192010272-6-7-2023-54-CC-ECHZ-CSKPXQ-20230607114244

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 192010272
Report Date: 06/07/2023
Date Signed: 06/07/2023 11:42:58 AM

Document Has Been Signed on 06/07/2023 11:42 AM - 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:	ANDRADE FAMILY CHILD CARE		FACILITY NUMBER:	192010272
ADMINISTRATOR:	ANDRADE, ALICIA EDUVIJES		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(562) 803-4793
CITY:	DOWNEY	STATE: CA	ZIP CODE:	90242
CAPACITY: 14	TOTAL ENROLLED CHILDREN: 13	CENSUS: 6	DATE:	06/07/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	09:00 AM
MET WITH:	Alicia Andrade		TIME COMPLETED:	12:00 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	Licensing Program Analyst (LPA) Elka Chavez conducted an unannounced 1-Year Required inspection to the above facility on 06/07/2023 in Spanish. LPA arrived at the facility at 9:00 AM and met with Licensee, Alicia Andrade who guided analyst on a tour of the facility. Also present during this inspection, was, Licensee’s Assistant, Gabriela Pelayo. Entrance Checklist for Family Child Care Homes was provided to the licensee upon entry. There were 6 children present upon arrival. Hours of operation are Monday through Friday from 6:00 AM to 7:00PM. The home is a single-story home. The home consists of 4 bedrooms, 2 bathrooms, living room, kitchen, dining area, laundry room, detached garage, shed, front yard and backyard (fenced). Care is mainly provided in the living room. There are two separate hallways on both sides of the living room. Both hallways contain two bedrooms and one bath. One bedroom on either side is accessible to children in care. The guest bathroom located in the hallway to the right of the main entrance is accessible while the remaining two bedrooms and second guest bathroom are off limits. The off-limit areas are made inaccessible with child proof doorknobs. The kitchen is accessible only when eating, otherwise it is off limits and made inaccessible with a child proof gate. LPA observed a shed, laundry room and detached garage located in the backyard. LPA observed doors are kept locked and are inaccessible to children in care. There were no pets or wall heater observed in the home. LPA observed a decorative fireplace in the living room. Areas accessible to children are Kitchen, living room, two bedrooms, one bathroom and backyard (fenced). Areas off limits to children and parents are: Two bedrooms, one bathroom, shed, laundry room, detached garage and front yard. All off-limit areas need to be made inaccessible to children in care. The licensee understands that licensing staff may have access to off-limit areas during inspection visit if necessary. Food is provided by Licensee. Individuals residing in the home have been discussed and noted. All adults present in the home have obtained a criminal record clearance or exemption.

SUPERVISORS NAME: Karen Chambers
LICENSING EVALUATOR NAME: Elka Chavez
LICENSING EVALUATOR SIGNATURE:	DATE: 06/07/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/07/2023

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: ANDRADE FAMILY CHILD CARE	FACILITY NUMBER: 192010272
	VISIT DATE: 06/07/2023

NARRATIVE

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All areas identified on the facility sketch that are accessible for children to use were inspected for safety, comfort, and cleanliness. The following was observed and reviewed during this inspection:

LPA reviewed required posted documentation for Facility License, Publication (PUB) 394- Notification of Parent Rights and Licensing Form (LIC) 9148- Earthquake Preparedness form. Facility records were reviewed for LIC 9040- Facility Roster, LIC 610- Facility Disaster Plan and Disaster drill log, last drill conducted on 5/02/23.

At 9:30 AM smoke and carbon monoxide detectors were tested and are operable. Fire extinguisher indicated fully charged and was serviced on 7/11/22. The home maintains telephone service via landline and cell phone. The home is observed to be clean and orderly. There are toys and other age appropriate material available for children. LPA observed knives and medication are kept in a box in a kitchen cabinet above the stove. LPA observed cleaning supplies are kept locked in the off-limit laundry room. Licensee understands that all poisons must be locked. Isolation area for sick children waiting to be picked up is in the kitchen, away from the other children. Per Licensee there are no firearms or weapons stored in the home. LPA observed that licensee is implementing COVID-19 precautions and procedures.

Licensee cares for two infants. LPA observed infants nap in the bedroom next to the bathroom used by children in care. LPA observed the door is kept open and there is a camera in the napping room. Napping equipment does not block entrances or exits. Infant mattresses were observed to be firm with tightly fitted sheets. LPA did not observe loose object, bumpers, objects hanging, or objects attached to the play yards. There are currently no infants with pacifiers. Each infant has their own play yard and bedding. Bedding is washed weekly or as needed by the Licensee. Licensee does not provide any overnight care at this time.

Currently, children are using the backyard for outdoor play. The outdoor play area was observed to be fenced. LPA observed that the outdoor yard has toys and other materials for children to play with. LPA did not observe any objects that could be hazardous to children in care. There are no pools or spas, or other bodies of water.

Children’s records were reviewed for (LIC) 282- Affidavit Regarding Liability Insurance, Immunization Records, LIC 700- Identification and Emergency Information, LIC 627- Consent for Medical Treatment, LIC

SUPERVISORS NAME: Karen Chambers
LICENSING EVALUATOR NAME: Elka Chavez
LICENSING EVALUATOR SIGNATURE:	DATE: 06/07/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/07/2023

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: ANDRADE FAMILY CHILD CARE	FACILITY NUMBER: 192010272
	VISIT DATE: 06/07/2023

NARRATIVE

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995A Notification of Parents’ Rights, LIC 9227- Infant sleep form (0-12 months, and documentation of 15-minute Infant Sleep Check (0-24 months). At 10:20 AM during records review LPA observed child #3 did not have LIC 9227 form on file. LPA observed children #1, #2, #3, #4 and #5 were not the facility roster.

Staff records were reviewed for approved Pediatric First Aid and CPR certification, LIC-501: Personnel Record, LIC 508- Criminal Record Statement, LIC 9052- Employee Rights, Proof of immunization against measles, pertussis and influenza or influenza declination, TB clearance or risk assessment, LIC 9108- Statement Acknowledging Requirement to Report Child Abuse and current Mandated Reporter Training Certificate.

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/process.

Licensee Alicia Andrade 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 Alicia Andrade and discussed the Child Care Licensing Safe Sleep webpage at

SUPERVISORS NAME: Karen Chambers
LICENSING EVALUATOR NAME: Elka Chavez
LICENSING EVALUATOR SIGNATURE:	DATE: 06/07/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/07/2023

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: ANDRADE FAMILY CHILD CARE	FACILITY NUMBER: 192010272
	VISIT DATE: 06/07/2023

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https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPA also informed licensee Alicia Andrade 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 observations and records review, the following deficiencies listed on the attached LIC 809 (deficiency page) are being cited in accordance with California Code of Regulations Title 22. Deficiencies that are being cited need to be cleared to protect the children’s health & safety.

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

Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

Exit interview conducted and report was reviewed with the licensee Alicia Andrade.

SUPERVISORS NAME: Karen Chambers
LICENSING EVALUATOR NAME: Elka Chavez
LICENSING EVALUATOR SIGNATURE:	DATE: 06/07/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/07/2023

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 06/07/2023 11:42 AM - It Cannot Be Edited

Created By: Elka Chavez On 06/07/2023 at 11:04 AM

Link to Parent Document Below:

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME: ANDRADE FAMILY CHILD CARE	FACILITY NUMBER: 192010272
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 06/07/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

102417(g)(8)

Operation of A Family Child Care Home

(8) Each family child care home shall have a current roster of children as specified in Health and Safety Code Section 1596.841. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on record review children #1 through #5 were not listed in the roster, the licensee did not comply with the section cited above which poses a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 06/07/2023
	Plan of Correction
1 2 3 4	Going forward will update roster as soon as a child is enrolled and disenrolled.

Type B

Section Cited

CCR

102425(c)

Infant Safe Sleep

An Individual Infant Sleeping Plan [LIC 9227 (3/20)] shall be completed for each infant up to 12 months of age the provider has in care and included in the infant's file at the facility. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on record review,child #3 is missing LIC 9227 form which poses a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 06/07/2023
	Plan of Correction
1 2 3 4	Going forward she will make sure to review documents once the are completed and returned by parents.

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:

Karen Chambers

LICENSING EVALUATOR NAME:

Elka Chavez

LICENSING EVALUATOR SIGNATURE:

DATE: 06/07/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/07/2023

LIC809 (FAS) - (06/04)

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