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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198017036
Report Date: 07/14/2023
Date Signed: 07/14/2023 10:53:02 AM

Document Has Been Signed on 07/14/2023 10:53 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:AMADOR FAMILY CHILD CAREFACILITY NUMBER:
198017036
ADMINISTRATOR:AMADOR, SYLVIAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(818) 638-7278
CITY:GLENDALESTATE: CAZIP CODE:
91201
CAPACITY: 14TOTAL ENROLLED CHILDREN: 2CENSUS: 2DATE:
07/14/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
08:30 AM
MET WITH:Sylvia Amador, LicenseeTIME COMPLETED:
11:15 AM
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Licensing Program Analyst (LPA) Anomeh Eivazian conducted an unannounced required 1- year inspection to the above facility on 07/14/23. LPA arrived at the facility at 8:30 AM and met with Sylvia Amador, Licensee who guided analyst on a tour of the facility. A COVID 19 risk assessment was conducted prior to entering the facility. Per licensee, Sylvia Amador facility hours are Monday to Friday from 8:30 a.m. to 6:00 p.m. LPA provided a copy of Entrance Checklist—Family Child Care Home (LIC126) to licensee.

This is a one story home located on the first level. The home consists of 3 bedrooms, 2 & 1/2 bathrooms, kitchen, dining room, living room (FIREPLACE: inaccessible), den (children's play room), laundry room, garage, front yard and backyard (fenced). The children use the half bathroom in the back room, dining room, living room, den, and backyard (fenced). Per licensee, areas off limits to children and parents include: 2 bedrooms, 2 bathrooms, kitchen, laundry room, front yard, detached garage and the very back of the backyard. LPA did not observe stairs in the home. During this inspection individuals who reside in the home were discussed and notes on Confidential Name List (LIC811) and attached to this report. Per licensee, parents enter the home through the main entrance which leads to the living room.

All areas identified on the facility sketch that are accessible for children to use were inspected for safety, comfort, and cleanliness. At 8:50 a.m., Licensee took this LPA on a tour of the home. LPA was toured through the interior starting with the living room, LPA observed sofas, a coffee table, and TV in the living room. Next LPA toured the dining room and observed a dining table and chairs in the dining room. Next LPA toured the kitchen and observed child proof safety latches on the cabinets where licensee stores sharp items. Next LPA toured the den (children play room) and observed children tables, chairs, and toys in the daycare room. Next LPA toured the half bathroom in the back bedroom and did not observe any hazards. Per licensee, children only walk through the last bedroom to use the bathroom. Per licensee, the required 2A 10BC fire extinguisher was not available in the home during this inspection. Licensee tested the carbon monoxide and smoke detectors in the living room. It sounded off the alarms and heard by LPA to be functional.
REPORT CONTINUES ON NEXT PAGE 1 of 4
SUPERVISORS NAME: Christina Gabelman
LICENSING EVALUATOR NAME: Anomeh Eivazian
LICENSING EVALUATOR SIGNATURE: DATE: 07/14/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/14/2023
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: AMADOR FAMILY CHILD CARE
FACILITY NUMBER: 198017036
VISIT DATE: 07/14/2023
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Detergents, cleaning compounds, medications, and other items which could pose a danger to children were observed to be 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.

Next LPA toured the backyard fenced. Currently, children are using the back yard for outdoor play time. The outdoor play area was observed to be fenced. LPA observed that the outdoor yard has toys and other materials for children to play with. LPA did not observe any objects that can pose a danger to children on the outdoor yard. Back of backyard which is off-limit area, is gated to prevent access. The licensee states that supervision is always provided.

Per licensee, she provides food for children in care. Licensee was advised that if food is brought from the children’s homes, all containers must be labeled with child’s name and properly stored or refrigerated. Per Licensee, at 9:30 a.m there are weapons, firearms, pools, spas, hot tubs, fish ponds, or similar bodies of water on the premises. Per licensee, there are two dogs on the premises which are accessible to the children.

The licensee was observed to be operating within the licensed capacity and is not exceeding the required limitations during this inspection. During this inspection two children were present in the home. All adults present have obtained a criminal record clearance on Licensing Information System (LIS). Per licensee, currently she does not have assistant. Licensee 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.

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 expired on 06/2023. Licensee did not have current required mandated reporter training on file. There are first aid supplies available on the premises in the closet in the hallway of bedrooms. LPA advised licensee that if a child shows signs of illness he/she/they shall be separated from other children.
REPORT CONTINUES ON NEXT PAGE 2 of 4
SUPERVISORS NAME: Christina Gabelman
LICENSING EVALUATOR NAME: Anomeh Eivazian
LICENSING EVALUATOR SIGNATURE:

DATE: 07/14/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/14/2023
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: AMADOR FAMILY CHILD CARE
FACILITY NUMBER: 198017036
VISIT DATE: 07/14/2023
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At 9:40 a.m., facility roster was reviewed and completed. Per licensee currently there are 2 children enrolled, one being licensee's biological child. LPA reviewed 1 children's records, including emergency information from 1 enrolled children, and all 1 reviewed files were completed.

The licensee did not have proof of immunization against influenza, pertussis, and measles. All homes shall conduct fire and disaster drills at least once every six months, and document the date and time of each drill. Last drill documented was conducted on 03/20/23.

Emergency Disaster Plan, Parent’s Rights Poster and the Facility License were observed to be posted at the wall in the daycare area. LPA did not observe the following items during the inspection: Infant Walkers, Johnny Jumpers, Saucer Chairs, Trampolines and/or any other item that fall into these categories are not permitted in a family child care facility.

Smoking is prohibited in a licensed Family Child Care Home. Per Licensee, no one smokes in the home. There is telephone service via a a cellphone that is used and the cellphone stays at the facility during operation hours. Per licensee she does not carry liability insurance or a bond in accordance with standard
established by Family Child Care statue. Signed statements (LIC282) on 1 reviewed file.
INFANT CARE: Per licensee, she does not provide care to infants. LPA did not observe any infants swaddled while in care. LPA advised the Licensee that infants shall be placed on their backs for sleeping and shall be supervised. Infants shall be checked on every 15 minutes and the time of each 15-minute check shall be documented with child’s name and date. The LIC 9227 Individual Infant Sleeping Plan shall be completed for each infant up to 12 months of age. A copy of the LIC 9227 was provided to Licensee. LPA provided the licensee with a copy of A Child Care Provider’s Guide to Safe Sleep, by American Academy of Pediatrics. LPA also consulted and explained Child Abuse Reporting, Never Shake a Baby, and Safe Sleeping practices.
SAFE SLEEP: LPA discussed the safe sleep regulations with licensee, and discussed the Child Care Licensing Safe Sleep webpage at http://www.cdss.ca.gov/inforescources/child-care-licensing/public-information-and-resoucrces/safe-sleep as an additional resource. LPA also informed licensee of the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at http://www/cpsc.gov/ and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment. Boppy recall: https://www.cpsc.gov/Recalls/2021/The-Boppy-Company-Recalls-Over-3-Million-Original-Newborn-Loungers-Boppy-Preferred-Newborn-Loungers-and-Pottery-Barn-Kids-Boppy-Newborn-Loungers-After-8-Infant-Deaths-Suffocation-Risk
REPORT CONTINUES ON NEXT PAGE 3 of 4
SUPERVISORS NAME: Christina Gabelman
LICENSING EVALUATOR NAME: Anomeh Eivazian
LICENSING EVALUATOR SIGNATURE:

DATE: 07/14/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/14/2023
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: AMADOR FAMILY CHILD CARE
FACILITY NUMBER: 198017036
VISIT DATE: 07/14/2023
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Medication: Incidental Medical Services (IMS) policy was discussed. The licensee states that she will provide IMS. Per licensee, there are no children enrolled that require IMS at this time. 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.

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

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) was given and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

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 experienced. If you have any questions regarding the process or tools, please send them by email to inspectionprocess@dss.ca.gov. For additional information regarding inspection tools and methods, please visit the Program website at www.cdss.gov/inforesouces/community-care-liceinsing/inspection-process

Licensee, Sylvia Amador was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain child care by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.



During the exit interview, the Licensee, Sylvia Amador, confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS.

Exit interview conducted and report was reviewed with the Licensee, Sylvia Amador at 11:15 AM..
REPORT END 4 of 4
SUPERVISORS NAME: Christina Gabelman
LICENSING EVALUATOR NAME: Anomeh Eivazian
LICENSING EVALUATOR SIGNATURE:

DATE: 07/14/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/14/2023
LIC809 (FAS) - (06/04)
Page: 4 of 6
Document Has Been Signed on 07/14/2023 10:53 AM - It Cannot Be Edited


Created By: Anomeh Eivazian On 07/14/2023 at 09:54 AM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME: AMADOR FAMILY CHILD CARE
FACILITY NUMBER: 198017036

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/14/2023

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
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Based on LPA's observation, the licensee did not comply with the section cited above and required 2A 10BC fire extinguisher was not available in the home during this inspection which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 08/14/2023
Plan of Correction
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Per licensee, she will have the required 2A10BC fire extinguisher by plan of correction due date and a copy of receipt will be submitted to LPA via email.
Type B
Section Cited
HSC
1596.8662(b)(1)
Administration of Child Day Care Licensing
(1) On or before March 30, 2018, a person who, on January 1, 2018, is a licensed child day care provider, administrator, or employee of a licensed child day care facility shall complete the mandated reporter training provided pursuant to paragraphs (2) and (3) of subdivision (a), and shall complete renewal mandated reporter training every two years following the date on which he or she completed the initial mandated reporter training.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on licensee's file review, the licensee did not comply with the section cited above and licensee did not have current mandated reporter training certificate on file which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 08/14/2023
Plan of Correction
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Per licensee, she will take the required mandated reporter training and a copy of certificate will be submitted to LPA via email by 08/14/23.
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:Christina Gabelman
LICENSING EVALUATOR NAME:Anomeh Eivazian
LICENSING EVALUATOR SIGNATURE:
DATE: 07/14/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/14/2023


LIC809 (FAS) - (06/04)
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Document Has Been Signed on 07/14/2023 10:53 AM - It Cannot Be Edited


Created By: Anomeh Eivazian On 07/14/2023 at 09:54 AM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME: AMADOR FAMILY CHILD CARE
FACILITY NUMBER: 198017036

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/14/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102416(c)
Personnel Requirements
(c) The licensee and other personnel as specified shall complete training on preventive health practices, including pediatric cardiopulmonary resuscitation and pediatric first aid, pursuant to Health and Safety Code Section 1596.866.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on licensee's file review, the licensee did not comply with the section cited above and did not have current pediatric first aid and cpr certificate, expired: 06/2023 which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 08/14/2023
Plan of Correction
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Per licensee she will take pediatric first aid and cpr by plan of correction due date and a copy of certificate will be submitted to LPA via email.
Type B
Section Cited
HSC
1597.622(a)(1)
General Provisions and Definitions
(1) Commencing September 1, 2016, a person shall not be employed or volunteer at a family day care home if he or she has not been immunized against influenza, pertussis, and measles. Each employee and volunteer shall receive an influenza vaccination between August 1 and December 1 of each year.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on licensee's file review, the licensee did not comply with the section cited above and licensee did not have proof of immunization against pertussis, measles and influenza on file which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 08/14/2023
Plan of Correction
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Per licensee, she will have proof of immunization against influenza, measles and pertussis by plan of correction due date and a copy will be submitted to LPA via email.
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:Christina Gabelman
LICENSING EVALUATOR NAME:Anomeh Eivazian
LICENSING EVALUATOR SIGNATURE:
DATE: 07/14/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/14/2023


LIC809 (FAS) - (06/04)
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