<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198020271
Report Date: 07/12/2019
Date Signed: 07/12/2019 02:47:33 PM

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:LAGUNA FAMILY CHILD CAREFACILITY NUMBER:
198020271
ADMINISTRATOR:EMILY H. LAGUNAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(213) 422-2176
CITY:PASADENASTATE: CAZIP CODE:
91103
CAPACITY:14CENSUS: 2DATE:
07/12/2019
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
01:30 PM
MET WITH:Emily LagunaTIME COMPLETED:
03:00 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) Ariel Cazares conducted an announced pre-licensing inspection today. LPA met with the Applicant Emily Laguna who guided analyst on a tour of the facility. Those residing in the home are 2 adults and 2 children, and 1 cat. Per applicant, operating hours will be Monday-Friday, 8:00-4:30pm. Applicant states they want to care for children 0-12 y/o.

All areas identified on the facility sketch were inspected. There are two homes on the property with separate addresses (968 & 988). This is a one story home which consists of 2 bedrooms, 3 restrooms, kitchen, family/living room, daycare room, frontyard and backyard (fenced), and detached garage. The home was inspected for safety, comfort, cleanliness, telephone service, heating and ventilation, inaccessibility to hazardours items. Accessible to daycare children: Daycare room, 1 adjacent restroom, the living room, and frontyard and backyard. Off limits/inaccessible to daycare children: 2 bedrooms, 2 restrooms, kitchen, and detached garage. Bedrooms will be kept locked.

Applicant completed the Preventative Health and Safety training on 01/10/19, CPR/1st Aid Certifications expire 02/2021, and mandated reporter training was completed on 04/23/19.
SUPERVISOR'S NAME: Claudia GuangorenaTELEPHONE: (323) 981-3417
LICENSING EVALUATOR NAME: Ariel AlmazanTELEPHONE: (323) 981-2949
LICENSING EVALUATOR SIGNATURE:

DATE: 07/12/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/12/2019
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: LAGUNA FAMILY CHILD CARE
FACILITY NUMBER: 198020271
VISIT DATE: 07/12/2019
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
LPA inspected the areas to be used by the daycare children. The daycare space will be accessed through a separate entrance at the side of the home. Upon entrance there is an area for required postings. The daycare room has its own restroom and no hazards were observed. There are toys and play equipment available. The living room will be used for additional activity space. There is a combination smoke/carbon monoxide detector in the living room that is in functioning order. There is a fire extinguisher located in the daycare room that is fully charged and was purchased on 3/12/19. The kitchen will be kept off limits via a safety gate. LPA did not observe any hazards in the kitchen. There are no fire arms or weapons in the home.

LPA inspected the outdoor spaces. The outdoor spaces will be accessed through the daycare room. Currently there is work being done in the yards that needs to be completed prior to use by children. Applicant will section off a part of the backyard that can be used freely by children that is free from any hazards. Applicant will submit photos. LPA did not observe any pools, spas, or other bodies of water.

The following was discussed with the applicant:
·Individuals who are 18 years of age or older living in the home must obtain a criminal record clearance. Individuals within one month of their 18th birthday must be fingerprinted immediately. Failure to obtain a criminal record background check clearances prior to initial presence in the home will result in an immediate $100.00 dollar or more per day Civil Penalty.
SUPERVISOR'S NAME: Claudia GuangorenaTELEPHONE: (323) 981-3417
LICENSING EVALUATOR NAME: Ariel AlmazanTELEPHONE: (323) 981-2949
LICENSING EVALUATOR SIGNATURE:

DATE: 07/12/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/12/2019
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: LAGUNA FAMILY CHILD CARE
FACILITY NUMBER: 198020271
VISIT DATE: 07/12/2019
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
During this visit, the LPA reviewed and issued Forms/Records to Keep in Your Family Child Care Home (LIC 311D) to the applicant. LPA reviewed Sudden Infant Death Syndrome (SIDS), Shaken Baby Syndrome, and safe sleep practices with licensee. *Infants should always sleep on their backs, mouths facing up, light bedding.* Safe sleep concepts were provided to applicant. LPA advised the applicant how to access forms, regulations and quarterly updates on the Child Care Licensing Website at: www.ccld.ca.gov

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



Per applicant, there are no other licenses held at this location. There is a fire clearance of file with the department. An exception is pending for the applicant to qualify for a large family child care home.

The following corrections must be completed prior to licensure and are due by 7/19/19:
1. Section off an area of outdoor space free from hazards.

Exit interview was conducted with the Applicant Emily Laguna and a copy of this report was provided.
SUPERVISOR'S NAME: Claudia GuangorenaTELEPHONE: (323) 981-3417
LICENSING EVALUATOR NAME: Ariel AlmazanTELEPHONE: (323) 981-2949
LICENSING EVALUATOR SIGNATURE:

DATE: 07/12/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/12/2019
LIC809 (FAS) - (06/04)
Page: 4 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: LAGUNA FAMILY CHILD CARE
FACILITY NUMBER: 198020271
VISIT DATE: 07/12/2019
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
·In the absence of the licensee a qualified adult must be present supervising the children; a qualified adult is an individual who has a valid and current adult/infant CPR & Pediatric First Aid certification, TB clearance, and a valid criminal record clearance associated to the facility license.
·A current roster of children enrolled must be available and maintained for a period of three years, even after children no longer are attending the facility.
·The fire extinguisher type 2A-10BC must be serviced annually or as often as necessary and smoke and carbon monoxide detectors should be checked and batteries replaced as needed.
·Changes should be reported to the Department as soon as they occur such as construction, remodeling, telephone number changes and/or if you move from your home.
·Reporting Requirements: Any unusual incidents or injuries must be reported to the Department within 24 hours via telephone and within seven (7) days in writing. Mandated reporter requirements was reviewed and explained.
·Fire and safety drills must be performed every six months and documented for review by the Department.
·Smoking is prohibited in a family child care home, 24/7.
·Children and Staff records must be maintained and updated as needed and must be available for review by the Department.
·No baby bouncers, No infant walkers, No Johnny jumpers, No saucer chairs, No trampolines and any other item that falls into that category are not permitted in the facility.
·All adults living and working in the home shall be made of aware of the Departments right to inspection authority.
·Liability insurance was discussed with applicant.
·Mandated reporter training must be taken every 2 years.
SUPERVISOR'S NAME: Claudia GuangorenaTELEPHONE: (323) 981-3417
LICENSING EVALUATOR NAME: Ariel AlmazanTELEPHONE: (323) 981-2949
LICENSING EVALUATOR SIGNATURE:

DATE: 07/12/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/12/2019
LIC809 (FAS) - (06/04)
Page: 3 of 4