304206439-6-20-2019-06-CC-WPOT-BDBS3H-20190620133110

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 304206439
Report Date: 06/20/2019
Date Signed: 06/20/2019 08:00:29 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868

FACILITY NAME:	DUENEZ, KARLA		FACILITY NUMBER:	304206439
ADMINISTRATOR:	DUENEZ, KARLA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(949) 380-0623
CITY:	LAKE FOREST	STATE: CA	ZIP CODE:	92630
CAPACITY:	14	CENSUS: 11	DATE:	06/20/2019
TYPE OF VISIT:	Case Management - Other	UNANNOUNCED	TIME BEGAN:	11:30 AM
MET WITH:	Karla Duenez		TIME COMPLETED:	02:00 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	An inspection was conducted at the facility by Licensing Program Analyst (LPA) Port for the purpose of monitoring compliance plan on file. A review of adult records indicates that all facility residents, staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions. There are presently 4 adults (including licensee) and 1 minor child living in the home. During today’s inspection the home and grounds were toured and the licensee was operating within the licensed capacity. There were 3 infants and 8 preschool age children in care. Also present assisting with day care children were assistant, Ana Angulo and the licensee's mother Rosa Arellano. Operating hours are 7:00 AM to 5:30 PM, Monday through Friday. The floor plan was verified. This a single story 3 bedroom and 2 bathroom home. The main day care area is the front living room and bedroom 1 which is used as the napping room. The laundry room, garage, bedroom 2, and master bathroom are off limits. The children use the backyard as the outdoor play area, and it is completely fenced. The outdoor play area is free from hazards. There are no bodies of water on the premises. There is a fireplace in the living room screened by a fire place cover and inaccessible to children in care. Items which could pose a danger to children (detergents, cleaning compounds, and medications) were stored out of the reach of children. The licensee stated poisonous items are not stored on site, and none were observed during today's inspection. The home provides safe toys, equipment, and materials. During today’s inspection each child was observed to have safe, healthful, and comfortable accommodations, furnishings, and equipment. There is a working smoke detector and fire extinguisher in the home that meet statutory and State Fire Marshall standards. The licensee stated there is a carbon monoxide detector at the facility, however the device was not visibly labeled as a carbon monoxide detector. The licensee was not able to produce documentation to show the device is a carbon monoxide detector. The facility has conducted an emergency drill within the past six months. The licensee stated there are no firearms and/or other dangerous weapons in the home and none were observed during today's visit. Page 1 of 3 (Continued on Page 2)

SUPERVISOR'S NAME: Rina Lopez	TELEPHONE: (714) 703-2808
LICENSING EVALUATOR NAME: Wendy Port	TELEPHONE: (714) 703-2815
LICENSING EVALUATOR SIGNATURE:	DATE: 06/20/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/20/2019

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, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868

FACILITY NAME: DUENEZ, KARLA	FACILITY NUMBER: 304206439
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 06/20/2019

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 07/03/2019 Section Cited HSC 1597.543	1 2 3 4 5 6 7	Carbon Monoxide Detectors. Effective January 1, 2015, this law requires all licensed facilities and certified family homes, as specified, to have one or more carbon monoxide (CO) detectors in the facility that meet specific standards, and requires the Department to account for their presence during....This requirement was not met as evidenced by:	1 2 3 4 5 6 7	The licensee stated she will purchase a carbon monoxide detector and provide a photo of the installed carbon monoxide detector by the due date of 07/03/2019.
	8 9 10 11 12 13 14	The licensee stated there is a carbon monoxide detector at the facility, however the device was not visibly labeled as a carbon monoxide detector. The licensee was not able to produce documentation to show the device is a carbon monoxide detector. This poses a potential health and safety risk to children in care.	8 9 10 11 12 13 14
	1 2 3 4 5 6 7		1 2 3 4 5 6 7
	1 2 3 4 5 6 7		1 2 3 4 5 6 7

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: Rina Lopez	TELEPHONE: (714) 703-2808
LICENSING EVALUATOR NAME: Wendy Port	TELEPHONE: (714) 703-2815
LICENSING EVALUATOR SIGNATURE:	DATE: 06/20/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/20/2019

LIC809 (FAS) - (06/04)

Page: 4 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, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868

FACILITY NAME: DUENEZ, KARLA	FACILITY NUMBER: 304206439
	VISIT DATE: 06/20/2019

NARRATIVE

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The following electronic links were also provided:
English: https//www.cdph.ca.gov/programs/SIDS/Documents/SIDSchildcaresafesleep.pdf
Spanish: https//www.cdph.ca.gov/programs/SIDS/Documents/ChildCareProvSleepSPAN2011.pdf
AAP:https://www.healthychildren.org/English/ages-stages/baby/sleep/Pages/A-Parents-Guide-to-Safe-Sleep.aspx
NIH: https://safetosleep.nichd.nih.gov/safesleepbasics/environment/room/text_alternative
Safe to Sleep Campaign: https://safetosleep.nichd.nih.gov/materials

The following violation of the California Code of Regulations, Title 22; Division 12, was observed and cited today: Carbon Monoxide Detector Health & Safety Code see LIC 809D.

Inspection, report review and exit interview was conducted in Spanish. Notice of Site Visit was posted during the visit. Licensee was informed that the notice of site visit must be posted for 30 consecutive days. Failure to post will result in civil penalties of $100. Appeal rights provided and explained. The licensee was provided a copy of their appeal rights (LIC 9058 01/16) and their signature on this form acknowledges receipt of these rights. First level appeals should be sent to the regional manager to the address listed above. Licensee was informed of how/where to access regulations and forms from CCLD website: www.ccld.ca.gov.

SUPERVISOR'S NAME: Rina Lopez	TELEPHONE: (714) 703-2808
LICENSING EVALUATOR NAME: Wendy Port	TELEPHONE: (714) 703-2815
LICENSING EVALUATOR SIGNATURE:	DATE: 06/20/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/20/2019

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, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868

FACILITY NAME: DUENEZ, KARLA	FACILITY NUMBER: 304206439
	VISIT DATE: 06/20/2019

NARRATIVE

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The licensee stated she is present in the home and ensures that children that children in care are supervised at all times. The licensee stated children are not left in parked vehicles. The licensee states when temporarily absent from the home, she arranges for a substitute adult to care for and supervise children in her absence.

The licensee's pediatric CPR/First Aid certification is current, which expires 11/05/2019. Proof of immunization against influenza (or written decline) pertussis and measles for licensee and both assistants present today were reviewed and within compliance of SB 792.

Beginning March 31, 2018, Health and Safety Code 1596.8662 requires all licensed providers, applicants, directors and employees to complete training as specified on their mandated reporter duties and to renew their training every two years, per A.B. 1207. The licensee is exempt from this requirement due to not being available in Spanish.

The facility has an updated children’s roster. Children’s records were reviewed and found to be in substantial compliance.

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 .

Facility was advised on how to receive notifications for quarterly updates and provided with Child Care Advocate contact information: childcareadvocatesprogram@dss.ca.gov A hard copy of the Spring 2019 Child Care Quarterly Update was provided to the licensee. A hard copy of the Department of Social Services Lead Information brochure was explained and provided to the licensee A hard copy of the 2016 “A Child Care Providers Guide to Safe Sleep” was provided to the licensee.

(Continued on Page 3)

SUPERVISOR'S NAME: Rina Lopez	TELEPHONE: (714) 703-2808
LICENSING EVALUATOR NAME: Wendy Port	TELEPHONE: (714) 703-2815
LICENSING EVALUATOR SIGNATURE:	DATE: 06/20/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/20/2019

LIC809 (FAS) - (06/04)

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