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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198015575
Report Date: 01/31/2020
Date Signed: 01/31/2020 01:31:05 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:VASQUEZ FAMILY CHILD CAREFACILITY NUMBER:
198015575
ADMINISTRATOR:VASQUEZ, JOSEFAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(323) 327-8175
CITY:SOUTH GATESTATE: CAZIP CODE:
90280
CAPACITY:14CENSUS: 5DATE:
01/31/2020
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:30 AM
MET WITH:Joshefa Vasquez, LicenseeTIME COMPLETED:
01:40 PM
NARRATIVE
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An unannounced Annual Random Required Inspection was conducted by Licensing Program Analyst (LPA) Fabiola Vasquez LPA met with licensee Josefa Vasquez, who guided LPA on a tour of the facility. This is a single story duplex unit located in the front part of the property with its own address number. Currently residing in the home are 4 adults and 3 minor. Staff #1, Staff #2, Staff #3, Staff #4, Staff #5 were present during the inspection. Upon arrival, LPA observed five children in care, one of the four children is licensee's biological child.
Ages of care are 0-13 years and hours of Operation are Monday to Friday 6:30-7:00,

Areas accessible to children were inspected as follows: Den converted into a play area, hallway leading to the kitchen, bathroom in the located in the den, and back yard.
Areas off limits include: 4 bedrooms, 2 bathrooms front yard, kitchen, living, family room, drive way.

All areas used by children were inspected for safety, comfort, cleanliness, ventilation and heating . Detergents, cleaning compounds, medicines, sharp objects, hazardous items that can pose a danger to children are inaccessible. The licensee understands that any poisons must be locked with a key or combination lock.

Per licensee, there are no weapons or firearms or bodies of water on the premises. LPA did not observe swimming pools or spas on the premises. The backyard is adequately fenced. There are age appropriate toys and equipment on the premises. The smoke detectors and carbon monoxide detectors are present and in operational condition. The required 2A-10BC fire extinguisher has been serviced on 02/12/19. There are emergency supplies on the premises and a first aid kit. The fire extinguisher type 2A-10BC must be serviced annually or as often as necessary. Smoke and Carbon Monoxide detectors should be checked and batteries replaced as needed.


CONTINUE...809 C
SUPERVISOR'S NAME: Brandi VanOostenTELEPHONE: (323) 981-3365
LICENSING EVALUATOR NAME: Fabiola VasquezTELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:

DATE: 01/31/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/31/2020
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 4
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: VASQUEZ FAMILY CHILD CARE
FACILITY NUMBER: 198015575
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/31/2020
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
02/07/2020
Section Cited

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Personnel Requirements
The licensee and other personnel as specified shall complete training on preventive health practices,… pediatric first aid

This requirement was not met as evidenced by:
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Based on LPA observation, Licensee is missing training on preventive health practices for staff 1, Staff #2.

This poses a potential risk to the health and safety of children in care
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Type B
02/14/2020
Section Cited

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On or before March 30, 2018, a person who, on January 1, 2018, is a licensed child care provider, administrator, or employee of a licensed child day care facility shall complete the mandated reporter training provided... mandated reporter training.
This poses a potential risk to the health and safety of children in care
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Based on LPA observation, Licensee is missing training on preventive health practices for staff 1, Staff #2.

This poses 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: Brandi VanOostenTELEPHONE: (323) 981-3365
LICENSING EVALUATOR NAME: Fabiola VasquezTELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:
DATE: 01/31/2020
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/31/2020
LIC809 (FAS) - (06/04)
Page: 3 of 4
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: VASQUEZ FAMILY CHILD CARE
FACILITY NUMBER: 198015575
VISIT DATE: 01/31/2020
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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

CPR Card valid until: 11/12/2021

Child Care Roster, Disaster Plan, and Children's Records were reviewed and discussed.


Children records and required licensing forms were discussed as well as mandated child abuse reporting and criminal record clearance requirement.
The following was discussed with the Licensee:

Individuals who are 18 years of age or older living in the home must obtain a criminal record clearance. Individuals within one month of their 18th birthday must be fingerprinted immediately. Failure to obtain a criminal record background check clearance prior to initial presence in the home will result in an immediate $100.00 dollar or more per day Civil Penalty.

In the absence of the Licensee, a qualified adult must be present supervising the children; a qualified adult is an individual who has a valid and current adult/infant CPR & Pediatric First Aid certification and a valid criminal record clearance associated to the facility license.

All forms of children and staff enrolled must be available and maintained for a period of three years, even after children no longer are attending the facility. Annual fees must be paid promptly and by the due date or a late fee shall be assessed and/or the License shall be terminated.
Changes should be reported to the Department as soon as they occur such as construction, remodeling, telephone number changes and/or if you move from your home.

Any unusual incidents or injuries must be reported to the Department within 24 hours via telephone and within seven (7) days in writing. Fire and safety drills must be performed every six months and documented for review by the Department. Smoking is prohibited in a family child care home. Children and Staff records must be maintained and updated as needed and must be available for review by the Department.

CONTINUE...809 C

SUPERVISOR'S NAME: Brandi VanOostenTELEPHONE: (323) 981-3365
LICENSING EVALUATOR NAME: Fabiola VasquezTELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:

DATE: 01/31/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/31/2020
LIC809 (FAS) - (06/04)
Page: 2 of 4
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: VASQUEZ FAMILY CHILD CARE
FACILITY NUMBER: 198015575
VISIT DATE: 01/31/2020
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POSTING REQUIREMENTS: Parent’s Rights Poster was, License posted.

Infant Care: Baby walkers, saucer chairs, bouncers, Johnny Jumpers or any similar items are prohibited.

LPA provided a Safe Sleep Awareness Campaign (PIN) 19-02-CCP dated February 20, 2019 packet, Never Shake a Baby (Pub 271), A Child Care Providers Guide to Safe Sleep (SIDS) American Academy of Pediatrics and California Child Passenger Safety Law during today’s inspection.

Copies of Facility Sketch LIC 999, was provided,

All adults living and working in the home shall be made of aware of the Departments right to inspection authority, which includes but not limited to the right to enter the home when children are being cared for, interview children and adults and review documentation.


· It is recommended that First-Aid kits be available on premises.
· 100% Outdoor supervision required at all times. If outdoor area not adequately fenced, provider must be with children at all times when outdoors.

LPA advised the licensee how to access forms, regulations and quarterly updates on line at: www.ccld.ca.gov.

The following deficiencies are being cited in accordance to Title 22 Regulations. The Notice of Site Visit (LIC 9213) – must remain posted for 30 days during the hours of operation after each site inspection by a licensing representative. Failure to maintain posting as required will result in a civil penalty of $100.00. Exit interview was conducted with Josefa Vasquez, A copy of this report and appeal rights were provided.

REPORT END....

SUPERVISOR'S NAME: Brandi VanOostenTELEPHONE: (323) 981-3365
LICENSING EVALUATOR NAME: Fabiola VasquezTELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:

DATE: 01/31/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/31/2020
LIC809 (FAS) - (06/04)
Page: 4 of 4