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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376627405
Report Date: 12/18/2019
Date Signed: 12/18/2019 03:34:38 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 7575 METROPOLITAN DR., STE 110
SAN DIEGO, CA 92108
FACILITY NAME:JIMENEZ, MARIA FAMILY CHILD CAREFACILITY NUMBER:
376627405
ADMINISTRATOR:MARIA JIMENEZFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(914) 294-7349
CITY:LA MESASTATE: CAZIP CODE:
91942
CAPACITY:14CENSUS: 8DATE:
12/18/2019
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
01:30 PM
MET WITH:Maria Jimenez, LicenseeTIME COMPLETED:
03:35 PM
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Licensing Program Analyst (LPA), Marie Hernandez conducted an unannounced Annual/Random inspection. LPA met with the Licensee. During the inspection, there are eight children with the Licensee and the Adult Helper, Magalie Garcia. The facility is within the ratio and capacity. The day care hours are Monday through Friday from 7:00 AM to 5:00 PM. The facility accepts children between the ages 6 months and 13 years old. The Licensee accompanied LPA on the tour of the home. The off limit areas have been made inaccessible with the use of safety gates and child proof door knobs. The garage is off limits and made inaccessible with the use of a child proof lock. The day care areas are the downstairs bedroom #2, living room, the downstairs bathroom #2 and a portion of the backyard (patio area). There are no hazardous substances accessible. There are no weapons and/or bodies of water in the home. The fire extinguisher is full and of adequate size. It is in the kitchen area. The smoke alarm and carbon monoxide detector are operational. The home is clean, orderly and has adequate ventilation and heating. The Licensee has provided sufficient space for the children to eat, nap and play within the home. The children’s toys and play equipment are safe and age appropriate. The home has a working phone. The required forms are posted. The children’s records were reviewed. The last disaster/fire drill was conducted on 07/18/2019. The facility roster is current and complete. The Licensee's pediatric first aid/CPR expires on 12/30/2020, and the Adult Helper, Magalie Garcia's pediatric First Aid/CPR expires on 05/18/2021. The Licensee and the Helper have met the immunization requirements per SB792, and the AB 1207 (Mandated Reporter Training) requirements. The AB 1207 (SB792) must be renewed every two years from date of certification. LPA discussed California Megan's Law and provided the website as follows: www.meganslaw.ca.gov. Effects of Lead Exposure Handout was discussed and provided to the Licensee.
SUPERVISOR'S NAME: Joe CarrascoTELEPHONE: (619) 767-2243
LICENSING EVALUATOR NAME: Marie HernandezTELEPHONE: (619) 767-2244
LICENSING EVALUATOR SIGNATURE:

DATE: 12/18/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/18/2019
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 2
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 7575 METROPOLITAN DR., STE 110
SAN DIEGO, CA 92108
FACILITY NAME: JIMENEZ, MARIA FAMILY CHILD CARE
FACILITY NUMBER: 376627405
VISIT DATE: 12/18/2019
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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, an updated Plan of Operation that includes 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. Services were in place today. The safe sleep handouts were discussed and provided.

Reviewed the information regarding Sudden Infant Death Syndrome (SIDS) and SUIDS and back to sleep. The handouts "A Child Care Provider's Guide to Safe Sleep and the Safe Sleep Regulation Concepts were discussed and provided to the Licensee. The Licensee is reminded of the following: Due to health & safety, Infants cannot sleep in highchairs, baby swings, beds, sofas and/or car seats. Infants must always sleep in appropriate accommodations that do not pose a safety risk. Baby bouncers, baby rockers, baby jumpers, baby walkers and baby saucers are prohibited in the day care. Reviewed the criminal record transfer requests, mandated reporting requirements (AB 1207), incident reporting, fire/disaster drills and logs, child roster, the crib standards, child passenger safety law, immunization's, child's records, and the forms/records to keep at the facility. Discussed the ratio and capacity. The Licensee is reminded that smoking is prohibited in the day care. The Licensee is reminded that upon moving and/or changing the phone number, the Licensee must contact the Licensing Agency immediately.

The Licensee is advised to sign up for Quarterly Updates and Provider Information Notices (PINs) for one or more programs on our website: www.ccld.ca.gov. Select “Child Care” then “Quick Links” and Quarterly Updates. Select “Receive Important Updates” then put the email address in and choose which program(s) you would like to subscribe to and select “subscribe.”

No deficiency cited today. An exit interview was conducted and a copy of the report, and the Notice of Site Visit were provided to the Licensee. LPA observed the Licensee post the Notice of Site Visit in a prominent place. Licensee states it is understood that this notice must be posted for 30 days.
SUPERVISOR'S NAME: Joe CarrascoTELEPHONE: (619) 767-2243
LICENSING EVALUATOR NAME: Marie HernandezTELEPHONE: (619) 767-2244
LICENSING EVALUATOR SIGNATURE:

DATE: 12/18/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/18/2019
LIC809 (FAS) - (06/04)
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