198014345-6-2-2022-33-CC-NTCG-CEZPTL-20220602113607

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 198014345
Report Date: 06/02/2022
Date Signed: 06/02/2022 11:36:28 AM

Document Has Been Signed on 06/02/2022 11:36 AM - It Cannot Be Edited

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:	DE SANTIAGO FAMILY CHILD CARE		FACILITY NUMBER:	198014345
ADMINISTRATOR:	DE SANTIAGO, ANA L.		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(626) 808-2046
CITY:	PASADENA	STATE: CA	ZIP CODE:	91107
CAPACITY:	14	CENSUS: 9	DATE:	06/02/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	08:55 AM
MET WITH:	Ana De Santiago - Licensee		TIME COMPLETED:	11:47 AM

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Licensing Program Analyst (LPA) Nolan Tcheng conducted an unannounced annual random inspection to the above facility. At 8:55am, LPA met with licensee, Ana De Santiago. Also present during this inspection, is Licensee’s Assistant. The licensee states that she currently has 14 children enrolled. A current children’s roster is available and is current. Licensee’s hours of operation are 7am-6am, Monday-Friday. Licensee tries to do 23 hrs.

This is a one-story home which consists of 3 bedrooms, 2 bathrooms, kitchen, dining area in kitchen, living room, front yard and backyard (fenced). The children use living room, kitchen, dining area in kitchen, bathroom in hallway, and backyard. Per licensee, areas off limits to children and parents include: bedrooms, front yard, and additional bathroom. All areas identified on the facility sketch were inspected. The licensee provides food for children in care.

The licensee states that 4 adults and 0 children currently live in the home. Persons residing in the home are identified on the attached LIC811. Licensee states that she currently has one assistant. All individuals present in the home have obtained a criminal record clearance or exemption prior to working, residing or volunteering in a licensed home. Per licensee, there are no weapons, firearms or bodies of water on the premises.

PHYSICAL PLANT

At 9am, LPA was lead on a tour of the facility by the licensee. Emergency Disaster Plan, Parent’s Rights Poster and the Facility License are observed to be posted by the front entrance. The first room toured was the kitchen with an attached dining area. Per licensee, children in care eat at the table. LPA observed the kitchen to be kept safe and free of hazards. Sharp knives were observed to be in a drawer with a safety latch. Detergents, cleaning compounds, medications, and other items which could pose a danger are inaccessible to children. The licensee states that there are no poisons in the home and understands that storage areas for poisons must be locked with a key or combination lock.
REPORT CONTINUES PAGE 1 of 4

SUPERVISOR'S NAME: Claudia Guangorena	TELEPHONE: (323) 981-3417
LICENSING EVALUATOR NAME: Nolan Tcheng	TELEPHONE: (323) 240-6201
LICENSING EVALUATOR SIGNATURE:	DATE: 06/02/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/02/2022

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: DE SANTIAGO FAMILY CHILD CARE	FACILITY NUMBER: 198014345
	VISIT DATE: 06/02/2022

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The next room reviewed was the living room that has toys and equipment appropriate for children in care. There is a changing table present for children who wear diapers. There are learning sections used by the facility for reading and lessons. At 9:15am, a fire extinguisher was observed to be a 1A 10BC fire extinguisher. Licensee had two that were both purchased 02/2022 as indicated on receipt. LPA explained to the licensee that the required fire extinguisher for child care is a 2A 10BC. Licensee was unaware of this and stated they will immediately go get one. LPA is assessing a Technical Violation. Per State Fire Marshall standards, fire extinguishers shall be serviced annually. The bathroom was reviewed and observed to be safe and free of any hazards. Smoke and carbon monoxide detectors were tested and are operable. There are first aid supplies available. The licensee states that there is a land line on the premises. Per licensee, the living room or outside, will be used as an area for an ill child until an authorized representative comes to pick up child. LPA observed napping equipment in the form of mats. Equipment is stored in a storage bin on the patio.

At 9:20am LPA observed the back yard area. The outdoor play area was observed to be fenced. At this time, children are using the back yard for outdoor play time. There is a deck/patio with couches. There is a separate deck patio that is used for outdoor arts and crafts. Children are able to play on a grass area that can be used for water play or a kiddie pool. LPA discussed safe use of a kiddie pool. There were small play houses and slides for children to use, as well as a swing set and large play house/structure for children to use. LPA observed bikes for children. The licensee is observed to be operating within the license capacity limitations.

FACILITY RECORDS:

The licensee and other personnel have completed training on preventive health practices including Pediatric First Aid and CPR. The licensee's Pediatric First Aid and CPR expires on 11/2023 Licensee and other personnel have complete mandated reporter training 08/2021. The licensee does have proof of immunization against influenza, tuberculosis, pertussis, and measles. Children’s records were reviewed, including but not limited to, a copy of the emergency information card that contains all the information specified by regulation. At 10am, LPA observed that children's files did not have immunization records present in file from a medical office. LPA discussed the importance to have records for children in care.

LPA observed health and safety practices being conducted at facility. There were signs promoting hand washing and most of the activities are conducted outside.

REPORT CONTINUES PAGE 2 of 4

SUPERVISOR'S NAME: Claudia Guangorena	TELEPHONE: (323) 981-3417
LICENSING EVALUATOR NAME: Nolan Tcheng	TELEPHONE: (323) 240-6201
LICENSING EVALUATOR SIGNATURE:	DATE: 06/02/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/02/2022

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: DE SANTIAGO FAMILY CHILD CARE	FACILITY NUMBER: 198014345
	VISIT DATE: 06/02/2022

NARRATIVE

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The following was discussed:
-Individuals who are 18 years of age or older living in the home must be finger print cleared prior to being in the presence of the children in care. Individuals within one month of their 18th birthday must be fingerprinted immediately.
-There is one small dog that is accessible to children in care.
-Infant Walkers, Johnny Jumpers, Saucer Chairs, Trampolines and/or any other item that falls into these categories are not permitted in a family child care facility.
-Smoking is prohibited in a license family child care home.

Infant Care: Licensee states that they are currently caring for infants. LPA advised the licensee to sleep infants where they can be directly supervised at all times and advised the licensee against sleeping infants in a separate room. Licensee states that infants sleep in the the living room with an adult present. 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. LPA consulted and explained Child Abuse Reporting, Updated Parent’s Rights Poster with Complaint Hotline information, Never Shake a Baby, Sudden Infant Death Syndrome (SIDS), and Safe Sleeping practices. PIN 20-24-CCP was provided and explained during the inspection.

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

To improve the quality and value of the new inspection process, a survey will be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or tools, please send them by email to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/process

REPORT CONTINUES PAGE 3 of 4

SUPERVISOR'S NAME: Claudia Guangorena	TELEPHONE: (323) 981-3417
LICENSING EVALUATOR NAME: Nolan Tcheng	TELEPHONE: (323) 240-6201
LICENSING EVALUATOR SIGNATURE:	DATE: 06/02/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/02/2022

LIC809 (FAS) - (06/04)

Page: 3 of 6

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: DE SANTIAGO FAMILY CHILD CARE	FACILITY NUMBER: 198014345
	VISIT DATE: 06/02/2022

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LPA advised the licensee how to access forms, regulations and quarterly updates on line at: www.ccld.ca.gov. AB1207 Mandated Child Abuse Reporting – Implementation was discussed with Licensee. Website provided: http://mandatedreporterca.com/

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

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.

Exit interview was conducted with Licensee Ana De Santiago, at 11:28am. Copy of Report was provided. PLan of Corrections was discussed with licensee.

END OF REPORT PAGE 4 of 4

SUPERVISOR'S NAME: Claudia Guangorena	TELEPHONE: (323) 981-3417
LICENSING EVALUATOR NAME: Nolan Tcheng	TELEPHONE: (323) 240-6201
LICENSING EVALUATOR SIGNATURE:	DATE: 06/02/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/02/2022

LIC809 (FAS) - (06/04)

Page: 6 of 6

Document Has Been Signed on 06/02/2022 11:36 AM - It Cannot Be Edited

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: DE SANTIAGO FAMILY CHILD CARE	FACILITY NUMBER: 198014345
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 06/02/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

102418(g)

Immunizations

(g) The licensee shall document each child's immunizations as required by the California Code of Regulations, Title 17, Section 6070, and shall maintain such documentation for as long as the child is enrolled. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on record review, the licensee did not comply with the section cited above in 9 out of 15 child files, Child #1, 3-6, 11, 13-15, did not have record of immunizations, which poses a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 07/01/2022
	Plan of Correction
1 2 3 4	Per Licensee, they will obtain a a copy of immunization record for Child #1, 3-6, 11, 13-15, and will submit proof to LPA by POC date.

Section Cited


	Deficient Practice Statement
1 2 3 4
	POC Due Date:
	Plan of Correction
1 2 3 4

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: Claudia Guangorena	TELEPHONE: (323) 981-3417
LICENSING EVALUATOR NAME: Nolan Tcheng	TELEPHONE: (323) 240-6201
LICENSING EVALUATOR SIGNATURE:	DATE: 06/02/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/02/2022

LIC809 (FAS) - (06/04)

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