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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198020612
Report Date: 10/12/2020
Date Signed: 10/12/2020 05:11:23 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:MEDINA & CAMARENA FAMILY CHILD CAREFACILITY NUMBER:
198020612
ADMINISTRATOR:MEDINA, M/CAMARENA, FELIPEFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(626) 392-0726
CITY:EL MONTESTATE: CAZIP CODE:
91732
CAPACITY:14CENSUS: 0DATE:
10/12/2020
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
02:54 PM
MET WITH:Maria V. Medina, Applicant/LicenseeTIME COMPLETED:
03:56 PM
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A PRE-LICENSING INSPECTION CONDUCTED IN SPANISH
This was an announced pre-licensing inspection to evaluate facility for a Family Child Care Home relocation conducted by Licensing Program Analyst (LPA) Mireya García. Due to COVID-19 and precautionary measures, this pre-licensing inspection was conducted with Applicant/Licensee Maria V. Medina, via a tele-inspection by use of WhatsApp video call. Applicant/Licensee was previously licensed for Medina Family Child Care Home (LIC#198018523) at 3523 Maxon Road El Monte, CA 91732.
LPA confirmed with Applicant/Licensee those residing in the home consists of herself and 3 other adults, who all have obtained criminal record clearance. There are no children residing in the home. The Applicant/Licensee will operate from Monday through Friday, from 4:00 a.m., to 5:30 p.m. Ages to care for will be from 0 months - 12 years old.

During this tele-inspection the Applicant/Licensee took this LPA on a tour of the home. During this tour, the following was noted: At 2:55 p.m., LPA was toured through the interior of the home. This is a one story home which consists of front porch, four (4) bedrooms (three (3) are located in the home and one (1) is located in the detached garage area), three (3) restrooms (two (2) restrooms are located inside the home and one (1) is located in the detached garage area), living room (daycare space), dining room, kitchen, garage (detached locked by key), Gym room (detached locked by key located outside in the back yard area), outdoor steel storage shed (locked with pad lock), frontyard (fenced), and backyard (fenced). LPA did not observe any hazards inside of the home. LPA asked to be shown the electrical outlets in the areas used by the children and observed to be covered. Detergents, cleaning compounds, medicines, sharp objects and hazardous items that can pose a danger to children are inaccessible in areas designated for children. The Applicant/Licensee states that poisons are locked by key in the garage. The Applicant/Licensee was advised that any poisons must be locked with a key or combination lock. LPA also observed appropriate equipment, toys, and games for children. LPA observed the kitchen blocked off with a safety gate.
REPORT CONTINUES ON NEXT PAGE - 1 of 4
SUPERVISOR'S NAME: Valarie CookTELEPHONE: (323) 981-3362
LICENSING EVALUATOR NAME: Mireya GarciaTELEPHONE: (323) 558-2192
LICENSING EVALUATOR SIGNATURE:

DATE: 10/12/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/12/2020
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: MEDINA & CAMARENA FAMILY CHILD CARE
FACILITY NUMBER: 198020612
VISIT DATE: 10/12/2020
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The value on the 2A10BC fire extinguisher indicates fully charged, as indicated on receipt of purchased dated on 03/09/2020. There is a first aid kit located in the living room. There are smoke detectors throughout the home and a carbon monoxide detector in the living room which Applicant/Licensee tested; LPA heard the alarm and found them to be operational. At 3:20 p.m., LPA was toured through the exterior of the home. The backyard will be used for daycare space. Backyard is adequately fenced. Per Applicant/Licensee, there are no pets, firearms, weapons or bodies of water on the premises. There are age appropriate toys and play equipment on site.

All areas identified on the facility sketch were inspected. Areas that are accessible to daycare children are: front porch, living room (daycare space), dining room, one (1) restroom (located inside the home), and backyard (fenced). Based on the Facility Sketch submitted, areas off limits to children and parents are: Four (4) bedrooms, two (2) restrooms (one located inside the home and the other located in the detached garage area), kitchen, garage (detached), gym room (detached), outdoor steel storage shed (locked with pad lock), frontyard (fenced) and the sides portion of the home to remain off limits to children.
**Rooms that are off-limits need to be made inaccessible during operating hours** The Applicant/Licensee does understand that licensing staff may have access to off-limit areas during inspection visit if necessary.

The following was discussed with the Applicant/Licensee:
· 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.
· 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.
REPORT CONTINUES ON NEXT PAGE - 2 of 4
SUPERVISOR'S NAME: Valarie CookTELEPHONE: (323) 981-3362
LICENSING EVALUATOR NAME: Mireya GarciaTELEPHONE: (323) 558-2192
LICENSING EVALUATOR SIGNATURE:

DATE: 10/12/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/12/2020
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: MEDINA & CAMARENA FAMILY CHILD CARE
FACILITY NUMBER: 198020612
VISIT DATE: 10/12/2020
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· 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.

Infant Care: Applicant/Licensee states that she does care for infants. LPA observed an infant crib located in the living room (daycare room) area. LPA advised the Applicant/Licensee to sleep infants where the infant can be directly supervised and advised against sleeping infants in a separate room. Infants should sleep mouth up, on their backs, free of clutter surrounding their sleeping space. LPA reviewed and discussed PIN 20-24-CCP-SP recently approved safe sleep regulations in effect with Applicant/Licensee.

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

Per Applicant,/Licensee she will 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.

The Applicant/Licensee states that they will provide food for children in care.
REPORT CONTINUES ON NEXT PAGE - 3 of 4
SUPERVISOR'S NAME: Valarie CookTELEPHONE: (323) 981-3362
LICENSING EVALUATOR NAME: Mireya GarciaTELEPHONE: (323) 558-2192
LICENSING EVALUATOR SIGNATURE:

DATE: 10/12/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/12/2020
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: MEDINA & CAMARENA FAMILY CHILD CARE
FACILITY NUMBER: 198020612
VISIT DATE: 10/12/2020
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The Applicant/Licensee has completed the required Health and Safety Training; Childhood Nutrition, Lead Exposure Training (completion date: 09/27/2020), Pediatric First Aid and CPR (expires on 09/2022). The Applicant/Licensee has proof of immunization against influenza, pertussis, and measles. Applicant/Licensee completed required mandated reporter training on 12/17/2019. Mandated reporter training must be completed every 2 years. www.mandatedreporterca.com

LPA will email PIN 20-24-CCP-SP: Recently approved Safe Sleep Regulations in effect, Capacity Handout (Small & Large), and information regarding best practices to maintain safe and healthy environment during COVID-19 health crisis. LPA advised the Applicant/Licensee how to access forms, regulations and quarterly updates on the Child Care Licensing website at: www.ccld.ca.gov. Per Applicant/Licensee, there are no dual licenses at this address.

The Licensing Department received a granted Fire Clearance for a capacity of 14 children on 08/14/2020.

During the course of conversation with Applicant/Licensee who states that she no longer wants to add spouse Felipe Camarena as part of the Family Child Care LIC 279 (SP) application due to her request to increase licensed capacity from 8 to 14 children and per Applicant/Licensee spouse does not have the 1-year experience required. Applicant/Licensee will re-submit an LIC 279 application for Family Child Care under Maria V. Medina Family Child Care.

This home currently meets the description of a safe and healthy environment for children as described in Chapter 1, Division 12, Title 22 of California Code of Regulations and a fire clearance has been approved for a maximum capacity of 14 children. The facility will be submitted for approval of a large family child care license upon receiving updated LIC 279 application from Applicant/Licensee. LPA reminded Applicant/Licensee to adhere to capacity limitations and conditions listed on the license.



Exit interview was conducted with Applicant/Licensee Maria V. Medina, via tele-inspection. A copy of this report and appeal rights (LIC 9058 (SP)) will be emailed with a read receipt and confirmation of receipt of email, which will act as the Applicant’s/Licensee’s signature. Applicant/Licensee will also sign report and mail to the Department. REPORT END - PAGE 4 of 4
SUPERVISOR'S NAME: Valarie CookTELEPHONE: (323) 981-3362
LICENSING EVALUATOR NAME: Mireya GarciaTELEPHONE: (323) 558-2192
LICENSING EVALUATOR SIGNATURE:

DATE: 10/12/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/12/2020
LIC809 (FAS) - (06/04)
Page: 4 of 4