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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 304312914
Report Date: 01/23/2020
Date Signed: 01/23/2020 12:56:27 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:MAGALLON, BLANCA & HORMAZA, JOSEFACILITY NUMBER:
304312914
ADMINISTRATOR:MAGA, BLANCA & HOR, JOSEFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(714) 356-7188
CITY:ANAHEIMSTATE: CAZIP CODE:
92804
CAPACITY:14CENSUS: 3DATE:
01/23/2020
TYPE OF VISIT:Annual/RequiredUNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Licensee Blanca MagallonTIME COMPLETED:
01:25 PM
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An unannounced annual inspection was conducted at the facility by Licensing Program Analyst’s (LPA’s) Odom and Villa. LPA’s met with Licensees Blanca Magallon and Jose Hormaza and toured the entire facility. LPA’s observed 1 infant, and 2 preschool age children in day care room with Assistant Maria De Jesus Macias. The facility was within licensed capacity and the required ratio. Licensee stated there are presently 3 adults living in the home and 2 minor children. Licensee, Licensee husband, adult daughter and two minor children. Child care operating hours are Monday through Saturday, 5:00 a.m. to 9:00p.m. A review of staff records on this date indicates that all facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions.

During today’s inspection each child was observed to have safe, healthful, and comfortable accommodations, furnishings, and equipment. The facility floor plan is a 1 story home with 4 bedrooms, and 3 restrooms. Licensee stated all bedrooms, 2 bathroom, dining room and garage are off-limits. Off limits areas are made inaccessible by means of baby gates, door knobs and door locks. The accessible child care areas are the child care room, bathroom adjacent to the kitchen, kitchen and living room. The children’s back patio is used for outdoor play area, but Licensee stated, patio is currently off limits until they fix the flooring and cover the bricks. Licensee stated, it should be ready approximately in 1-2 months. The front yard is off limits. Home has two fireplaces that are fenced, and no wall heater. The facility has Body of water it was observed during today's visit, an in ground jacuzzi which is located on a closed off section of the property, Licensee does not have access to the jacuzzi, because there is a 6-foot wooden wall that divide the property, and there is no access to get to the jacuzzi from the Licensee’s side of the property. LPA’s had to climb the 6-foot wall by utilizing a bucket to observe the in ground jacuzzi that it’s not accessible to the children.

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SUPERVISOR'S NAME: Judy HansonTELEPHONE: (714) 703-2807
LICENSING EVALUATOR NAME: Carmen OdomTELEPHONE: (714) 703-2819
LICENSING EVALUATOR SIGNATURE:

DATE: 01/23/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/23/2020
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 6
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: MAGALLON, BLANCA & HORMAZA, JOSE
FACILITY NUMBER: 304312914
VISIT DATE: 01/23/2020
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Items which could pose a danger to children (detergents, cleaning compounds, and medications) were stored out of the reach of children in garage and locked up. Poisonous items are not stored on site, and none were observed during today's inspection. The facility provides safe toys, equipment, and materials. There is a working combined carbon monoxide detector and smoke detector, and fire extinguisher (2A10BC) in the home that meet statutory and State Fire Marshall standards. The facility did not conduct an emergency drill within the past six months, last one dated on 03/2019. A technical advisory will be provided to Licensee for Fire and Disaster drill not performed every 6 months. The licensee stated there are no firearms or other dangerous weapons in the home.

The LPA advised the licensee to submit a new application (LIC279) to licensing department for any changes to hours and days of planned operation, and for any changes to facility, including on/off limit areas and change in phone number. The licensee has a landline home phone that is used for child care. The licensee was reminded that if a cell phone is used as the primary child care phone, it must remain on the premises always during hours of operation.

The licensee does have a current children roster (LIC9040) at the facility. LPA inspected children’s records for a copy of the emergency information card that contains all the information specified by regulation (LIC700), Notification of Parents’ Rights receipts (LIC995), California School Immunization Records (blue card) and found to be in compliance.

The Licensees Pediatric CPR/First Aid certification expired on 1/13/2020. The assistant’s Pediatric CPR/First Aid certification expires on 04/2021 and 05/2020. Beginning September 1, 2016, Health and Safety (H&S) 1597.622 states, a person shall not be employed or volunteer at a family day care home if he or she has not been immunized against influenza, pertussis, and measles. Proof of immunization against pertussis, measles for licensees and assistants were reviewed and within compliance. Licensees and assistants provided a written declination letter for influenza shot.

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SUPERVISOR'S NAME: Judy HansonTELEPHONE: (714) 703-2807
LICENSING EVALUATOR NAME: Carmen OdomTELEPHONE: (714) 703-2819
LICENSING EVALUATOR SIGNATURE:

DATE: 01/23/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/23/2020
LIC809 (FAS) - (06/04)
Page: 2 of 6
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: MAGALLON, BLANCA & HORMAZA, JOSE
FACILITY NUMBER: 304312914
VISIT DATE: 01/23/2020
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Children's records for three children were reviewed for Children’s immunization on the California School Immunization Card (CDPH 286), a signed copy of the Family Child Care Home Notification of Parents’ Rights, and a signed copy of the Acknowledgement of Receipt of Licensing Reports for Type A Citation for 04/2019, Licensee was in compliance.

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 Blanca Magallon has Mandated Reporter training completed on 02/20/19. The licensee Jose Hormaza and assistant Maria De Jesus Macias is exempt from this requirement due to the training not being available in Spanish.

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

The licensees understand they must be present in the facility and must ensure children in care are always supervised and children are not to be left in parked vehicles. When the licensee is temporarily absent from the facility, arrangements must be made for a qualified substitute adult to care and supervise children while absent. The substitute adult must have the required criminal record, child abuse index clearances, immunization, Pediatric CPR/First Aid, and mandated reporter training.

CCLD website www.ccld.ca.gov was provided to licensee to access regulations, updates, and licensing forms. Licensee was advised to register through childcareadvocatesprogram@dss.ca.gov in order to receive quarterly updates. Licensee was advised of their responsibility to review the Provider Information Notices (PIN) found on the CCLD website.

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SUPERVISOR'S NAME: Judy HansonTELEPHONE: (714) 703-2807
LICENSING EVALUATOR NAME: Carmen OdomTELEPHONE: (714) 703-2819
LICENSING EVALUATOR SIGNATURE:

DATE: 01/23/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/23/2020
LIC809 (FAS) - (06/04)
Page: 3 of 6
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: MAGALLON, BLANCA & HORMAZA, JOSE
FACILITY NUMBER: 304312914
VISIT DATE: 01/23/2020
NARRATIVE
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A copy of the California Department of Social Services Lead Information Brochure was explained and provided to the licensee. A copy of the 2016 “A Child Care Providers Guide to Safe Sleep” was provided to the licensee. The following electronic links were also provided:
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
LPA reviewed with licensee the following safe sleep best practices:
· Always place infants on their backs for sleeping
· Use only a tight-fitting sheet on the crib or play yard mattress
· Do not hang any items from the crib or above the crib
· Keep all items, including blankets, out of the crib or play yard
· Pacifiers may be used as long as they do not have items attached to them
· Infants should not be swaddled or have any items covering them while sleeping
· The temperature of the room should be comfortable enough for an adult to wear a t-shirt and not be too hot or too cold.

Individuals who are 18 years of age or older living in the home must be finger print cleared prior to presence in the facility. Individuals within one month of their 18th birthday must be fingerprinted immediately. No smoking, no infant walkers, baby bouncers, Johnny Jumpers, exersaucer or any other similar items that fall into that category are allowed in the facility. Disaster drills, posting requirements, children record, mandated child abuse and injury/ death reporting, and criminal records clearances/exemption transfer requests, SIDS and Never Shake a Baby. LPA reviewed how to report an unusual incident.

LPA Odom reviewed staff files and 2 out 4 staff did not have current pediatric CPR/First Aide certification it expired on 01/13/2020.

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SUPERVISOR'S NAME: Judy HansonTELEPHONE: (714) 703-2807
LICENSING EVALUATOR NAME: Carmen OdomTELEPHONE: (714) 703-2819
LICENSING EVALUATOR SIGNATURE:

DATE: 01/23/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/23/2020
LIC809 (FAS) - (06/04)
Page: 4 of 6
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: MAGALLON, BLANCA & HORMAZA, JOSE
FACILITY NUMBER: 304312914
VISIT DATE: 01/23/2020
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The facility was not in compliance and the following violations of the California Code of Regulations, Title 22; Division 12, were observed and cited today:

CPR Personnel Requirements 102416(c) The licensee and other personnel as specified shall complete training on preventive health practices, including pediatric cardiopulmonary resuscitation and pediatric first aid, pursuant to Health and Safety Code Section 1596.866.

Inspection, report review and exit interview was conducted with Licensee Blanca Magallon 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: Judy HansonTELEPHONE: (714) 703-2807
LICENSING EVALUATOR NAME: Carmen OdomTELEPHONE: (714) 703-2819
LICENSING EVALUATOR SIGNATURE:

DATE: 01/23/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/23/2020
LIC809 (FAS) - (06/04)
Page: 5 of 6
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: MAGALLON, BLANCA & HORMAZA, JOSE
FACILITY NUMBER: 304312914
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/23/2020
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
01/31/2020
Section Cited

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102416(c) CPR Personnel Requirements The licensee and other personnel as specified shall complete training on preventive health practices, including pediatric cardiopulmonary resuscitation and pediatric first aid, pursuant to Health and Safety Code Section 1596.866.
This requirement is not met as evidence by:
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Based on records reviewed, 2 out of the 4 staff files had expired pediatric CPR/First Aid certification in which poses a potential health risk to children in care.
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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: Judy HansonTELEPHONE: (714) 703-2807
LICENSING EVALUATOR NAME: Carmen OdomTELEPHONE: (714) 703-2819
LICENSING EVALUATOR SIGNATURE:
DATE: 01/23/2020
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/23/2020
LIC809 (FAS) - (06/04)
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