198016465-10-22-2021-54-CC-KCHE-C82U7Y-20211022152043

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 198016465
Report Date: 10/22/2021
Date Signed: 10/22/2021 03:20:59 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:	CARDENAS FAMILY CHILD CARE		FACILITY NUMBER:	198016465
ADMINISTRATOR:	CARDENAS, MARIA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(323) 569-6474
CITY:	LOS ANGELES	STATE: CA	ZIP CODE:	90002
CAPACITY:	14	CENSUS: 9	DATE:	10/22/2021
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	01:25 PM
MET WITH:	Edwin Cardenas, Licensee's Assistant		TIME COMPLETED:	03:45 PM

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)Katrina Chicote conducted an Unannounced Required – 1 Year inspection to the above facility on 10/22/2021 at 1:25 PM. LPA Chicote conducted COVID-19 Screening Call prior to entering facility. Upon arrival, LPA disclosed the purpose of the inspection and met with Licensee's Assistant, Edwin Cardenas, who guided the LPA on a tour of the facility. Also present was another Licensee's Assistant, who has criminal record clearance. Individuals living in the home were discussed. There were nine napping day care children present during today’s inspection. Licensee states that there are currently ten children enrolled, which includes one infant. The children's roster was reviewed and is current. Per Licensee's Assistant, the facility’s hours of operation are Monday thru Friday, 6:00am to 5:00pm. Emergency Disaster Plan, License, and Parents’ Rights were posted at the time of inspection. Disaster drill log was also available during today’s inspection, last disaster drill conducted on 10/2021. This is a single-story home which consists of three bedrooms and one bathroom, kitchen, living/dining room, den, front yard, back yard, and detached garage. Areas used by the children include the den (located next to Kitchen), Bathroom 1, and Bedroom 1 (used for Infant Room). Per Licensee, areas off limits to children and parents include kitchen, living/dining room, Bedrooms 2 and 3, and detached garage. Per Licensee's Assistant, children will have access to den, which is main daycare space, through separate front entrance. LPA observed that main daycare space has separate front entrance from rest of the home. At 1:32 PM, LPA observed there is a door blocking kitchen from main daycare space, making kitchen and rest of home off limits to children and families. At 1:34 PM, LPA observed all areas identified on the facility sketch as accessible to children were inspected to ensure that they are clean and orderly with ventilation and heating for the safety of the children. There is a working telephone maintained in the home. LPA observed main day care space to have shelves with puzzles, art supplies, blocks, dramatic play toys, and other age appropriate toys, free of loose and sharp parts available Report continues- Page 1 of 3

SUPERVISOR'S NAME: Trevino Cochran	TELEPHONE: (323) 981-3385
LICENSING EVALUATOR NAME: Katrina Chicote	TELEPHONE: (323) 629-7658
LICENSING EVALUATOR SIGNATURE:	DATE: 10/22/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/22/2021

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: CARDENAS FAMILY CHILD CARE	FACILITY NUMBER: 198016465
	VISIT DATE: 10/22/2021

NARRATIVE

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for children in care at time of inspection. At 2:00 PM, LPA observed Bathroom 1, which children will access through a door in main daycare space, to have operable toilet and sink, adequate hand washing supplies, and floor to be free of hazards. At 1:42 PM, LPA observed a dog in the home, per Licensee's Assistant, dog is kept separate from children during daycare hours. LPA observed dog to be kept in off limits bedroom during inspection. LPA observed Bedroom 1 used for infants to have a pack n play for infant sleep and carpet flooring. Detergents, cleaning compounds, medications, and other items which can pose a danger to children are inaccessible. At 1:38 PM, LPA observed these items and sharp knives to be kept in off limits kitchen area. Per Licensee's Assistant they also store these items in a closet in the off limits area of the home. The Licensee states that there are no poisons in the home.

Per Licensee's Assistant, the children will have access to backyard area for outdoor play. At 1:47 PM, LPA observed backyard, which children will access through a door in main daycare space, to have concrete and adequate perimeter fencing through-out the yard. LPA observed plastic play houses, small tricycles, child size tables and chairs, and other age appropriate toys free of loose and sharp parts available for the children in the backyard. LPA observed a detached garage in backyard. Licensee's Assistant states detached garage is off limits, at 1:49 PM LPA observed these doors to be locked. LPA observed and all trees, shrubs, and plants are maintained at time of inspection.

Per Licensee's Assistant, there are no weapons, firearms in the home and there are no bodies of water around the premises. LPA observation did not see these items at time of inspection. Per Licensee's Assistant, they provide food for children in care.

At 1:39 PM, LPA observed the valve on the required 2A 10BC fire extinguisher indicates fully charged with service tag (picture taken). At 1:42 PM, LPA observed smoke and carbon monoxide detectors are in operable condition. LPA observed First Aid kit kept in main daycare space and was inventoried for necessary supplies. The Licensee has current Pediatric First Aid and CPR. Proof of immunization against influenza, pertussis, and measles was readily available during today’s inspection. The Licensee has also taken the Mandated Reporter Training
—CPR Card valid until: 01/10/2022
—Fire Extinguisher was last serviced on: 05/07/2018
—Mandated Reporter AB1207 Completed: 07/12/2021

Report continues- Page 2 of 3

SUPERVISOR'S NAME: Trevino Cochran	TELEPHONE: (323) 981-3385
LICENSING EVALUATOR NAME: Katrina Chicote	TELEPHONE: (323) 629-7658
LICENSING EVALUATOR SIGNATURE:	DATE: 10/22/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/22/2021

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: CARDENAS FAMILY CHILD CARE	FACILITY NUMBER: 198016465
	VISIT DATE: 10/22/2021

NARRATIVE

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The following were discussed:
Incidental Medical Services (IMS)
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

Licensee (or facility representative) was reminded that all adults 18 and over living or working in the home, including employees and volunteers, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a licensed Family Child Care Home. A civil penalty of $100.00 minimum/day up to $500.00 maximum per day/per person will be assessed if this regulation is violated.

Rooms that are off-limits need to be made inaccessible during operating hours. NO smoking, NO infant walkers, NO Johnny jumpers, NO saucer chairs, NO incline sleepers and any other item that falls into that category are permitted in the facility.

The Licensee was advised that inaccessibility of hazards must be constantly reassessed depending on the children in care. A hard copy of PIN 20-24-CCP Recently Approed Safe Sleep Regulations in Effect, LIC 9227, and LIC857 was provided.

Based on this information, the following deficiencies on the attached LIC 809D 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 inspection by a licensing representative. Failure to maintain posting as required will result in a civil penalty of $100.00.

Exit interview was conducted and report was reviewed with the Licensee (or facility representative), Edwin Cardenas. Report Ends - Page 3 of 3

SUPERVISOR'S NAME: Trevino Cochran	TELEPHONE: (323) 981-3385
LICENSING EVALUATOR NAME: Katrina Chicote	TELEPHONE: (323) 629-7658
LICENSING EVALUATOR SIGNATURE:	DATE: 10/22/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/22/2021

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: CARDENAS FAMILY CHILD CARE	FACILITY NUMBER: 198016465
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 10/22/2021

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

102417(g)(1)

Operation of A Family Child Care Home

(g) The home shall be free from defects or conditions which might endanger a child. Safety precautions shall include but not limited to: (1) Fireplaces and open face heaters shall be screened to prevent access by children. The home shall contain a fire extinguisher and smoke detector device which meet standards established by the State Fire Marshall. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	At 1:39 PM, LPA observed fire extinguisher with service tag dating 05/07/2018, which is not serviced within the year at time of inspection. This poses a potential health, safety, and personal rights risk to children in care.
	POC Due Date: 10/25/2021
	Plan of Correction
1 2 3 4	Licensee's Assistant states they will purchase a new fire extinguisher and provide a photo copy of receipt and new extinguisher by POC date via email.

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: Trevino Cochran	TELEPHONE: (323) 981-3385
LICENSING EVALUATOR NAME: Katrina Chicote	TELEPHONE: (323) 629-7658
LICENSING EVALUATOR SIGNATURE:	DATE: 10/22/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/22/2021

LIC809 (FAS) - (06/04)

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