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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198018860
Report Date: 06/07/2022
Date Signed: 06/07/2022 01:18:12 PM


Document Has Been Signed on 06/07/2022 01:18 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:SANDOVAL FAMILY CHILD CAREFACILITY NUMBER:
198018860
ADMINISTRATOR:CLAUDIA SANDOVALFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(323) 604-7958
CITY:LOS ANGELESSTATE: CAZIP CODE:
90011
CAPACITY:14CENSUS: 4DATE:
06/07/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:35 AM
MET WITH:Claudia Sandoval, LicenseeTIME COMPLETED:
01:25 PM
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Annual Inspection in Spanish

On Tuesday, June 7, 2022 at 10:30 a.m. Licensing Program Analyst (LPA) Mayra Rivera conducted an unannounced annual inspection and met with Licensee Claudia Sandoval who guided LPA Rivera on a tour of the facility.

Family members residing in the home has been discussed with Licensee and are cleared. Operating hours are Monday to Friday from 7:00 a.m. to 6:00 p.m. and care for children ages 0 to 12.

This facility is a one-story home that consists of three bedrooms, one full and half bathroom, kitchen, living room, dining area and front yard and backyard (fenced and gated). All areas identified on the facility sketch were inspected. Areas that are accessible to children and identified on the facility sketch include; living room, half bathroom, kitchen/dining area and backyard.

Areas off limits to children include- 3 bedrooms, and front yard. LPA observed all off limits areas closed and a child proof round ball in placed on the doorknobs making it inaccessible to children to open the doors.

At 10:55 a.m LPA Rivera inspected the facility for safety, comfort, cleanliness, ventilation and working phone (cell phone). For ventilation, LPA Rivera observed AC/heater central and the vents on the top ceiling walls. LPA observed the furniture, children materials, to be in good condition and age appropriate. LPA did not observe cribs or play yard because Licensee currently is not providing care for infants.

At approximately 11:10 a.m, LPA Rivera entered the restroom and observed the toilet, hand washing sink, and hand soap. LPA observed the bottom cabinet closed and did not observe hazard materials and observed the restroom to be in good condition.

SUPERVISOR'S NAME: Karen ChambersTELEPHONE: (323) 981-3368
LICENSING EVALUATOR NAME: Mayra RiveraTELEPHONE: (323) 629-7782
LICENSING EVALUATOR SIGNATURE:
DATE: 06/07/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/07/2022
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: SANDOVAL FAMILY CHILD CARE
FACILITY NUMBER: 198018860
VISIT DATE: 06/07/2022
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At approximately 11:16 a.m. LPA observed cleaning compounds items stored inside the top kitchen cabinet above the refrigerator making it inaccessible to children to reach. LPA observed knives and sharp objects stored inside the kitchen drawer and LPA observed the drawer with child proof lock in place making it inaccessible to children to open the drawer. For drinking water, LPA observed water dispenser and water bottles. Licensee provides the meals and is enrolled with the Child and Adult Care Food Program.

LPA Rivera asked Licensee if there are any pets, poisons, firearms, weapons or bodies of water. Licensee stated she has one dog, and no body of waters, firearms, weapons or poisons. LPA did not observe firearms, weapons, poisons nor bodies of water. Licensee was advised that if any poisons (ex; drano, rat poison or items with skull hazard symbol), firearms and weapons are purchased, it is required to be locked with a key or combination lock and firearm and ammunition must be stored separately.



At 11:25 a.m. LPA Rivera observed the required 2A10BC fire extinguisher located in the living room and kitchen and the valve on the green area indicating fully charged and serviced on 1/14/22. LPA observed one carbon monoxide detector in the kitchen and one smoke detector in the living room. The both detectors were tested, and LPA Rivera heard the sound. The smoke and carbon detectors are operable. LPA observed the First Aid complete with band aids, gauzes, adhesive bandages and antiseptic wipes and located in the kitchen.

At approximately 11:36 a.m, LPA Rivera inspected the outdoor area for safety, comfort and cleanliness. LPA observed the yard to be safe, cleaned, fenced and gated. LPA also observed the side gates closed with a self-latch shade structure provides adequate shade. LPA observed play equipment to be in good condition and age appropriate. LPA observed the dog on the side yard behind the side gate.

LPA observed Licensee Pediatric First Aid/ CPR certification with expiration date 5/17/2023, Health and Safety certification dated 1/29/2019 and Licensee has proof of immunization against Pertussis, and missing MMR and Influenza. Licensee has completed the mandated reporter (AB 1207) training on 7/17/21. Licensee was advised that the mandated reporter training must be completed every 2 years, and is available at www.mandatedreporterca.com

LPA observed the children roster, LIC 610A Emergency Disaster Plan, Pub 394 Notification of Parents Rights, LIC 999 Facility sketch, child car seat law posted on a bulletin board by the main entrance. At approximately 11:45 a.m LPA reviewed licensee, staff #1 and child #1 files. LPA observed the children’s files to be up to date and complete. Staff #1 is missing proof of MMR and TDAP. Currently has no children with medication.

SUPERVISOR'S NAME: Karen ChambersTELEPHONE: (323) 981-3368
LICENSING EVALUATOR NAME: Mayra RiveraTELEPHONE: (323) 629-7782
LICENSING EVALUATOR SIGNATURE:

DATE: 06/07/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/07/2022
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: SANDOVAL FAMILY CHILD CARE
FACILITY NUMBER: 198018860
VISIT DATE: 06/07/2022
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Criminal Record Statement
Licensee Claudia Sandoval was reminded that all adults 18 and over living in the home, persons who provide care and supervision to children, and staff who have contact with children, 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.

Safe Sleep
LPA discussed the safe sleep regulations with Licensee Claudia Sandoval and discussed the Child Care Licensing Safe Sleep webpage at https://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.

LPA Rivera also reviewed Sudden Infant Death Syndrome (SIDS), Never Shake A Baby, and Lead Exposure information with licensee. LPA transportation, highchair is only and only for feeding and stated items cannot be misused. No smoking, No infant walkers, No Johnny jumpers, No saucer chairs, No trampolines and any other item that falls into this category are not permitted in a family child care facility.

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

Licensee has been given technical violations for missing proof for staff #1 MMR, TDAP and staff #2 MMR.

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

SUPERVISOR'S NAME: Karen ChambersTELEPHONE: (323) 981-3368
LICENSING EVALUATOR NAME: Mayra RiveraTELEPHONE: (323) 629-7782
LICENSING EVALUATOR SIGNATURE:

DATE: 06/07/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/07/2022
LIC809 (FAS) - (06/04)
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