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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198020076
Report Date: 01/28/2020
Date Signed: 01/28/2020 10:48:42 AM

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 CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME:DIAZ FAMILY CHILD CAREFACILITY NUMBER:
198020076
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY:8CENSUS: 4DATE:
01/28/2020
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
09:10 AM
MET WITH:Maria Elena DiazTIME COMPLETED:
11:00 AM
NARRATIVE
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Licensing Program Analysts (LPAs) Ariel Cazares and Katrina Chicote conducted an unannounced annual random site inspection to the home. Upon arrival, LPA met with Licensee Maria Elena Diaz and toured the facility. Inspection was conduced in Spanish. There were 3 children present, 1 arrived later. Individuals residing in the home are the licensee and adult child. Licensee’s operating hours are Monday-Friday 6am-7pm.

The home is a one story, 3-Bed, 2-Bath home. The following areas are used for day-care: Living room and dining room area, kitchen, 1 bedroom, 1 restroom, the converted garage and back yard. Off limit areas include: 2 bedrooms, 1 bathroom, laundry room, and front driveway. Licensee has the required postings posted on wall in the garage/activity space. First Aid/CPR certificate are valid through 9/21/2021 for the licensee. Licensee's disaster drill log notes last drill conducted on 01/6/2020. Licensee has a working telephone.

LPAs inspected all areas used by the daycare children. Fire extinguisher located near the kitchen was last purchased on 11/26/18 and is due for a service or repurchase. There is an operational smoke detector/carbon monoxide combination detector in the living room that was tested. The home has electrical outlet covers throughout and maintains a First Aid Kit. There are adequate age appropriate toys, books, and games. The napping room was observed to have appropriate napping equipment such as cots and no hazards were observed. The garage is located adjacent to the nap room, separated by a door.The garage has been converted into an activity space. There is a fire clearance on file. Licensee was advised that the space can only be used for activities not including eating, sleeping, or toileting.There are no firearms present on the premises as stated by licensee.

LPAs inspected the backyard used by children. LPAs observed a water fountain/fish pond in the backyard on top of the grassy area that is propped up from floor level, but is not fenced or covered to prevent access by children. Per licensee, the children do not climb the grassy area and she maintains supervision. LPA informed licensee that the fountain, although not easily accessible, would need to meet fencing requirements. There are birds in and outside the home kept in bird cages.

SUPERVISOR'S NAME: Ana ChicoTELEPHONE: (323) 981-3374
LICENSING EVALUATOR NAME: Ariel CazaresTELEPHONE: (323) 981-2949
LICENSING EVALUATOR SIGNATURE:

DATE: 01/28/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/28/2020
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 4
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 CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME: DIAZ FAMILY CHILD CARE
FACILITY NUMBER: 198020076
VISIT DATE: 01/28/2020
NARRATIVE
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Children's roster and files were readily available and complete. Staff #1's file was reviewed. Staff is missing proof of measles and influenza vaccine or declining statement.

The following were discussed: Individuals who are 18 years of age or older living in the home must be finger print cleared prior to being in the presence of the children in care. Individuals within one month of their 18th birthday must be fingerprinted immediately. No smoking, No infant walkers, No baby bouncers, No Johnny jumpers, No exersaucers and any other item that falls into that category. LPA discussed disaster drills, posting requirements, children records requirements, mandated child abuse and injury/death reporting.

· LPA reviewed LIC 311D with licensee, reminding her of required forms. LPA reviewed SIDs, Never Shake A Baby, and safe sleeping practices. Infants should sleep mouth up, on their backs, free of clutter surrounding their sleeping space. Safe Sleep Concepts were provided.
· 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
· A qualified Assistant must be present and actively involved in caring for children whenever nine (9) or more children are present at the facility in a large family child care home.
· LPA advised the Licensee to access forms and regulations on line at: www.ccld.ca.gov

Deficiencies were cited in accordance with California Code of Regulations Title 22. See 809-D. A request for a capacity increase was made by the licensee. A capacity increase for a license of 14 may be granted pending corrections to the deficiencies cited. There is a current fire clearance on file.

Exit interview was conducted with Licensee Maria Elena Diaz. A copy of this report and appeal rights were provided and explained. The Notice of Site Visit (LIC 9213) – must remain posted for 30 days during the hours of operation after each site visit by a licensing representative. Failure to maintain posting as required will result in a civil penalty of $100.00.
SUPERVISOR'S NAME: Ana ChicoTELEPHONE: (323) 981-3374
LICENSING EVALUATOR NAME: Ariel CazaresTELEPHONE: (323) 981-2949
LICENSING EVALUATOR SIGNATURE:

DATE: 01/28/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/28/2020
LIC809 (FAS) - (06/04)
Page: 2 of 4
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 CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME: DIAZ FAMILY CHILD CARE
FACILITY NUMBER: 198020076
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/28/2020
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
01/30/2020
Section Cited

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All licensees shall ensure the inaccessibility of pools (in-ground and above-ground), fixed-in-place wading pools, hot tubs, spas, fish ponds and similar bodies of water through a pool cover or by surrounding the pool with a fence.
This requirement has not been met as evidenced by LPAs observation of a water
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fountain/fish pond in the backyard. This poses a potential risk to the health and safety of children in care.
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Type B
01/31/2020
Section Cited

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The home shall contain a fire extinguisher and smoke detector device which meet standards established by the State Fire Marshal.

This requirement has not been met as evidenced by fire extinguisher not being serviced since purchase date of 11/26/18
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as noted on purchase receipt. This poses a potential risk to the health and safety of children.
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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: Ana ChicoTELEPHONE: (323) 981-3374
LICENSING EVALUATOR NAME: Ariel CazaresTELEPHONE: (323) 981-2949
LICENSING EVALUATOR SIGNATURE:
DATE: 01/28/2020
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/28/2020
LIC809 (FAS) - (06/04)
Page: 3 of 4
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 CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME: DIAZ FAMILY CHILD CARE
FACILITY NUMBER: 198020076
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/28/2020
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
02/04/2020
Section Cited

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The family day care home shall maintain documentation of the required immunizations or exemptions from immunization, as set forth in this section, in the person’s personnel record that is maintained by the family day care home.
This requirement has not been met as evidenced by review of staff #1's file.
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Staff did not have proof of measles and influenza vaccine on file. This poses a potential risk to the health and safety of children in care.
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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: Ana ChicoTELEPHONE: (323) 981-3374
LICENSING EVALUATOR NAME: Ariel CazaresTELEPHONE: (323) 981-2949
LICENSING EVALUATOR SIGNATURE:
DATE: 01/28/2020
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/28/2020
LIC809 (FAS) - (06/04)
Page: 4 of 4