304311726-10-10-2019-06-CC-YVIA-BGTUCK-20191010152805

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 304311726
Report Date: 10/10/2019
Date Signed: 10/10/2019 03:28:10 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:	PEREZ, JENNY		FACILITY NUMBER:	304311726
ADMINISTRATOR:	PEREZ, JENNY		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(562) 690-9251
CITY:	LA HABRA	STATE: CA	ZIP CODE:	90631
CAPACITY:	14	CENSUS: 7	DATE:	10/10/2019
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	01:50 PM
MET WITH:	Jenny Perez, Licensee		TIME COMPLETED:	03:45 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	Licensing Program Analyst (LPA) Villa conducted an unannounced annual random inspection to ensure the health & safety standards as required by regulations governing family child care homes are met. Upon arrival LPA Villa was greeted by Licensee, Jenny Perez. Also present during this inspection was assistant Rosana Hernandez. All adults present during this inspection have obtained a criminal record clearance prior to working or residing in the home. Census was obtained during today’s inspection there were 7 children present, three of which are infants under two years of age. The facility was observed to be within ratio. Per Licensee she has 12 children enrolled in her day care four of which are infants. An updated children’s roster was available during the inspection. Licensee states her hours of operation are 24-hour care, Monday thru Friday. A tour of the home was conducted inside and outdoors. Per Licensee there are 3 adults and 0 children residing in the home. The home is a single-story home with four bedrooms and two bathrooms. The areas designated for the day care is the back family room adjacent to the kitchen, the dinning room area that is designated solely for the child care and a bedroom located near the dinning room. The bedroom located near the dinning room is designated for infants as stated by Licensee The restroom that is being used by the children is located in the hallway of the home. Per Licensee she escorts the children in the home when they need to use the restroom. The off-limit areas are the 3 bedrooms, restroom next to the bedrooms, kitchen, living room, and the attached garage. Licensee states the backyard area is used for the children outdoor play time. The back yard was observed to be fenced and free of hazards.The licensee stated there are no firearms on the premises. Disinfectants, cleaning solutions, poisons and other items that are dangerous to children were properly stored and or locked away. The smoke detector, fire extinguisher, and carbon monoxide detector were present and within regulations. The toys appear age appropriate and in good condition for the ages served. The home had safe and comfortable furnishings and equipment for the children. CPR & First Aid are current for licensee (exp. 01/12/2021). Some of the children's files were reviewed and had the required parents' rights, emergency contact information, affidavit regarding lability insurance, consent for medical treatment, and immunization information.

SUPERVISOR'S NAME: Judy Hanson	TELEPHONE: (714) 703-2807
LICENSING EVALUATOR NAME: Yesenia Villa	TELEPHONE: (714) 293-9465
LICENSING EVALUATOR SIGNATURE:	DATE: 10/10/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/10/2019

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

FACILITY NAME: PEREZ, JENNY	FACILITY NUMBER: 304311726
	VISIT DATE: 10/10/2019

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Licensee has the Parent’s Rights poster and other appropriate forms posted. Staff files were reviewed for Immunizations, MMR, TDAP and Influenza and Mandated Reporter certificate for Licensee and assistant. All files were observed to be complete. Children records were reviewed for LIC700 and Immunization cards. All records were observed to be complete. Licensee was reminded that the Mandated reporter training expires every two years. Licensee had the fire disaster drill log up to date last drill conducted 09/10/2019. Licensee has a working telephone via cell phone and home phone.

The licensee maintains a first aid kit in the home. The following were discussed: Individuals who are 18 years of age or older living in the home must be finger print cleared prior to being in the presence of the children in care. Individuals within one month of their 18th birthday must be fingerprinted immediately. No smoking, No infant walkers, No baby bouncers, No Johnny jumpers, No exersaucers and any other item that falls into that category is to be in the home. LPA discussed disaster drills, posting requirements, children records requirements, mandated child abuse and injury/death reporting. LPAs reviewed SIDs, safe sleeping practices. Infants should sleep mouth up, on their backs, free of clutter surrounding their sleeping space. Safe sleep guidelines flyer was provided during today’s visit.

Incidental Medical Services (IMS) policy was discussed. Licensee states there are no children requiring medication in her care. 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.htmLPA advised the Licensee to access forms and regulations on line at: www.ccld.ca.gov, Licensee was advised where to access the quarterly updates. LPA Villa demonstrated how to access quarterly updates with the State cell phone.
There were no citations cited under Title 22 Regulations during this inspection.
The Notice of Site Visit (LIC 9213) – must remain posted for 30 consecutive days during the hours of operation after each site visit by a licensing representative. Failure to maintain posting as required will result in a civil penalty of $100.00. Exit interview was conducted with Licensee and Appeal rights were provided and explained. Licensee was informed that appeals must be submitted in writing within 15 days of a citation.
An exit interview was completed with licensee Jenny Perez.

SUPERVISOR'S NAME: Judy Hanson	TELEPHONE: (714) 703-2807
LICENSING EVALUATOR NAME: Yesenia Villa	TELEPHONE: (714) 293-9465
LICENSING EVALUATOR SIGNATURE:	DATE: 10/10/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/10/2019

LIC809 (FAS) - (06/04)

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