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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198017313
Report Date: 02/05/2020
Date Signed: 02/05/2020 12:47:41 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:PENA FAMILY CHILD CAREFACILITY NUMBER:
198017313
ADMINISTRATOR:PENA, DIANAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(562) 889-4109
CITY:LONG BEACHSTATE: CAZIP CODE:
90805
CAPACITY:14CENSUS: 1DATE:
02/05/2020
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
10:20 AM
MET WITH:Diana PenaTIME COMPLETED:
01:02 PM
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Licensing Program Analyst (LPA) Warren Birks conducted an unannounced random inspection. LPA met with Licensee Diana Pena who was providing care for one infant along with a cleared assistant. LPA also observed two housekeepers cleaning. The Licensee indicated she hired the housekeepers as she is rehabilitating from an injury. LPA informed Licensee to always provide supervision when outside service people are hired. There are five children enrolled.

This is a one story home which consists of 2 bedrooms, 1 bathroom, kitchen, living room and backyard (fenced), there is a shed in the backyard. The children use the bathroom, living room, kitchen area and backyard for play. Per licensee, areas off limits to children and parents include: 2 bedrooms and detached sheds. The LPA toured all areas used by children during this visit.

All areas used by children were inspected for safety, comfort, cleanliness, ventilation and heating (central). The licensee states that there are no poisons in the home. The licensee understands that any poisons must be locked with a key or combination lock. Detergents, cleaning compounds, medicines, sharp objects were ire inaccessible. LPAs observed an empty baby bouncer and rocker that will need to be removed from accessible areas. Per licensee, there are no weapons, firearms or bodies of water on the premises. There are appropriate toys observed for children. The Licensee's 2A 10BC fires extinguisher is fully charge however the last date of service is unknown. Smoke and carbon monoxide detectors in the living room were tested and are in operable condition. There are emergency supplies on the premises and a first aid kit. The last date of emergency drill was May 2018.

The licensee understands that in her absence a qualified adult individual who has a valid and current adult/infant CPR & Pediatric First Aid certification and a valid criminal record clearance (associated to the facility) can care for children. The licensee's CPR expires in April 2021. LPA observed children's files to be complete and contain Identification and Emergency forms, Immunization Records and Parent's Rights.
SUPERVISOR'S NAME: Karen ChambersTELEPHONE: (323) 980-4934
LICENSING EVALUATOR NAME: Warren BirksTELEPHONE: 323-981-3373
LICENSING EVALUATOR SIGNATURE:

DATE: 02/05/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/05/2020
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: PENA FAMILY CHILD CARE
FACILITY NUMBER: 198017313
VISIT DATE: 02/05/2020
NARRATIVE
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There were NO ZERO TOLERANCE deficiencies cited during this visit. Zero Tolerance includes:
Absence of Supervision; Accessible Bodies of Water. No bodies of water on the premises; Accessible Firearms, Ammunition or Both. No firearms or weapons in the home; Refused Entry to a Facility or Any Part of a Facility in Violation of Section 1596.852, 1596.853 or 1597.09. Regulations 101238 (g)(2); The Presence of an Excluded Individual. No excluded individuals; Children are not left in parked vehicles.

POSTING REQUIREMENTS: Parent’s Rights Poster, Facility License and Emergency Disaster Plan is posted. SMOKING IS PROHIBITED IN A LICENSED FAMILY CHILD CARE HOME. No infant walkers, No Johnny jumpers, No saucer chairs, No trampolines and any other item that falls into that category are not permitted in the facility.

INFANT CARE: LPA advised the licensee to sleep infants where the infant can be directly supervised. If the licensee chooses to sleep infants in another room, the licensee is advised to conduct periodic checks. LPA discussed the following. 1) Safe Sleeping Poster (www.sidsandkids.org).

Medication: 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.

UPDATE: H&S 1597.622: 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. All adults have the required immunizations. The Licensee and assistants were unable to provide immunization records at this time.

Beginning January 1, 2018, Health and Safety Code 1596.8662 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.

SUPERVISOR'S NAME: Karen ChambersTELEPHONE: (323) 980-4934
LICENSING EVALUATOR NAME: Warren BirksTELEPHONE: 323-981-3373
LICENSING EVALUATOR SIGNATURE:

DATE: 02/05/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/05/2020
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: PENA FAMILY CHILD CARE
FACILITY NUMBER: 198017313
VISIT DATE: 02/05/2020
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Effective January 1, 2018: Existing licensees must meet requirements by March 30, 2018. Preventive (OCAP) online training modules are free of cost and available at http://www.mandatedreporterca.com/. Licensee and staff provided the evidence of the required 1/1/18 Mandated Reporter Training.

LPA informed licensee of Items not permitted in Licensed facility (Napping Rockers, bouncers, car seats).

LPA also advised Licensee to always make ensure that items such as medicines, perfumes, cosmetics, mouth wash, shampoos, lotions are always inaccessible to children. Inaccessibility means locked away or out of reach if they are placed in a high storage area (5 feet or higher).

The Notice of Site Visit (LIC 9213) and Licensing Report– must remain posted for 30 days during the hours of operation after each site visit by a licensing representative. Failure to maintain posting as required will result in a $100.00 civil penalty. Exit interview conducted with Licensee Diana Pena.

SUPERVISOR'S NAME: Karen ChambersTELEPHONE: (323) 980-4934
LICENSING EVALUATOR NAME: Warren BirksTELEPHONE: 323-981-3373
LICENSING EVALUATOR SIGNATURE:

DATE: 02/05/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/05/2020
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: PENA FAMILY CHILD CARE
FACILITY NUMBER: 198017313
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/05/2020
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
03/05/2020
Section Cited

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The home shall be free from defects or conditions which might endanger a child. Safety precautions shall include but not be limited to: The home shall contain a fire extinguisher and smoke detector device which meet standards established by the State Fire Marshal. Service date for fire extinguisher is unknown and smoke detector batteries were low. This poses a potential risk to children in care.
Type B
02/05/2020
Section Cited

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Personal Rights : To receive safe, healthful, and comfortable accommodations, furnishings, and equipment.. This requirement was not met as evidenced by: LPA observed an empty rocker on the couch. This poses a potential risk to children in care.
Type B
02/12/2020
Section Cited

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Each family child care home shall conduct fire drills and disaster drills at least once every six months. The licensee shall document the drills, including the date and time of each drill. This documentation shall be kept at the family child care home. This requirement was nmot met as evisdenced by: Last disaster drill documented May 2018. This is a potential risk to children.
Type B
02/05/2020
Section Cited

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Employees or volunteers at family day care home; immunization requirements; records; exemptions The family day care home shall maintain documentation of the required immunizations or exemptions from immunization, as set forth in this section, in the person’s personnel record that is maintained by the family day care home.
The Licensee and her assistants do not currently have immunization documentation. This is a potential risk to the health and safety of children in care.
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: Karen ChambersTELEPHONE: (323) 980-4934
LICENSING EVALUATOR NAME: Warren BirksTELEPHONE: 323-981-3373
LICENSING EVALUATOR SIGNATURE:
DATE: 02/05/2020
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/05/2020
LIC809 (FAS) - (06/04)
Page: 4 of 4