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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198018822
Report Date: 03/28/2023
Date Signed: 03/28/2023 02:46:21 PM


Document Has Been Signed on 03/28/2023 02:46 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 CNTR DR. 200-B
MONTEREY PARK, CA 91754



FACILITY NAME:ETOLLE FAMILY CHILD CAREFACILITY NUMBER:
198018822
ADMINISTRATOR:ETOLLE, JULILEEFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(323) 538-1368
CITY:MONTEBELLOSTATE: CAZIP CODE:
90640
CAPACITY:14CENSUS: 2DATE:
03/28/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:05 AM
MET WITH:Julilee Etolle, LicenseeTIME COMPLETED:
02:25 PM
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Licensing Program Analyst (LPA) Mireya García conducted an unannounced annual required inspection. LPA met with licensee, Julilee Etolle guided analyst on a tour of the facility both indoors and outdoors. There were two (2) preschool age children present during LPA’s arrival. The Licensee states that there are currently three (3) children enrolled.

Family members residing in the home are 3 adults (criminal record clearances on file) and 1 minor child.

This is a two-story home which consists of 4 bedrooms, 2 bathrooms, living room, kitchen, family room, sunroom, laundry room, front yard (unfenced) and backyard (fenced). The children use the bathroom near the kitchen, kitchen, family room, sunroom and back yard. Per licensee's, areas off limits to children and parents include: 4 bedrooms, living room, restroom near the laundry room, and front yard. The LPA toured all areas used by children during this visit.

Report continues on next page 1 of 5.
SUPERVISOR'S NAME: Brandi VanOostenTELEPHONE: (323) 981-3365
LICENSING EVALUATOR NAME: Mireya GarciaTELEPHONE: (323) 981-3390
LICENSING EVALUATOR SIGNATURE:
DATE: 03/28/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/28/2023
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 6


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: ETOLLE FAMILY CHILD CARE
FACILITY NUMBER: 198018822
VISIT DATE: 03/28/2023
NARRATIVE
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During this tour, the following was noted: At 11:10 a.m., LPA was toured through the interior of the home. Areas accessible to children were inspected to ensure that they are clean and orderly with ventilation and central heating for safety and comfort. There were safe toys, play equipment and materials observed for children. Licensee states there are poisons in the home. LPA observed storage of poison (Ant Killer Spray) that is kept inside a cabinet in the locked laundry room. The licensee does understand that poisons must be locked with a key or combination lock. There is a working telephone service maintained in the home.

Per Licensee she currently does not have any infants enrolled in her day care program. Licensee states that at this time she does not plan to care for infants however will provide infant care if the need arises. LPA did not observe infant equipment during this inspection. Licensing staff advise if the Licensee does decide to care for infants to sleep infants where they can be directly supervised and advised against sleeping infants in a separate room. Infants under 12 months should sleep mouth up, on their backs, free of clutter surrounding their sleeping space. The LIC 9227 (Individual Sleeping Plan) for infants up to 12 months and PIN 20-24-CCP: Recently Approved Safe Sleep Regulations in Effect were explained and a copy was issued to the Licensee. Title 22 Regulation Section 102425(j) Infant Safe Sleep was discussed with the Licensee, including but not limited to documentation that shall be maintained.

Report continues on next page 2 of 5.
SUPERVISOR'S NAME: Brandi VanOostenTELEPHONE: (323) 981-3365
LICENSING EVALUATOR NAME: Mireya GarciaTELEPHONE: (323) 981-3390
LICENSING EVALUATOR SIGNATURE:

DATE: 03/28/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/28/2023
LIC809 (FAS) - (06/04)
Page: 2 of 6
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: ETOLLE FAMILY CHILD CARE
FACILITY NUMBER: 198018822
VISIT DATE: 03/28/2023
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Per licensee, there are no weapons, firearms or bodies of water on the premises. Children’s records were reviewed to ensure that each child has an Identification and Emergency form. The valve on the required 2A 10BC fire extinguisher indicates fully charged, licensee states fire extinguisher was purchased last year however, no purchase receipt was available for LPA review. There is a smoke detector located in the family room and a carbon monoxide detector located in the kitchen which were tested at 11:30 a.m. and are in operable condition. The licensee has current Pediatric First Aid and CPR, which will expire on 04/2023.

Incidental Medical Services (IMS) policy was discussed. Per Licensee there are currently no children enrolled who required IMS. 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

The following was discussed:

SB792 (Immunization Requirements for Staff and Employees) and AB1207 Mandated Child Abuse Reporting – On or before March 30, 2018 any person who works in a child care facility shall complete the training and renew the training every 2 years. Report continues on next page 3 of 5.

SUPERVISOR'S NAME: Brandi VanOostenTELEPHONE: (323) 981-3365
LICENSING EVALUATOR NAME: Mireya GarciaTELEPHONE: (323) 981-3390
LICENSING EVALUATOR SIGNATURE:

DATE: 03/28/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/28/2023
LIC809 (FAS) - (06/04)
Page: 3 of 6
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: ETOLLE FAMILY CHILD CARE
FACILITY NUMBER: 198018822
VISIT DATE: 03/28/2023
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The following was discussed:
  • 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 clearances prior to initial presence in the home will result in an immediate $100.00 dollar or more per day Civil Penalty.
  • The Licensee shall be present in the home and shall ensure that children are supervised at all times.
  • Children shall not be left in park vehicles.
  • The capacity specified on the license shall be the maximum number of children for whom care can be provided.
  • Car seats shall only be used for transportation purposes and shall not be used for sleeping.
  • All children in care have the right to receive safe, healthful, and comfortable accommodations, furnishings and equipment.
  • When a child shows signs off illness, they will be separated from other children until the nature if the illness is determined.

CHILDREN’S FORMS/RECORDS, FACILITY FORMS/RECORDS and INFORMATION TO BE POSTED, Disaster drills, posting requirements, children records requirements, mandated child abuse and injury/death reporting, and criminal record transfer requirements were discussed.
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SUPERVISOR'S NAME: Brandi VanOostenTELEPHONE: (323) 981-3365
LICENSING EVALUATOR NAME: Mireya GarciaTELEPHONE: (323) 981-3390
LICENSING EVALUATOR SIGNATURE:

DATE: 03/28/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/28/2023
LIC809 (FAS) - (06/04)
Page: 4 of 6
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: ETOLLE FAMILY CHILD CARE
FACILITY NUMBER: 198018822
VISIT DATE: 03/28/2023
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LPA advised the licensee how to access forms, regulations and quarterly updates on the Child Care Licensing website at: www.ccld.ca.gov

At this time, there were no deficiencies cited during today’s inspection.

A notice of site visit was given and must remain posted for 30 days.



Exit interview conducted and report was reviewed with facility representative, Julilee Etolle.

Report ends here page 5 of 5.
SUPERVISOR'S NAME: Brandi VanOostenTELEPHONE: (323) 981-3365
LICENSING EVALUATOR NAME: Mireya GarciaTELEPHONE: (323) 981-3390
LICENSING EVALUATOR SIGNATURE:

DATE: 03/28/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/28/2023
LIC809 (FAS) - (06/04)
Page: 5 of 6