP CODE:
91010
CAPACITY:14CENSUS: 10DATE:
01/28/2020
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Licensee Veronica Jimenez
TIME COMPLETED:
01:40 PM
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Licensing Program Analyst (LPA) Bardo Baluyot and Licensing Program Manager (LPM) Ana Chico conducted an unannounced random inspection. LPA met with licensee, Veronica Jimenez who guided analyst on a tour of the facility. Also present were Elizabeth Maldonado and Kristen Maldonado, licensee's assistants. There were 10 children present during this inspection, two being infants. Ms. Jimenez states that there are currently 18 children enrolled. Children's roster was reviewed and is current. Disaster drill log was available, last drill was conducted on 01/10/2020.

This is a single story home which consists of 3 bedrooms (rear bedroom used as a day care room), 2 bathrooms, kitchen, dining room, living room (FIREPLACE: which is inaccessible), detached garage, front yard, and backyard (fenced). The children use the rear portion of the home which includes: Day care room, bathroom, patio, detached garage and backyard. Per licensee, areas off limits to children and parents include: 2 bedrooms, living room, 1 bathrooms, kitchen, laundry room and front yard. The LPA toured all areas used by children during this inspection. Although a playpen was observed in the detached garage, licensee states that children do not nap. Additional playpens and cots were observed in the day care room. Licensee states that she fully understands that the garage was not licensed and that napping and/or eating is prohibited. Family members residing in the home have received clearance. Licensee provides breakfast, AM and PM snacks, and lunch in a family style setting.
All areas used by children were inspected for safety, comfort, cleanliness, telephone, ventilation and heating (central). The licensee states that there are no poisons in the home. The licensee understands that any poisons must be locked with a key or combination lock. Detergents, cleaning compounds, medicines, sharp objects and hazardous items that can pose a danger to children are inaccessible in some areas in the home.
REPORT CONTINUES ON NEXT PAGE 1 of 3
SUPERVISOR'S NAME: Ana ChicoTELEPHONE: (323) 981-3351
LICENSING EVALUATOR NAME: Bardo BaluyotTELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:

DATE: 01/28/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/28/2020
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 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 CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME: JIMENEZ FAMILY CHILD CARE
FACILITY NUMBER: 198012910
VISIT DATE: 01/28/2020
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Per licensee, there are no pets, weapons, firearms or bodies of water on the premises. There were age appropriate toys observed for children. There is wooden play structure used by children in care. Licensee was referred to the National Playground Safety Regulations or the manufacturers recommendations for playground safety. Posting requirements were observed to be posted. Licensee was advised that posting requirements must be posted in the home. Copies of licensing posting requirements may remain in the detached garage. Children’s records were reviewed.

The valve on the required 2A 10BC fire extinguisher indicates fully charged, however, licensee was not able to provide proof of date purchased. Smoke and carbon monoxide detectors were tested, and are in operable condition. There are emergency supplies on the premises.

The licensee was observed to be operating within the licensed capacity and is not exceeding the required limitations. The licensee has proof of current pediatric first aid and CPR (expires: 11/20/2020) as do her assistants. Licensee provides transportation. Licensee and her assistants completed required mandated reporter training, certificates on file. Mandated reporter training must be completed every 2 years. www.mandatedreporterca.com The following was discussed:

INFANT CARE: Licensee states that she does care for infants. LPA discussed the licensee’s plan for supervising sleeping infants. Licensee states the following: Any infants in care will nap in the day care room. LPA advised the licensee to sleep infants where the infants can be directly supervised and advised against sleeping infants in a separate room. The licensee states that she will not sleep infants in a separate room. Per Licensee, infants will sleep in daycare room. LPA reviewed SIDs, Never Shake A Baby, and safe sleeping practices. Infants should sleep mouth up, on their backs, free of clutter surrounding their sleeping. LPA observed that licensee had a copy of the Child Care Provider’s Guide to Safe Sleep, by American Academy of Pediatrics. Online copy can be downloaded at: https://www.cdph.ca.gov/programs/SIDS/Documents/SIDSchildcaresafesleep.pdf

REPORT CONTINUES ON NEXT PAGE 2 of 3
SUPERVISOR'S NAME: Ana ChicoTELEPHONE: (323) 981-3351
LICENSING EVALUATOR NAME: Bardo BaluyotTELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:

DATE: 01/28/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/28/2020
LIC809 (FAS) - (06/04)
Page: 2 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 CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME: JIMENEZ FAMILY CHILD CARE
FACILITY NUMBER: 198012910
VISIT DATE: 01/28/2020
NARRATIVE
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Medication: 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

No smoking, No infant walkers, No Johnny jumpers, No saucer chairs, No trampolines and any other item that falls into this category are not permitted in a family child care facility.

Per licensee, she does not carry liability insurance. The law requires Family Child Care provider to carry liability insurance or bond in the amount of $300,000 annually or to maintain the singed statement in the facility file. LPA advised the licensee how to access forms, regulations and quarterly updates, and provider information notices (PIN) on line at: www.ccld.ca.gov

LPA explained Child Abuse Reporting, Updated Patent’s Rights Poster with Complaint Hotline information. Any unusual incidents or injuries must be reported to the Department within 24 hours via telephone and within seven (7) days in writing. (use LIC624) for written report). Licensees shall reveal each facility license number in all advertisements, publications, or announcements made with the intent to attract clients. Licensee was provided with the Department's brochure on the Effects of Lead Exposure and was advised to register with the CCLs department website for quarterly updates.

LPA issued the Confidential Names List (LIC 811) to the licensee during this inspection. The Confidential Names List documents the children’s files that were reviewed during this inspection.
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SUPERVISOR'S NAME: Ana ChicoTELEPHONE: (323) 981-3351
LICENSING EVALUATOR NAME: Bardo BaluyotTELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:

DATE: 01/28/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/28/2020
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 CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME: JIMENEZ FAMILY CHILD CARE
FACILITY NUMBER: 198012910
VISIT DATE: 01/28/2020
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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.


See 809D for deficiencies cited in accordance to California Title 22 Regulations. Exit interview was conducted with Licensee. Appeal rights explained & provided.
SUPERVISOR'S NAME: Ana ChicoTELEPHONE: (323) 981-3351
LICENSING EVALUATOR NAME: Bardo BaluyotTELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:

DATE: 01/28/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/28/2020
LIC809 (FAS) - (06/04)
Page: 4 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 CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME: JIMENEZ FAMILY CHILD CARE
FACILITY NUMBER: 198012910
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/28/2020
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
02/03/2020
Section Cited

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Operation of FCC. The home shall contain a fire extinguisher and smoke detector device which meet standards established by the State Fire Marshal. This requirement was not met as evidenced by licensee unable to provide proof of purchase date. This is a potential risk to the health and safety of children in care.
Type B
02/10/2020
Section Cited

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Operation of a FCC. The home shall be kept clean and orderly, with heating and ventilation for safety and comfort. LPA observed door frame of garage w/ chipping paint. This requirement was not met as evidenced by licensee unable to provide proof of purchase date. This is a potential risk to the health and safety of children in care.

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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: Ana ChicoTELEPHONE: (323) 981-3351
LICENSING EVALUATOR NAME: Bardo BaluyotTELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:
DATE: 01/28/2020
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/28/2020
LIC809 (FAS) - (06/04)
Page: 5 of 5