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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198400117
Report Date: 07/28/2021
Date Signed: 07/28/2021 03:20:31 PM

Document Has Been Signed on 07/28/2021 03:20 PM - It Cannot Be Edited

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 CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME:PEREZ FAMILY CHILD CAREFACILITY NUMBER:
198400117
ADMINISTRATOR:TERESA PEREZFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(310) 872-4112
CITY:CARSONSTATE: CAZIP CODE:
90745
CAPACITY: 14TOTAL ENROLLED CHILDREN: 0CENSUS: 4DATE:
07/28/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
02:32 PM
MET WITH:Teresa PerezTIME COMPLETED:
03:40 PM
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Licensing Program Analyst (LPA) Raul Navarro conducted an unannounced random annual inspection. LPA arrived at 2:32pm and met with Licensee Teresa Perez who guided this LPA on a tour of the facility. There were four children present during today’s inspection. Licensee states that there are currently seven children enrolled. The Licensee is within the conditions, limitations, and capacity specified on the license. The children's roster was reviewed and is current.

This is a one story home which consists of four bedrooms and three bathrooms. Areas used by the children were inspected as follows: living room, kitchen, dining room, one bedroom, one bathroom, and back yard. Per Licensee, areas off limits to children and parents include: three bedrooms, two bathrooms, front yard, and garage. The Licensee uses the living room as the designated ill isolation area.

Areas accessible to children were inspected to ensure that they are clean and orderly with ventilation and heating for the safety of the children. There is a working telephone service maintained in the home. All adults present in the home have obtained a criminal record clearance or exemption prior to working, residing or volunteering in the licensed childcare home. There are no pets. Detergents, cleaning compounds, medications, and other items which can pose a danger to children are inaccessible. Poisons are locked, as required

Per Licensee, there are no weapons, firearms or bodies of water on the premises. There are safe toys, play equipment and materials observed for children. Emergency Disaster Plan was posted at the time of inspection. The valve on the required 2A 10BC fire extinguisher indicates fully charged, last serviced on 06/2021.

Report continues- Page 1 of 3
SUPERVISORS NAME: Karen Chambers
LICENSING EVALUATOR NAME: Raul Navarro
LICENSING EVALUATOR SIGNATURE: DATE: 07/28/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/28/2021
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 3
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 CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME: PEREZ FAMILY CHILD CARE
FACILITY NUMBER: 198400117
VISIT DATE: 07/28/2021
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Smoke and carbon monoxide detectors in the hallway were tested and are in operable condition. The Licensee has current EMS approved Pediatric First Aid and CPR, which will expire on 08/2022. Proof of immunization against influenza, pertussis, and measles for the Licensee was readily available during today’s inspection. The Licensee has also taken the Mandated Reporter Training.

Licensee states that infants sleep in the bedroom where they are constantly supervised. Appropriate sleeping arrangements were observed. The play yards did not hinder the entrance or exit from the sleeping space. The play yard was observed to be free of loose articles and objects. No objects were observed to be hanging above or attached to the side of the play yard. LPA did not observe any infants swaddled while in care. LPA advised the Licensee that infants shall be placed on their backs for sleeping and shall be supervised. Infants shall be checked on every 15 minutes and the time of each 15 minute check shall be documented with child’s name and date. The LIC 9227 Individual Infant Sleeping Plan shall be completed for each infant up to 12 months of age.

The following was discussed: 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. The Licensee shall be present in the home and shall ensure that children in care are supervised at all times. When temporarily absent from the home, the licensee shall arrange for a substitute adult with current training in pediatric first aid and pediatric CPR is on site to care for and supervise children in their absence. Children shall not be left in parked vehicles.

Rooms that are off-limits need to be made inaccessible during operating hours. Smoking is prohibited in a licensed Family Child Care Home. Per Licensee, no one smokes in the home. Infant walkers, johnny jumpers, saucer chairs, trampolines and any other item that falls into that category are not permitted in the facility. Car seats shall only be used for transportation purposes and shall not be used for sleeping.

The Licensee was advised how to access forms and Regulations online at www.ccld.ca.gov. Licensee was made aware that it is his/her responsibility to know the regulations as well as anyone who assists in providing care.
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SUPERVISORS NAME: Karen Chambers
LICENSING EVALUATOR NAME: Raul Navarro
LICENSING EVALUATOR SIGNATURE:

DATE: 07/28/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/28/2021
LIC809 (FAS) - (06/04)
Page: 2 of 3
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 CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME: PEREZ FAMILY CHILD CARE
FACILITY NUMBER: 198400117
VISIT DATE: 07/28/2021
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Children’s records were reviewed to ensure that each child has an Identification and Emergency form. LPA issued the Confidential Names List (LIC 811) to the licensee during this visit. The Confidential Names List documents the children’s files that were reviewed during this inspection.

At this time, the licensee is in compliance with California Title 22 Regulations. Therefore, there are no citations being issued today.

Exit interview was conducted with Licensee Teresa Perez. The Licensee was provided a copy of their appeal rights (LIC 9058) and their signature on this form acknowledges receipt of these forms.



The Notice of Site Visit (LIC 9213) – must remain posted for 30 days during the hours of operation after each site inspection by a licensing representative. Failure to maintain posting as required will result in a civil penalty of $100.00.

Report ends- Page 3 of 3
SUPERVISORS NAME: Karen Chambers
LICENSING EVALUATOR NAME: Raul Navarro
LICENSING EVALUATOR SIGNATURE:

DATE: 07/28/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/28/2021
LIC809 (FAS) - (06/04)
Page: 3 of 3