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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198019362
Report Date: 04/18/2023
Date Signed: 04/18/2023 12:22:38 PM


Document Has Been Signed on 04/18/2023 12:22 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:JIMENEZ FAMILY CHILD CAREFACILITY NUMBER:
198019362
ADMINISTRATOR:ADRIANA JIMENEZFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(562) 704-5820
CITY:NORWALKSTATE: CAZIP CODE:
90650
CAPACITY:14CENSUS: 1DATE:
04/18/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:15 AM
MET WITH:Licensee Adriana Jimenez TIME COMPLETED:
12:30 PM
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On 4/18/23 Licensing Program Analyst (LPA) Jeanette Estrada conducted an unannounced required 1 year inspection at the above facility. LPA met with the Licensee Adriana Jimenez and informed her of the purpose for the visit. LPA provided the Facility Entrance Checklist to the Licensee. All residents were discussed. Facility provides care to children ages 0 to 11 years old. Facility is open Monday to Thursday 6AM to 4:00AM. There was one child present during the inspection.
This is a one story, 3 bedroom, 2 bathroom home with a living room, kitchen, enclosed backyard, attached garage.
Per Licensee areas on limits to children are: living room, kitchen, hallway bathroom, two bedrooms and the backyard.
Per Licensee areas off limits to children are: Garage, one bedroom and one bathroom (inside off limits bedroom) and the dog run in the backyard.
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 LIC 9040 and a disaster drill log. Last documented drill was conducted on 1/30/23. There is an operable carbon monoxide detector and an operable smoke detector in the facility. LPA observed a 2A10BC Fire Extinguisher in the living room which indicated full and was last serviced in August 2022 per the service tag. 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.
There are toys and other age appropriate materials available for children in one of the on limit bedrooms. The second bedroom is open for napping. Sharp objects, detergents and cleaning compounds were inaccessible. Knives are kept in an upper kitchen cabinet, cleaning compounds are kept above the refrigerator, personal medicines are kept in a locked cabinet in the hallway. Heating and ventilation was evaluated. The home has central air and heating.
SUPERVISOR'S NAME: Valarie CookTELEPHONE: (323) 513-3828
LICENSING EVALUATOR NAME: Jeanette EstradaTELEPHONE: (323) 229-6521
LICENSING EVALUATOR SIGNATURE:
DATE: 04/18/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/18/2023
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: JIMENEZ FAMILY CHILD CARE
FACILITY NUMBER: 198019362
VISIT DATE: 04/18/2023
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There is an electric fireplace in the living room. Per Licensee, the electric fireplace is disconnected. The children use the restroom in the hallway. LPA observed personal hygiene items in the restroom. LPA did not observe cleaning products or medicine in the restroom. Per the Licensee, the kitchen is on limits in passing and for meals. There is a safety gate separating the kitchen and the living room. Per Licensee, children use the backyard for outdoor play. There is a dog run area in the backyard. Per Licensee, dogs are contained in the dog run when children are outside. Per Licensee, Children are supervised while playing outside. Per Licensee, there are no poisons in the home. Licensee understands 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 or in one of the bedrooms, 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.
Infant Care: Currently licensee has one infant in the facility. LPA discussed the following with Licensee: Napping equipment shall not block entrances or exits. There shall be no loose objects in the crib or hanging off the sides of the crib. 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.
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 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
Staff records were reviewed: Licensee's Pediatric CPR/First Aid issued by the American Heart Association expires in May 2023. Licensee's Mandated Reporter training was completed on 9/7/2022. Licensee was advised of documentation required for staff.
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
SUPERVISOR'S NAME: Valarie CookTELEPHONE: (323) 513-3828
LICENSING EVALUATOR NAME: Jeanette EstradaTELEPHONE: (323) 229-6521
LICENSING EVALUATOR SIGNATURE:

DATE: 04/18/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/18/2023
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: JIMENEZ FAMILY CHILD CARE
FACILITY NUMBER: 198019362
VISIT DATE: 04/18/2023
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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.

Based on the LPA's observations and records review no deficiencies will be cited today 4/18/23.


Exit interview conducted and report was reviewed with the Licensee, Adriana Jimenez . A notice of site visit was given and must remain posted for 30 days.
SUPERVISOR'S NAME: Valarie CookTELEPHONE: (323) 513-3828
LICENSING EVALUATOR NAME: Jeanette EstradaTELEPHONE: (323) 229-6521
LICENSING EVALUATOR SIGNATURE:

DATE: 04/18/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/18/2023
LIC809 (FAS) - (06/04)
Page: 3 of 4