198018861-7-12-2023-54-CC-ECHZ-CTNSVD-20230712141236

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 198018861
Report Date: 07/12/2023
Date Signed: 07/12/2023 02:13:29 PM

Document Has Been Signed on 07/12/2023 02:13 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:	ANDRADE & CRUZ FAMILY CHILD CARE		FACILITY NUMBER:	198018861
ADMINISTRATOR:	A., CLAUDIA & C., HUMBERTO		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(562) 519-6817
CITY:	HAWAIIAN GARDENS	STATE: CA	ZIP CODE:	90716
CAPACITY:	14	CENSUS: 8	DATE:	07/12/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	09:00 AM
MET WITH:	Claudia Andrade		TIME COMPLETED:	02:15 PM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	Licensing Program Analyst (LPA) Elka Chavez conducted an unannounced 1-year required inspection to the above facility in Spanish on 07/12/2023. LPA arrived at the facility at 9:00 AM and met with Licensee, Claudia Andrade who guided analyst on a tour of the facility. Also present Co-Licensee, Humberto Cruz. Entrance Checklist for Family Child Care Homes was provided to the licensee upon entry. There were 8 children present upon arrival. Hours of operation are at all hours of the day from Monday through Friday. The Licensee understands that care for a child should not exceed 24 hours. This is a two-story home which consists of 4 bedrooms, 2.5 bathrooms, kitchen, dining room, living room, attached garage and front yard (fenced). Areas accessible to children are: First level of the home which includes the living room, dining room, kitchen, half bathroom, converted garage and front yard (fenced). The converted garage space is used for activities only and is accessed from the kitchen. Children nap in the living room. Areas off limits to children and parents are: The second story and bedroom by the living room. LPA observed stairs are screened to prevent access by children via child safety gate. All off-limit areas need to be made inaccessible to children in care. Licensee was reminded that the garage can only be utilized as activity space. There is no eating or sleeping permitted in the garage. The licensee understands that licensing staff may have access to off-limit areas during inspection visits if necessary. Food is provided by Licensee. Individuals residing in the home have been discussed and noted. All adults present in the home have obtained a criminal record clearance or exemption. 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 LIC 999A Facility Sketch or equivalent sketch. Facility records were reviewed for LIC 9040- Facility Roster, LIC 610- Facility Disaster Plan and Disaster drill log, last drill conducted on 6/14/23.

SUPERVISOR'S NAME: Karen Chambers	TELEPHONE: (323) 981-3350
LICENSING EVALUATOR NAME: Elka Chavez	TELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:	DATE: 07/12/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/12/2023

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: ANDRADE & CRUZ FAMILY CHILD CARE	FACILITY NUMBER: 198018861
	VISIT DATE: 07/12/2023

NARRATIVE

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At 9:30 AM smoke and carbon monoxide detectors were tested and are operable in the dining room and attached garage. Fire extinguisher indicated fully charged and was serviced in December 2022. The home maintains telephone service via cell phone. The home is observed to be clean and orderly. There are toys and other age-appropriate material available for children. LPA observed that detergents and cleaning compounds are kept locked in the laundry room located in the garage. At 9:35 AM LPA observed medicines are kept in a top shelf in a pantry in the kitchen. LPA observed licensee move the medicines to a kitchen cabinet above the kitchen counter. Licensee understands that all poisons must be locked. Isolation area for sick children waiting to be picked up is in the living room, away from the other children. Per Licensee there are no firearms or weapons stored in the home.

Licensee cares for three infants. LPA observed play yards visible in the living room. Napping equipment does not block entrances or exits. LPA did not observe loose object, bumpers, objects hanging, or objects attached to the play yards. There are currently no infants with pacifiers. Per Licensee, overnight care is available upon request, but does not have any children enrolled for overnight care. 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.

Currently, children are using the front yard for outdoor play. The outdoor play area was observed to be fenced. LPA observed that the outdoor yard has toys and other materials for children to play with. There are no pools or spas, or other bodies of water. The licensee states that supervision is always provided.

Children’s records were reviewed for 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). At 11:40 AM LPA did not observe proof of immunizations for child #7 and child #8. LPA observed child #8 was missing LIC 9227- Infant sleep form. LPA observed child #2, child #5 and child #8 were missing sleep logs.

Staff records were reviewed for approved Pediatric First Aid and CPR certification, LIC 9052- Employee Rights, Proof of immunization against measles, pertussis and influenza or influenza declination, TB clearance or risk assessment, LIC 9108- Statement Acknowledging Requirement to Report Child Abuse and

SUPERVISOR'S NAME: Karen Chambers	TELEPHONE: (323) 981-3350
LICENSING EVALUATOR NAME: Elka Chavez	TELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:	DATE: 07/12/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/12/2023

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: ANDRADE & CRUZ FAMILY CHILD CARE	FACILITY NUMBER: 198018861
	VISIT DATE: 07/12/2023

NARRATIVE

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current Mandated Reporter Training Certificate. LPA did not observe proof of MMR/Tdap for staff #4. LPA observed staff #3 was assisting with children in care and did not observe proof of immunizations. LPA observed proof of Pediatric First Aid and CPR certification from National CPR Foundation. LPA did not observe Emergency Medical Services Authority (EMSA) stickers for staff #1, 3 and 4.

To improve the quality and value of the new inspection process, a survey may 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 CARE tools, please send email inquiries 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/inspection-process.

Licensee Claudia Andrade was reminded that all adults 18 and over living or working in the home, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, 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 for a maximum of 5 days or, if the penalty is for a repeat violation, for a maximum of 30 days per person will be assessed if this regulation is violated.

LPA discussed the safe sleep regulations with licensee Claudia Andrade and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-andresources/safe-sleep as an additional resource. LPA also informed licensee Claudia Andrade 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.

Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02CCP. 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: https://www.ada.gov/resources/child-care-centers/.

SUPERVISOR'S NAME: Karen Chambers	TELEPHONE: (323) 981-3350
LICENSING EVALUATOR NAME: Elka Chavez	TELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:	DATE: 07/12/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/12/2023

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: ANDRADE & CRUZ FAMILY CHILD CARE	FACILITY NUMBER: 198018861
	VISIT DATE: 07/12/2023

NARRATIVE

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Licensee Claudia Andrade, Licensee was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain child care by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.

Based on the LPA’s observations and records review, the following deficiencies listed on the attached LIC 809 (deficiency page) are being cited in accordance with California Code of Regulations Title 22. Deficiencies that are being cited need to be cleared to protect the children’s health & safety.

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

Exit interview conducted and report was reviewed with the licensee Claudia Andrade.

SUPERVISOR'S NAME: Karen Chambers	TELEPHONE: (323) 981-3350
LICENSING EVALUATOR NAME: Elka Chavez	TELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:	DATE: 07/12/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/12/2023

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 07/12/2023 02:13 PM - It Cannot Be Edited

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: ANDRADE & CRUZ FAMILY CHILD CARE	FACILITY NUMBER: 198018861
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 07/12/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

102416(c)

Personnel Requirements

(c) The licensee and other personnel as specified shall complete training on preventive health practices, including pediatric cardiopulmonary resuscitation and pediatric first aid, pursuant to Health and Safety Code Section 1596.866. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on record review, Pediatric First Aid and CPR certification from National CPR Foundation did not have Emergency Medical Services Authority (EMSA) stickers for staff #1, 3 and 4 which poses a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 08/11/2023
	Plan of Correction
1 2 3 4	Going forward licensee will make sure that training is EMSA approved or from the American Red Cross or Heart Association.

Type B

Section Cited

HSC

1597.622(a)(1)

General Provisions and Definitions

(1) 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. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on record review at 11:15 AM LPA did not observe proof of MMR/Tdap for staff #4 and daughter was assisting with children was missing proof of immunizations (mmr/tdap/tb/influenza) which poses a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 08/02/2023
	Plan of Correction
1 2 3 4	LIcensee stated that she will make sure that she obtains all records prior to working or assisting with children in care. Licensee stated that she will also create a folder.

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 Chambers	TELEPHONE: (323) 981-3350
LICENSING EVALUATOR NAME: Elka Chavez	TELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:	DATE: 07/12/2023

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/12/2023

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 07/12/2023 02:13 PM - It Cannot Be Edited

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: ANDRADE & CRUZ FAMILY CHILD CARE	FACILITY NUMBER: 198018861
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 07/12/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

102418(a)

Immunizations

(a) Prior to admission to a family day care home, children shall be immunized against diseases as required by the California Code of Regulations, Title 17, beginning with Section 6000. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on record review child #7 & #8 were missing proof of immunizations which poses a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 07/19/2023
	Plan of Correction
1 2 3 4	Licensee stated that she will make sure to put back back forms she removes from the childrens files.

Type B

Section Cited

CCR

102421(b)

Child's Records

(b) The licensee shall maintain, in each child's record, a copy of the emergency information card as required in Section 102417(g)(7). This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on record review child #8 was missing form LIC 700 which poses a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 07/19/2023
	Plan of Correction
1 2 3 4	Licensee stated that she will make sure to put back back forms she removes from the childrens files.

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 Chambers	TELEPHONE: (323) 981-3350
LICENSING EVALUATOR NAME: Elka Chavez	TELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:	DATE: 07/12/2023

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/12/2023

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 07/12/2023 02:13 PM - It Cannot Be Edited

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: ANDRADE & CRUZ FAMILY CHILD CARE	FACILITY NUMBER: 198018861
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 07/12/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

102417(g)(8)

Operation of A Family Child Care Home

(8) Each family child care home shall have a current roster of children as specified in Health and Safety Code Section 1596.841. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on record review child #8 was not listed in the roster which poses a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 07/19/2023
	Plan of Correction
1 2 3 4	Licensee stated that she will have the roster in place where she can remember to update it.

Type B

Section Cited

CCR

102425(c)(2)

Infant Safe Sleep

An Individual Infant Sleeping Plan [LIC 9227 (3/20)] shall be completed for each infant up to 12 months of age the provider has in care and included in the infant's file at the facility. The Individual Infant Sleeping Plan [LIC 9227 (3/20)] shall be maintained in the infant’s file and shall be available to the Department for review. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on record review child #8 was missing form LIC9227 which poses a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 07/19/2023
	Plan of Correction
1 2 3 4	LIcensee will make sure that children under 12 months receive form LIC 9227 during enrollment.

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 Chambers	TELEPHONE: (323) 981-3350
LICENSING EVALUATOR NAME: Elka Chavez	TELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:	DATE: 07/12/2023

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/12/2023

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 07/12/2023 02:13 PM - It Cannot Be Edited

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: ANDRADE & CRUZ FAMILY CHILD CARE	FACILITY NUMBER: 198018861
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 07/12/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

102425(j)(2)(D)

Infant Safe Sleep

Documentation shall be maintained in the infant’s file and be available to the Department for review. Documentation shall include the following: This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on record review child #2, child #5 and child #8 were missing sleep logs which poses a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 07/12/2023
	Plan of Correction
1 2 3 4	Licensee stated that she make sure to keep a log in children files.

Section Cited


	Deficient Practice Statement
1 2 3 4
	POC Due Date:
	Plan of Correction
1 2 3 4

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 Chambers	TELEPHONE: (323) 981-3350
LICENSING EVALUATOR NAME: Elka Chavez	TELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:	DATE: 07/12/2023

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/12/2023

LIC809 (FAS) - (06/04)

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