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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198018091
Report Date: 06/27/2022
Date Signed: 06/27/2022 04:18:16 PM


Document Has Been Signed on 06/27/2022 04:18 PM - 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 CENTER DR 200B
MONTEREY PARK, CA 91754



FACILITY NAME:CALLE-MEDINA FAMILY CHILD CAREFACILITY NUMBER:
198018091
ADMINISTRATOR:CALLE, J. & MEDINA, IFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(323) 484-9092
CITY:SOUTH GATESTATE: CAZIP CODE:
90280
CAPACITY:14CENSUS: 6DATE:
06/27/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:44 PM
MET WITH:Licensees -Jenny Calle and Ines MedinaTIME COMPLETED:
04:35 PM
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On 6/27/22 Licensing Program Analysts (LPAs) Jeanette Estrada and Austin Estrada conducted an unannounced required 1 year inspection at the above facility. LPAs met with the Licensees Jenny Calle and Ines Medina and informed them of the purpose for the visit. Licensee J. Calle guided LPAs on a tour of the facility. There were 6 children present when LPAs arrived. Criminal record clearance for all adults present was verified. Licensee provides care to children ages 6 months to 12 years old and operation days/ hours are Monday through Friday 6AM to 6PM.
This is a one story 3 bedroom 2 bathroom home with a living room, dining room area, kitchen, detached garage, and fenced backyard. Areas on limits to children are the living room, dining room, hallway bathroom,and fenced backyard. Areas off limits to children are all bedrooms, second bathroom and kitchen. All areas identified on the facility sketch that are accessible for children to use were inspected for safety, comfort, and cleanliness. The following was observed and reviewed during this inspection: LPA reviewed required posted documentation for Facility License, Publication (PUB) 394- Notification of Parent Rights and Licensing Form (LIC) 9148- Earthquake Preparedness form. Facility records were reviewed for LIC 9040- Facility Roster, LIC 610- Facility Disaster Plan and Disaster drill log, last drill conducted on 6/1/22. Licensee had a copy of the Roster available during the inspection. There is an operable carbon monoxide detector and a smoke detector in the home. The 2A10BC Fire extinguisher in the kitchen indicated fully charged and were last serviced on 09/2021. The home maintains telephone service (landline). Food is provided by Licensees. Licensees were reminded if children bring food from home it must be labeled with the child’s name and properly stored or refrigerated. The home is observed to be clean and orderly. There are toys and other age appropriate materials available for children.
Sharp objects, detergents and cleaning compounds are kept in the off limits kitchen and are inaccessible to children in care. There is a safety gate separating the kitchen and the dining room. Sharp objects are kept in an upper cabinet in the kitchen inaccessible to children in care.
SUPERVISOR'S NAME: Valarie CookTELEPHONE: (323) 513-3828
LICENSING EVALUATOR NAME: Jeanette EstradaTELEPHONE: (323) 229-6521
LICENSING EVALUATOR SIGNATURE:
DATE: 06/27/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/27/2022
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: CALLE-MEDINA FAMILY CHILD CARE
FACILITY NUMBER: 198018091
VISIT DATE: 06/27/2022
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Cleaning products are kept in an upper cabinet in the laundry room next to the kitchen. Per Licensee J. Calle there is one child who requires medication. Per Licensee medication is kept in first aid pouch in a latched cabinet in the dining room. There is an air conditioning unit in the living room. LPA observed the wall heaters inaccessible to children. LPA observed age appropriate toys and materials in the day care room. Children have meals in the dining room area. Children use the restroom in the hallway. Per Licensee, children are supervised while playing outside.
Per Licensee poisons in the home are kept in the off limits garage. Licensee understands that all poisons must be locked, not only inaccessible to children. Isolation area for sick children waiting to be picked up is outside with adult supervision. Per Licensee, there are no firearms or weapons stored in the home. LPAs did not observe pools or spas, or other bodies of water.
Infant Care: Currently licensee cares for 2 infants. LPAs observed one crib in the dining room. One infant sleeps on a napping mat. Napping equipment does not block entrances or exits. Infant mattresses were observed to be firm with tightly fitted sheets. LPAs did not observe loose object, bumpers, objects hanging, or objects attached to the cribs. Per licensee wet or soiled sheets are laundered in the facility. Each infant has their own crib/ napping mat and bedding. LPAs and licensee reviewed the new Safe sleep regulations, including LIC 9227 Infant Sleep Plan for infants under 12 months, 15-minute sleep check documentation for infants 0-24 months.
Overnight Care: There is no overnight care provided at the moment. LPA discussed the following: Licensee is aware that they must remain wake while children are awake. If children sleep in separate area from licensee, the door must remain open. If licensee cannot hear children when they wake up, video or audio device can be used.
Children’s records were reviewed for (LIC) 282- Affidavit Regarding Liability Insurance, Immunization Records, LIC 700- Identification and Emergency Information, LIC 627- Consent for Medical Treatment, LIC 995A Notification of Parents’ Rights, LIC 9227- Infant sleep form (0-12 months, and documentation of 15-minute Infant Sleep Check (0-24 months)
Staff records were reviewed for approved Pediatric First Aid and CPR certification, LIC-501: Personnel Record, LIC 508-Criminal Record Statement, LIC 9052- Employee Rights, Proof of immunizations against measles, pertussis and influenza or influenza declination, TB clearance or risk assessment, LIC 9108- Statement of Child and Mandated Reporter Training Certificate. Both Licensees' CPR/First Aid expires on 10/24/23. Mandated Reporter training certificate: Jenny Calle completed on 7/13/21 and Ines Medina Completed on 6/18/20.
SUPERVISOR'S NAME: Valarie CookTELEPHONE: (323) 513-3828
LICENSING EVALUATOR NAME: Jeanette EstradaTELEPHONE: (323) 229-6521
LICENSING EVALUATOR SIGNATURE:

DATE: 06/27/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/27/2022
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: CALLE-MEDINA FAMILY CHILD CARE
FACILITY NUMBER: 198018091
VISIT DATE: 06/27/2022
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During inspection the children present was observed to be treated with dignity and respect, observed to be receiving safe, healthful and comfortable accommodations, furnishings and equipment, and free from corporal and/or unusual punishment.
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 Center and the ADA, available at: http://www.ada.gov/childqanda.htm
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. LPA discussed the safe sleep regulations with Licensee and discussed the Child Care Licensing Safe Sleep webpage athttps://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/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 https://www.cpsc.gov/ and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment.
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 experience. If you have any questions regarding the process or tools, please send them by email to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/process.
No deficiencies are being cited today. Exit interview conducted and report was reviewed with the Licensee Jenny Calle. A notice of site visit was given and must remain posted for 30 days.
SUPERVISOR'S NAME: Valarie CookTELEPHONE: (323) 513-3828
LICENSING EVALUATOR NAME: Jeanette EstradaTELEPHONE: (323) 229-6521
LICENSING EVALUATOR SIGNATURE:

DATE: 06/27/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/27/2022
LIC809 (FAS) - (06/04)
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