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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198018858
Report Date: 05/30/2023
Date Signed: 05/30/2023 12:01:52 PM

Document Has Been Signed on 05/30/2023 12:01 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:FELIX MEDINA FAMILY CHILD CAREFACILITY NUMBER:
198018858
ADMINISTRATOR:LUZ FELIX MEDINAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(562) 584-4062
CITY:NORWALKSTATE: CAZIP CODE:
90650
CAPACITY: 14TOTAL ENROLLED CHILDREN: 13CENSUS: 4DATE:
05/30/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:35 AM
MET WITH:Licensee Luz Felix MedinaTIME COMPLETED:
12:10 PM
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On 5/30/23 Licensing Program Analyst (LPA) Jeanette Estrada conducted an unannounced required 1 year inspection at the above facility. Upon arrival, LPA met with Staff 1(Licensee's adult daughter) who was present with 3 children. Licensee arrived approximately 5 minutes later. LPA informed Staff 1 and Licensee of the purpose for the visit and provided a copy of the facility entrance checklist (LIC 126). All residents living in the home were discussed and noted. Facility provides care to children ages 0 to 13 years old. The facility is open 24 hours from Monday to Friday although care is not provided for a continuous 24 hour period. LPA toured the facility with Staff 1. Licensee left facility at 11:24AM to pick up a child. Licensee returned at 11:35AM with one child. This is a one story, 3 bedroom, 2 bathroom home with a living room, kitchen/ dining area, enclosed backyard, detached garage. Per Licensee areas on limits to children are: One bedroom used as a daycare room, living room used as daycare activity space, one bathroom, a section of the kitchen for children's meals and the enclosed backyard. Per Staff 1 areas off limits to children are: Detached garage, two bedrooms, laundry room and a restroom located past the kitchen. LPA observed a safety gate separating the laundry room from the kitchen and safety knobs installed on the off limit bedrooms.All areas that are accessible to children were inspected for safety, comfort, and cleanliness. The following was observed and reviewed during this inspection: LPA observed required posted documentation at the entrance of the facility- Facility license, Publication (PUB) 394- Notification of Parent Rights. LPA observed a current facility roster LIC 9040 and a disaster drill log. Last documented drill was conducted on 5/16/23. There is an operable carbon monoxide/smoke detector in the living room. LPA observed a 2A10BC Fire Extinguisher in the kitchen which indicated full and was last serviced in November 2022 per the service tag. The home maintains telephone service (cell phone and landline). Food is provided by Licensee. Licensee was reminded if children bring food from home it must be labeled with the child’s name and properly stored or refrigerated. There are toys and other age appropriate materials available for children in the children's activity room and the living room. Sharp objects, detergents and cleaning compounds are inaccessible. Knives, cleaning products and personal medicines are kept in the kitchen. Knives are kept in a drawer with a magnetic lock, cleaning products are kept under the kitchen sink in a cabinet with a magnetic lock, detergents are kept in the laundry area which is off limits and medicine is kept in an upper cabinet.
SUPERVISORS NAME: Valarie Cook
LICENSING EVALUATOR NAME: Jeanette Estrada
LICENSING EVALUATOR SIGNATURE: DATE: 05/30/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/30/2023
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 CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME: FELIX MEDINA FAMILY CHILD CARE
FACILITY NUMBER: 198018858
VISIT DATE: 05/30/2023
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Per Staff 1, older children use the kitchen table for meals. LPA observed a safety gate separating the living room and the kitchen for when it is not in use. At this time, there are no children enrolled who require medication. Heating and ventilation was evaluated. There is an A/C wall unit in the living room. LPA observed an inaccessible wall heater in the living room. Children nap in the living room and in the day care room. LPA observed napping mats available for children. The children use the restroom in the hallway. LPA observed a latched cabinet under the sink where cleaning products and personal hygiene items are stored. No medicine was observed in the restroom. Children use the backyard for outdoor play. LPA observed age appropriate toys for children in the backyard. Per Staff 1, Children are supervised while playing outside. The detached garage is accessible through the backyard. The detached garage is off limits and maintained locked. LPA observed insect poison in the home kept in the off limits restroom past the kitchen. The restroom is maintained locked when children are present. Staff 1 was advised that all poisons must be locked, not only inaccessible to children. Isolation area for sick children waiting to be picked up is in the living room separated from other children in care. Per Staff 1, there are no firearms or weapons stored in the home. LPA did not observe any pools or spas, or other bodies of water. There is one pet dog in the home. The dog is contained in the backyard separated from children by a gate. Infant Care: Currently there is one infant over 12 months enrolled. LPA observed two play yards in the living room. LPA did not observe any loose or hanging items in the play yards. Napping equipment does not block the entrances or exits. LPA discussed the following with Licensee: Licensee was advised Infants shall not be swaddled in care. Car seats shall not be used for sleeping. LPA discussed the new Safe sleep regulation, including LIC 9227 Infant Sleep Plan for infants under 12 months, 15-minute sleep check documentation for infants 0-24 months. LPA reviewed the infant sleeping log. LPA advised Licensee to document time of each 15 minute check. Overnight Care: There is no overnight care provided at the moment. LPA discussed the following: Licensee is aware that they must remain awake 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. LPA verified that records contained (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
Staff records were reviewed: Licensee and Staff 1 have documentation of the required TB clearance and immunization against MMR, TDAP and flu. Licensee and Staff 1 completed mandated reporter training for child care providers on 4/19/23. Licensee and Staff 1's pediatric 1st aid/cpr certification issued by the American Red Cross expires in February 2024.
SUPERVISORS NAME: Valarie Cook
LICENSING EVALUATOR NAME: Jeanette Estrada
LICENSING EVALUATOR SIGNATURE:

DATE: 05/30/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/30/2023
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 CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME: FELIX MEDINA FAMILY CHILD CARE
FACILITY NUMBER: 198018858
VISIT DATE: 05/30/2023
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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
During inspection the child present was observed to be treated with dignity and respect, they were observed to be receiving safe, healthful and comfortable accommodations, furnishings and equipment, and free from corporal and/or unusual punishment. 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-sleephttps://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 were cited today.
Exit interview conducted and report was reviewed with . A notice of site visit was given and must remain posted for 30 days.
SUPERVISORS NAME: Valarie Cook
LICENSING EVALUATOR NAME: Jeanette Estrada
LICENSING EVALUATOR SIGNATURE:

DATE: 05/30/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/30/2023
LIC809 (FAS) - (06/04)
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