198400191-3-9-2022-54-CC-AMOY-CCCT8R-20220309133047

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 198400191
Report Date: 03/09/2022
Date Signed: 03/09/2022 01:31:06 PM

Document Has Been Signed on 03/09/2022 01:31 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:	CRUZ FAMILY CHILD CARE		FACILITY NUMBER:	198400191
ADMINISTRATOR:	KATHERINE ANNE CRUZ		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(323) 295-5892
CITY:	LOS ANGELES	STATE: CA	ZIP CODE:	90062
CAPACITY:	14	CENSUS: 4	DATE:	03/09/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	09:30 AM
MET WITH:	Katherine Cruz, Licensee		TIME COMPLETED:	01:45 PM

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Licensing Program Analyst (LPA) Alicia Mooberry conducted an unannounced Annual inspection. Upon arrival LPA met with licensee Katherine Cruz. LPA provided the LIC 126 Entrance Checklist. Licensee guided LPA on a tour of the facility. All areas identified on the facility sketch were inspected. There were 4 children present. Hours of operation are 24 hours, not to exceed 24 continuous hours at a time.

This is a one-story, 3 bedrooms / 1 bathroom single family home. Individuals residing in the home were discussed and noted. The home was inspected for safety, comfort, cleanliness, telephone service, heating and ventilation, inaccessibility to poisons, detergents, cleaning compounds, medicines, and hazardous items that can pose a danger to children.

Areas that are accessible to children include: Daycare room, 1 bedroom, bathroom, side and back yard.
Areas off limits based on facility sketch: Living room, kitchen, laundry room and detached garage
The entrance to the the facility is the side door leading to the main daycare room, set us as teaching/activity center and used for eating. The adjacent bedroom is used for circle time and nap time. Mats are available.

LPA observed covered wall heater and fire place. The kitchen is made inaccessible by a safety gate, knives and other sharp objects are in cabinets with safety latches. Detergents and cleaning supplies are kept in over-head cabinets in laundry room. There are door knob safety covers on off limit bedroom doors. Outlet covers were observed throughout the home.

The home is observed to be clean and orderly. There are age appropriate toys and equipment on the premises both indoors and in back yard. The back yard is used for outside play, contains a play structure with grass underneath.

LPA observed required posted documentation in facility entrance which included: Facility License, Publication (PUB) 394- Notification of Parent Rights and Licensing Form (LIC) 9148- Earthquake Preparedness form. LPA observed completed facility records including; LIC 9040- Facility Roster, LIC 610- Facility Disaster Plan.

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SUPERVISOR'S NAME: Valarie Cook	TELEPHONE: (323) 513-3858
LICENSING EVALUATOR NAME: Alicia Mooberry	TELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:	DATE: 03/09/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/09/2022

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 CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME: CRUZ FAMILY CHILD CARE	FACILITY NUMBER: 198400191
	VISIT DATE: 03/09/2022

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LPA left the facility at 11:40 and returned at 1:00 due to licensee having to transport children.
Licensee states that there are no poisons stored in the home and understands that all poisons must be lock, not only inaccessible to children. Per Licensee there are no firearms or weapons stored in the home. No swimming pool, spa or other bodies of water were observed during inspection. Licensee has no pets at this time.
The bathroom that children use is located in the observed to be clean and free of hazards. Isolation area for sick children waiting to be picked up is in the nap room, away from the other children.

The required fire extinguisher 2A 10BC (purchase receipt dated 12/26/19) has not been serviced. Licensee was reminded that fire extinguisher needs to be serviced yearly. Smoke and carbon monoxide detectors were tested and are operable. The home maintains telephone service via cell phone.

Infant Care: Per licensee, there are no infants currently enrolled. LPA informed licensee of the new Safe sleep regulations, including LIC 9227 Infant Sleep Plan for infants under 12 months, 15-minute sleep check documentation for infants 0-24 months, and provided PIN 20-24-CCP.

LPA discussed overnight care regulations with licensee. Per licensee there are no children receiving overnight care.

Record review revealed that licensee's Infant CPR/First Aid training certificate expired on 05/12/20. Licensee is enrolled in the required training scheduled for 4/2/22. Licensee was reminded to renew the Infant CPR/1st Aid every 2 years.

Children’s records were reviewed for (LIC) 282- Affidavit Regarding Liability Insurance, Immunization's Records, LIC 700- Identification and Emergency Information, LIC 627- Consent for Medical Treatment, LIC 995A Notification of Parents’ Rights, and documentation of 15-minute Infant Sleep Check (0-24 months)

and found that

During inspection all children were observed to be treated with dignity and respect, they were observed to be receiving safe, healthful and comfortable accommodations, furnishings and equipment, and free from corporal and/or unusual punishment.

LPA observed that licensee is implementing COVID-19 precautions and procedures. PIN 22-10-CCP discussed.

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SUPERVISOR'S NAME: Valarie Cook	TELEPHONE: (323) 513-3858
LICENSING EVALUATOR NAME: Alicia Mooberry	TELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:	DATE: 03/09/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/09/2022

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 CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME: CRUZ FAMILY CHILD CARE	FACILITY NUMBER: 198400191
	VISIT DATE: 03/09/2022

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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

To improve the quality and value of the new inspection process, a survey will be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or tools, please send them by email to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/inspection-process.

Licensee was reminded that all adults 18 and over living or working in the home, including employees and volunteers, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a licensed Family Child Care Home. A civil penalty of $100.00 minimum/day up to $500.00 maximum per day/per person will be assessed if this regulation is violated.

LPA discussed the safe sleep regulations with licensee and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPA also informed licensee of the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at https://www.cpsc.gov/ and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment.

Based on the LPA's observations and records review the following deficiencies will be cited today in accordance with California Title 22 Regulations.

A notice of site visit was given and must remain posted for 30 days.

Exit interview conducted and report was reviewed with the Licensee, Katherine Cruz. Appeal Rights were discussed and provided.

SUPERVISOR'S NAME: Valarie Cook	TELEPHONE: (323) 513-3858
LICENSING EVALUATOR NAME: Alicia Mooberry	TELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:	DATE: 03/09/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/09/2022

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 03/09/2022 01:31 PM - It Cannot Be Edited

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: CRUZ FAMILY CHILD CARE	FACILITY NUMBER: 198400191
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 03/09/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

102417(g)(7)

Operation of A Family Child Care Home

(7) An emergency information card shall be maintained for each child and shall include the child's full name, telephone number and location of a parent or other responsible adult to be contacted in an emergency, the name and telephone number of the child's physician and the parent's authorization for the licensee or registrant to consent to emergency medical care. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on record review, the licensee did not comply with the section cited above in 2 out of 4 children, Child #1 and #2 were missing documentation which poses a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 03/16/2022
	Plan of Correction
1 2 3 4	Per licensee, the required document will be completed for each child and a copy will be sent to LPA via email by POC due date.

Type B

Section Cited

CCR

102418(a)

Immunizations

(a) Prior to admission to a family day care home, children shall be immunized against diseases as required by the California Code of Regulations, Title 17, beginning with Section 6000. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on record reviews, the licensee did not comply with the section cited above in 4 out of 4 children, Child #1-#4 were missing proof of immunization which poses a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 03/16/2022
	Plan of Correction
1 2 3 4	Per licensee, the required document will be completed for each child and a copy will be sent to LPA via email by POC due date.

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

SUPERVISOR'S NAME: Valarie Cook	TELEPHONE: (323) 513-3858
LICENSING EVALUATOR NAME: Alicia Mooberry	TELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:	DATE: 03/09/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/09/2022

LIC809 (FAS) - (06/04)

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