198013729-9-6-2019-33-CC-CGRN-BFRNMT-20190906103539

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 198013729
Report Date: 09/06/2019
Date Signed: 09/06/2019 10:35:45 AM

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:	JUAREZ FAMILY CHILD CARE		FACILITY NUMBER:	198013729
ADMINISTRATOR:	JUAREZ, JUANA & MARIA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(626) 356-4350
CITY:	PASADENA	STATE: CA	ZIP CODE:	91104
CAPACITY:	14	CENSUS: 5	DATE:	09/06/2019
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	09:15 AM
MET WITH:	Juana and Maria Juarez		TIME COMPLETED:	10:55 AM

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) Crystal Green conducted an unannounced annual inspection. LPA met with both Licensees, Juana Juarez and Maria Juarez. There were 5 children present during this inspection. The licensee states that there are currently 10 children enrolled, children's roster was reviewed and is current. This a single- story home which consists of 5 bedrooms, 2 bathrooms, kitchen, dining room, living room and front yard. The front yard and patio are designated for outdoor play. Children have access to the 3 bedrooms, 1 bathroom, living room, front patio, and front yard(fenced). Children also use the kitchen/dining area for eating. Per licensee, areas off limits to children and parents include: The 2 back bedrooms and rear yard. The licensee provides food for children in care. Areas accessible to children were inspected to ensure that they are clean and orderly with ventilation and heating for safety and comfort. There is a working telephone service maintained in the home. Family members residing in the home are 4 adults and 2 children (criminal record clearances on file). Detergents, cleaning compounds, medications, and other items which can pose a danger to children are inaccessible in all areas of the home. 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, there are no weapons, firearms or bodies of water on the premises. LPA observed licensee to have a caged parrot located on the front patio. 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 and Consent for Medical Treatment on file. The valve on the required 2A10BC fire extinguisher indicates fully charged last service date 05/2018. Report Continues Page 1 of 2

SUPERVISOR'S NAME: Christina Gabelman	TELEPHONE: (323) 854-8930
LICENSING EVALUATOR NAME: Crystal Green	TELEPHONE: (323) 980-4930
LICENSING EVALUATOR SIGNATURE:	DATE: 09/06/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/06/2019

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: JUAREZ FAMILY CHILD CARE	FACILITY NUMBER: 198013729
	VISIT DATE: 09/06/2019

NARRATIVE

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Smoke detector and carbon monoxide detector were tested and are in operable condition. All homes shall conduct fire and disaster drills at least once every six months and document the date and time of each drill. The last drill documented was conducted on 07/08/2019. Both licensees have current Pediatric First Aid and CPR, which will expire 05/2020.

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 the publication: Commonly Asked Questions about Child Care Centers and the ADA, available at http://www.ada.gov/childqanda.htm

AB1207 Mandated Child Abuse Reporting www.mandatedreporterca.com – At this time both licensees are exempt from training due to training only offered in English.

Infant Care: Licensee states that she is currently not caring for infants.

LPA advised the licensee how to access forms, regulations and quarterly updates on the Child Care Licensing website at www.ccld.ca.gov

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.

Report Ends Page 2 of 2

SUPERVISOR'S NAME: Christina Gabelman	TELEPHONE: (323) 854-8930
LICENSING EVALUATOR NAME: Crystal Green	TELEPHONE: (323) 980-4930
LICENSING EVALUATOR SIGNATURE:	DATE: 09/06/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/06/2019

LIC809 (FAS) - (06/04)

Page: 2 of 2