198020463-6-2-2020-33-CC-ACAS-BQ7SWJ-20200602141426

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 198020463
Report Date: 06/02/2020
Date Signed: 06/02/2020 02:15:05 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:	MATA & HERNANDEZ FAMILY CHILD CARE		FACILITY NUMBER:	198020463
ADMINISTRATOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY:	8	CENSUS: 3	DATE:	06/02/2020
TYPE OF VISIT:	Case Management - Licensee Initiated	UNANNOUNCED	TIME BEGAN:	01:30 PM
MET WITH:	Merlyn Mata		TIME COMPLETED:	02:05 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	This was a case management inspection conducted by Licensing Program Analyst (LPA) Ariel Cazares due to COVID-19 and precautionary measures. This case management inspection was conducted with Licensee Merlyn Mata in Spanish via Zoom to address a request for a capacity increase to a Large FCCH license. This is a home that consists of 2 bedrooms, 1 ½ restrooms, kitchen, living room, dining room, laundry room, front yard (fenced), and parking garage in the back of home. Family members residing in the home are 2 adults and 1 minor child. Per licensee operating hours will be Monday – Friday from 6:30am- 7:00pm. The licensee is caring for children 0-12 years of age. LPA inquired about firearms, which licensee stated she does not have any in the home. LPA inquired about pets, which licensee stated she does not own in the home. During this tele-inspection the Licensee took this LPA on a tour of the home. At 1:33 pm, LPA was toured through the interior starting with the living room where 3 children were observed napping. Licensee confirmed that only 3 children were in care. LPA was toured through the dining room and the children's restroom. LPA did not observe accessible hazards. Licensee showed LPA the cabinet in the restroom is secured. Licensee showed LPA the kitchen which is kept off-limits via a safety gate. There is also a safety gate at the entrance to the hallway that keeps the bedrooms, 1 restroom, and the exit to the parking area off limits. Children only have access to the living room, dining room, and 1 restroom. At 1:37pm, LPA was toured through the front yard where children are received during drop off and where they play. The yard is fenced and no accessible/immediate hazards were observed.

SUPERVISOR'S NAME: Ana Chico	TELEPHONE: (323) 981-3374
LICENSING EVALUATOR NAME: Ariel Cazares	TELEPHONE: (323) 981-2949
LICENSING EVALUATOR SIGNATURE:	DATE: 06/02/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/02/2020

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 CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME: MATA & HERNANDEZ FAMILY CHILD CARE	FACILITY NUMBER: 198020463
	VISIT DATE: 06/02/2020

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At 1:38pm, the tour resumed indoors where licensee showed LPA the fire extinguisher serviced 10/19/2019, as read by licensee from the service tag. Licensee also tested the carbon monoxide and smoke detectors in the home. Both sounded off the alarms and heard by LPA to be functional. The licensee also showed the LPA the outdoor area from the back of the home. This is where the parking garage is located. Per licensee she does not allow children in the back.

Application and file have been reviewed and are complete. There is a fire clearance on file. The home has no need for corrections at this time based on the inspection conducted. LPA inquired into the licensees practices related to COVID-19. Licensee stated that she practices hygiene such as hand washing with the children. Licensee has hand sanitizer available in the drop off area and inside her home. Licensee states she practices social distancing with children, but does keep siblings together. Licensee stated she removed toys such as stuffed animals or cloth like toys and kept toys that can be easily cleaned.

Exit interview was conducted with Licensee Merlyn Mata, via tele-inspection, during which appeal rights were explained. This report along with a copy of the appeal rights will be sent to the Applicant/Licensee via email with a read receipt or confirmation of receipt of email, which will act as the Applicants/Licensee’s signature.

SUPERVISOR'S NAME: Ana Chico	TELEPHONE: (323) 981-3374
LICENSING EVALUATOR NAME: Ariel Cazares	TELEPHONE: (323) 981-2949
LICENSING EVALUATOR SIGNATURE:	DATE: 06/02/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/02/2020

LIC809 (FAS) - (06/04)

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