198020556-4-22-2020-33-CC-TRAO-BNWLQ3-20200422085651

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 198020556
Report Date: 04/21/2020
Date Signed: 04/22/2020 08:57:07 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:	CAMPOS ARTZINIEGA FAMILY CHILD CARE		FACILITY NUMBER:	198020556
ADMINISTRATOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY:	8	CENSUS: 0	DATE:	04/21/2020
TYPE OF VISIT:	Prelicensing	ANNOUNCED	TIME BEGAN:	11:00 AM
MET WITH:	Maite Campos Artziniega, Applicant		TIME COMPLETED:	11:40 AM

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 4/21/2020 at 11AM, Licensing Program Analyst (LPA) Thelma Razo and Licensing Program Manager (LPM) Ana Chico conducted an announced Pre-licensing inspection for a change of location. Applicant was previously licensed at 117 N. Verdugo Road, Glendale, CA 91206 under License #198018935. Inspection was made via FaceTime due to COVID-19 and as precautionary measures. LPA and LPM met with Maite Campos Artziniega, Applicant, who guided the virtual tour of the facility. Family members residing in the home are 3 adults and 1 child (applicant, spouse, brother and son). The applicant is requesting for a small family child care home with a capacity of 8. Per applicant, hours of operation will be Monday through Sunday. Applicant states she will care for children 3 months to 10 years old. A fire clearance is not required for small family child home. All areas identified on the facility sketch were inspected. This is a one-story home which consists of 2 bedrooms, 1 common bathroom, living room, dining room, kitchen, laundry area, backyard, and garage. Areas that are accessible to children are as follows: Living room, bathroom, and backyard. Per applicant, children will enter the facility through the main entrance door. Children can go straight to the bathroom without passing the off-limit areas. All cabinets and drawers in the kitchen have safety latches. Areas off limits based on facility sketch submitted to children and parents include: 2 bedrooms, kitchen, dining room and laundry area. **Rooms that are off-limits need to be made inaccessible during operating hours** Per applicant children will use the backyard for outdoor activity. Children will walk through the laundry area to go to the playarea. Children will be supervised at all times. The applicant does understand that licensing staff may have access to off-limit areas during inspection visit if necessary. Page 1 of 4 – Report continues next page

SUPERVISOR'S NAME: Ana Chico	TELEPHONE: (323) 513-3793
LICENSING EVALUATOR NAME: Thelma Razo	TELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:	DATE: 04/21/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/21/2020

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: CAMPOS ARTZINIEGA FAMILY CHILD CARE	FACILITY NUMBER: 198020556
	VISIT DATE: 04/21/2020

NARRATIVE

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Areas that will be used by children were inspected for safety, comfort, cleanliness, telephone service, ventilation and heating. Detergents, cleaning compounds, medicines, sharp objects and hazardous items that can pose a danger to children are inaccessible. The applicant states that there is no poison in the home, but does understand that if any poison is purchased, it is required to be locked with a key or combination lock. Applicant was advised that if food is brought from the children’s homes, all containers must be labeled with child’s name and properly stored or refrigerated.

Per applicant, there are no firearms, weapons, and bodies of water on the premises. There are toys available for children. The valve on the required 2A 10BC fire extinguisher is fully charged. Smoke detector was tested and is operable. During this inspection Carbon monoxide detector was also tested and is working.
Applicant has proof of CPR and pediatric First Aid training as indicated on the certificate. The applicant completed Health and Safety training on 2/28/2016, Pediatric First Aid and CPR expires on 3/16/2022. There are emergency supplies on the premises.

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. Once licensed, licensee must adhere to the following:
-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, immunization, 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 are no longer attending the facility.
-Annual fees must be paid promptly by the due date or a late fee shall be assessed and/or the License shall be terminated.
-The fire extinguisher type 2A-10BC must be serviced annually and smoke and carbon monoxide detectors should be checked, and batteries replaced as needed.

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SUPERVISOR'S NAME: Ana Chico	TELEPHONE: (323) 513-3793
LICENSING EVALUATOR NAME: Thelma Razo	TELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:	DATE: 04/21/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/21/2020

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: CAMPOS ARTZINIEGA FAMILY CHILD CARE	FACILITY NUMBER: 198020556
	VISIT DATE: 04/21/2020

NARRATIVE

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-Changes should be reported to the Department as soon as they occur such as construction, remodeling, telephone number changes and/or if moved out from home.
-Any unusual incidents or injuries must be reported to the Department within 24 business hour via telephone and within seven (7) days in writing. (use LIC624B for written report)
-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.
-Children and Staff records must be maintained and updated as needed and must be available for review by the Department.
-Dog(s) and or pets are recommended to be isolated from children in care.
- No smoking, 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 Department’s inspection authority, which includes but not limited to the right to enter the home when children are being cared for, interview children and adults and review documentation.
- Applicant shall reveal each facility license number in all advertisements, publications or announcements with the intent to attract clients.
- Emergency Disaster Plan, Parent’s Rights Poster and the Facility License are required to be posted.
- Lead poisoning information.
Infant Care: Applicant states that she will care for infants. LPA advised applicant that infants who are sleeping should be provided with direct supervision at all times and should not be placed in a separate room. LPA reviewed Sudden Infant Death Syndrome (SIDS), Never Shake A Baby, and safe sleeping practices. Infants should sleep mouth up, on their backs, free of clutter surrounding their sleeping space. Handouts will be provided via email. Applicant states that all children will be napping in the living room on cots.

Medication: 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.

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SUPERVISOR'S NAME: Ana Chico	TELEPHONE: (323) 513-3793
LICENSING EVALUATOR NAME: Thelma Razo	TELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:	DATE: 04/21/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/21/2020

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: CAMPOS ARTZINIEGA FAMILY CHILD CARE	FACILITY NUMBER: 198020556
	VISIT DATE: 04/21/2020

NARRATIVE

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Per applicant, there are no dual licenses at this address. Applicant’s email address was obtained during this inspection. The applicant was advised that email may be public information. Per applicant, she does not carry liability insurance or a bond in accordance with standard established by Family Child Care statue. Signed statements (LIC282) will be on children’s files. The law requires Family Child Care provider to carry liability insurance or bond in the amount of $300,000 annually or to maintain the signed statement in the facility file.
Applicant has completed the required mandated reporter training online on 01/15/2020. Mandated reporter training must be completed every 2 years. www.mandatedreporterca.com

Licensing forms, regulations and quarterly updates, and Provider Information Notices (PIN) can be accessed on the Child Care Licensing website at w ww.ccld.ca.gov or CDSS apps can be downloaded to mobile phone. LPA reviewed Forms/Records to Keep in Your Family Child Care Home (LIC 311D) with the applicant and will provide a copy via email. LPA discussed Child Abuse Reporting, Updated Parent’s Rights Poster with Complaint Hotline information.

Exit interview was conducted with Applicant 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 via email with a read receipt or confirmation of receipt of email which will act as the Applicant’s signature. A copy of this report and all other Licensing reports must be made available to the public for 3 years. Once licensed, the applicant is required to adhere to the terms and limitations stated on the license.

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SUPERVISOR'S NAME: Ana Chico	TELEPHONE: (323) 513-3793
LICENSING EVALUATOR NAME: Thelma Razo	TELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:	DATE: 04/21/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/21/2020

LIC809 (FAS) - (06/04)

Page: 4 of 4