198019339-5-10-2023-54-CC-JESA-CRPUNQ-20230510154421

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 198019339
Report Date: 05/10/2023
Date Signed: 05/10/2023 03:44:50 PM

Document Has Been Signed on 05/10/2023 03:44 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:	SANTOS FAMILY CHILD CARE		FACILITY NUMBER:	198019339
ADMINISTRATOR:	BENILDA SANTOS		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(562) 453-6149
CITY:	NORWALK	STATE: CA	ZIP CODE:	90650
CAPACITY:	14	CENSUS: 7	DATE:	05/10/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	11:55 AM
MET WITH:	Licensee Benilda Santos		TIME COMPLETED:	03:55 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	On 5/10/23 Licensing Program Analyst (LPA) Jeanette Estrada conducted an unannounced required 1 year inspection at the above facility. LPA met with the Licensee Benilda Santos. LPA informed Licensee of the purpose for the visit and provided Licensee with 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 12 years old The facility is open Monday to Friday 4:30 AM to 5:30PM . Upon arrival there were 7 children present with the Licensee and two staff present. Criminal record clearances were verified. The facility was in compliance with capacity requirements for a Large Family Child Care Home. This is a one story, 3 bedroom, 1 bathroom home with a living room, kitchen, day care area, dining room, enclosed backyard and front yard and garage. Per Licensee areas on limits to children are: two bedrooms used for napping, living room, day care area off of the living room, bathroom in the hallway, dining room, enclosed backyard and gated front yard Per Licensee areas off limits to children are: One bedroom, garage and kitchen. 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. Facility license, Publication (PUB) 394- Notification of Parent Rights. LPA observed a current facility roster and a disaster drill log. Last documented drill was conducted on 2/20/23. There is an operable carbon monoxide detector and an operable smoke detector located in the hallway next to the kitchen. LPA observed a 2A10BC Fire Extinguisher in the facility which indicated full but did not have a service tag. Per Licensee Fire extinguisher was purchased within a year but did not provide proof of purchase. The home maintains telephone service (cell phone). 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.

SUPERVISOR'S NAME: Valarie Cook	TELEPHONE: (323) 513-3828
LICENSING EVALUATOR NAME: Jeanette Estrada	TELEPHONE: (323) 229-6521
LICENSING EVALUATOR SIGNATURE:	DATE: 05/10/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/10/2023

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 11

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: SANTOS FAMILY CHILD CARE	FACILITY NUMBER: 198019339
	VISIT DATE: 05/10/2023

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
26
27
28
29
30
31
32

Page 2
There are toys and other age appropriate materials available for children in the day care area and the living room. Sharp objects, detergents and cleaning compounds are inaccessible. Knives and cleaning products are kept in the off limits kitchen. LPA observed a safety gate blocking access to the kitchen. Per Licensee, at this time, there are no children who require medication and personal medication is kept inaccessible to children in a bedroom .Heating and ventilation was evaluated. LPA observed a wall heater in the home. Wall heater was confirmed to be inoperable by a service tag from the Gas company. LPA did not observe any fire places in the home. LPA observed ceiling fans and a/c wall units for ventilation. Per Licensee, children nap in the living room. LPA observed napping mats available for children.
The children use the restroom next to the kitchen. LPA observed cleaning products in a latched cabinet under the sink. Per Licensee, children use the backyard and front yard for outdoor play. LPA observed age appropriate toys for available for children. Per Licensee, Children are supervised while playing outside. Per Licensee, there are no poisons kept in the home. Licensee were 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 Licensee, there are no firearms or weapons stored in the home. LPA did not observe any pools or spas, or other bodies of water. Per Licensee, there are two pet dogs in the home and they are kept away from children.
Infant Care: Currently there are 2 infants over 12 months enrolled. LPA observed 1 play yard in one on limits room and 2 cribs in the second on limits 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. Currently Licensee keeps a sleeping log for one infant due to there only being one infant that naps. Licensee was advised to keep a sleeping log for child 2 when they do nap.
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.

SUPERVISOR'S NAME: Valarie Cook	TELEPHONE: (323) 513-3828
LICENSING EVALUATOR NAME: Jeanette Estrada	TELEPHONE: (323) 229-6521
LICENSING EVALUATOR SIGNATURE:	DATE: 05/10/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/10/2023

LIC809 (FAS) - (06/04)

Page: 3 of 11

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: SANTOS FAMILY CHILD CARE	FACILITY NUMBER: 198019339
	VISIT DATE: 05/10/2023

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
26
27
28
29
30
31
32

Page 3 of report
Children's records were reviewed. Children's records were not complete. Licensee was advised children's records shall contain: (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. Licensee was advised all licensing forms shall be completely filled out and signed.
Staff records were reviewed: Licensee and both assistants did not have proof of immunization (measles, pertussis, flu) or proof of TB clearance. Licensee's mandated reporter training was completed on 10/13/22. Staff 1's mandated reporter training was completed on 11/27/22 and Staff 2's mandated reporter training was completed on 10/13/22. Licensee and staff did not have an approved pediatric first aid/ child cpr certificate. The certificate they all currently have is not EMSA certified or issued by the American Red Cross. Certificates for Staff 1 and 2 were completed within the last two years. Licensee was advised an approved course with a certificate issued by the American red cross or the American Heart Association or an EMSA approved course certificate will be required.
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.

SUPERVISOR'S NAME: Valarie Cook	TELEPHONE: (323) 513-3828
LICENSING EVALUATOR NAME: Jeanette Estrada	TELEPHONE: (323) 229-6521
LICENSING EVALUATOR SIGNATURE:	DATE: 05/10/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/10/2023

LIC809 (FAS) - (06/04)

Page: 4 of 11

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: SANTOS FAMILY CHILD CARE	FACILITY NUMBER: 198019339
	VISIT DATE: 05/10/2023

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
26
27
28
29
30
31
32

Page 4
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 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.
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.

The deficiencies listed on the following pages were observed by the LPA and are being cited in accordance with California Code of Regulations Title 22. Four type B deficiencies are being issued today. Please see attached LIC 809-Ds for citations. Deficiencies that are being cited need to be cleared to protect the children’s health & safety.

Exit interview conducted and report was reviewed with Licensee Benilda Santos. A notice of site visit was given and must remain posted for 30 days.

SUPERVISOR'S NAME: Valarie Cook	TELEPHONE: (323) 513-3828
LICENSING EVALUATOR NAME: Jeanette Estrada	TELEPHONE: (323) 229-6521
LICENSING EVALUATOR SIGNATURE:	DATE: 05/10/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/10/2023

LIC809 (FAS) - (06/04)

Page: 2 of 11

Document Has Been Signed on 05/10/2023 03:44 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: SANTOS FAMILY CHILD CARE	FACILITY NUMBER: 198019339
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 05/10/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

102417(g)(1)

Operation of A Family Child Care Home

(g) The home shall be free from defects or conditions which might endanger a child. Safety precautions shall include but not limited to: (1) Fireplaces and open face heaters shall be screened to prevent access by children. The home shall contain a fire extinguisher and smoke detector device which meet standards established by the State Fire Marshall. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation, the licensee did not comply with the section cited above in 1 out of 1 fire extinguisher observed in the facility which did not have a service tag which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 05/15/2023
	Plan of Correction
1 2 3 4	Per Licensee, fire extinguisher was purchased in 2022 but could not provide proof of purchase. Licensee will provide proof of purchase to LPA by due date.

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 iobservation and interview, the licensee did not comply with the section cited above in 3 out of 3 staff records which did not contain approved certification for pediatric first aid/child cpr which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 05/31/2023
	Plan of Correction
1 2 3 4	Licensee and staff will complete a EMSA approved pediatric first aid/cpr course or a course by the American Red Cross or American Heart Association. LPA advised Licensee that certificates must either contain the EMSA approved stickers or must be issued by the American red cross or American Heart Association. Licensee will submit proof of approved certificate to LPA via picture by due date.

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: Valarie Cook	TELEPHONE: (323) 513-3828
LICENSING EVALUATOR NAME: Jeanette Estrada	TELEPHONE: (323) 229-6521
LICENSING EVALUATOR SIGNATURE:	DATE: 05/10/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/10/2023

LIC809 (FAS) - (06/04)

Page: 5 of 11

Document Has Been Signed on 05/10/2023 03:44 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: SANTOS FAMILY CHILD CARE	FACILITY NUMBER: 198019339
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 05/10/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)

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 interview, the licensee did not comply with the section cited above in 3 out of 3 staff who did not have proof of the required immunization record which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 06/12/2023
	Plan of Correction
1 2 3 4	Licensee will obtain proof of the required immunization record for measles(MMR), Pertussis (TDAP) and flu (or submit a written flu declination) for herself and the assistants present. Licensee will submit records to LPA via mail by due date.

Type B

Section Cited

CCR

102417(g)(7)

Operation of A Family Child Care Home

(7) An emergency information card shall be maintained for each child and shall include the child's full name, telephone number and location of a parent or other responsible adult to be contacted in an emergency, the name and telephone number of the child's physician and the parent's authorization for the licensee or registrant to consent to emergency medical care. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on record review the licensee did not comply with the section cited above in 5 out of 5 children's records reviewed which did not contain form LIC 700 or the required information which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 06/12/2023
	Plan of Correction
1 2 3 4	Licensee will provide proof of complete records via picture by due date.

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: Valarie Cook	TELEPHONE: (323) 513-3828
LICENSING EVALUATOR NAME: Jeanette Estrada	TELEPHONE: (323) 229-6521
LICENSING EVALUATOR SIGNATURE:	DATE: 05/10/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/10/2023

LIC809 (FAS) - (06/04)

Page: 6 of 11