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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198015133
Report Date: 05/24/2019
Date Signed: 05/24/2019 01:40:39 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:PULIDO FAMILY CHILD CAREFACILITY NUMBER:
198015133
ADMINISTRATOR:PULIDO, YOLANDAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(323) 262-6842
CITY:LOS ANGELESSTATE: CAZIP CODE:
90023
CAPACITY:14CENSUS: 3DATE:
05/24/2019
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
12:20 PM
MET WITH:LicenseeTIME COMPLETED:
01:50 PM
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Licensing Program Analyst (LPA) Tiffanie Tran arrived at the home for the purpose of conducting an unannounced annual random inspection . Upon arrival, LPA met with licensee and three child care children. About 12:35 we and toured the home inside and out and the following was observed:
Licensee has Facility License (LIC 203), Emergency Disaster Plan (LIC610a), Child Care Facility Roster (LIC9040) Notification of Parents' Rights Poster (PUB 394) and Fire and disaster drills log conducted monthly. There is no changes to the physical plant of the FCCH. This is a single home with three bedrooms, two bathrooms, living room, kitchen/dining. Primary child care is conducted in the living room. Home is found to be clean, orderly and has proper heat and ventilation. Licensee has an operating smoke as well as an operating and fully charged Fire Extinguisher and a functional carbon monoxide. The licensee states there are no weapons or firearms in the home. Furniture and equipment were inspected for cleanliness, age appropriateness & good repair. Cots were inspected for cleanliness & good repair. Bathroom was inspected for inaccessibility of toxins and chemicals. Children have access to the kitchen area to enter the back yard. Kitchen cabinets observed with proper latched. All toxins/cleaning compounds and other potentially dangerous objects/materials made inaccessible to children. The Back yard is fully fenced and inspected for safety, potential hazards and no bodies of water observed. Licensee has a small outdoor dog locked on the side of the backyard making it inaccessible to children in care.
A review of the children's records was conducted and are found to have the following: LIC 282 Affidavit Liability Insurance, LIC 627/Consent for Medical Treatment, LIC 700/ID and Emergency Information, LIC 995A/Parent's Rights, LIC995E/Caregiver Background Check, LIC 9150/Parent Notification, LIC 9212/Parent's Responsibilities, PM 286/Immunization (Blue) Card. LPA observed licensee has current CPR and First Aid expired on 3/2021.
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
SUPERVISOR'S NAME: Trevino CochranTELEPHONE: (323) 981-3350
LICENSING EVALUATOR NAME: Tiffanie TranTELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:

DATE: 05/24/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/24/2019
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: PULIDO FAMILY CHILD CARE
FACILITY NUMBER: 198015133
VISIT DATE: 05/24/2019
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The following was discussed with the licensee:
Licensee was informed of responsibility to report suspected Child Abuse by calling the Child Abuse Hotline at 1-800-540-4000. Also call the Community Care Licensing office and follow up with a written Unusual Incident/Injury Report (LIC 624B).
LPA reminded that it is the facility responsibility to know the regulations as well as anyone who assists in providing care. LPA advised on how to access quarterly reports, forms, and regulations for Child Care online at www.cdss.ca.gov. to stay informed of any changes or updates to the regulations.
LPA shared the Child Care Advocate Program (CCAP) participates in many community activities and special projects in order to disseminate information on the State’s licensing role, provide information to the public and parents on child care licensing, and provide many other helpful resources to the licensees and the public. Facility may also register on CCAP website for the new quarterly report to be notified. CCAP’s direct contact information is as followed: Phone number: (916) 654-1541. Email address: childcareadvocatesprogram@dss.ca.gov
Beginning on January 1, 2018, AB 1207, requires all licensed providers, applicants, directors and employees to complete training as specified on their mandated reporter duties and to renew their training every two years. Volunteers are encouraged but not required to take the training. Website: www.mandatedreporterca.com
LPA discussed and provided the safe sleep for baby pamphlet. Each infant shall be constantly supervised and under direct visual observation by an adult person at all times. Under no circumstances shall any infant be left unattended. In order to visually observed and supervise sleeping infants there should be no obstruction to the view of the infants, which could include transparency walls and/or half walls. LPA recommend that infants sleep safest in crib with no bumpers, pillows, blankets, or toys, and on their backs, and every sleep time counts to reduce the risk of SIDS and other sleep-related causes of infant death.
The licensee was informed that the presence of adults in the home without Criminal Record Clearance or Exemption will be cited and civil penalty assessed for $100 per day. The licensee may find additional information and forms on the Department’s website at www.ccld.ca.gov including information on the Live Scan application (LIC 9163). Appointments can be made for Live Scan at 1-800-315-4507.
Licensee is reminded that smoking is prohibited on the premises during hours of operation.
No deficiency was found during today's inspection. An Exit interview was conducted. The copy of this report was provided to licensee.
SUPERVISOR'S NAME: Trevino CochranTELEPHONE: (323) 981-3350
LICENSING EVALUATOR NAME: Tiffanie TranTELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:

DATE: 05/24/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/24/2019
LIC809 (FAS) - (06/04)
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