197413650-9-1-2023-54-CC-KCHE-CV9U67-20230901151752

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 197413650
Report Date: 09/01/2023
Date Signed: 09/01/2023 03:18:13 PM

Document Has Been Signed on 09/01/2023 03:18 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT

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

FACILITY NAME:	PEREZ FAMILY CHILD CARE		FACILITY NUMBER:	197413650
ADMINISTRATOR:	PEREZ, ANA ADILIA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(323) 356-6849
CITY:	LOS ANGELES	STATE: CA	ZIP CODE:	90018
CAPACITY: 14	TOTAL ENROLLED CHILDREN: 5	CENSUS: 3	DATE:	09/01/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	12:55 PM
MET WITH:	Ana Perez, Licensee		TIME COMPLETED:	03:40 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	On 09/01/2023 at 1:00 pm, Licensing Program Analyst (LPA) Katrina Chicote conducted an Unannounced Required – 1 Year inspection to the above facility. Upon arrival, LPA disclosed the purpose of the inspection and met with Licensee, Ana Perez, who allowed entry into home. Also present in the home was Licensee's Assistant (A1) who guided the LPA on a tour of the facility. Licensee is Native Spanish speaker and A1 assisted with Spanish-English translation. Adults in the home were discussed and all have criminal record clearance. There were two preschool age children and one infant present during today’s inspection. Licensee states that there are currently five children enrolled. The children's roster was reviewed and is current. Required postings were observed posted upon entry to facility. Disaster drill log was also available during today’s inspection, last disaster drill conducted on 08/10/2023. This is a two-story home which consists of four bedrooms and three bathrooms, Kitchen, Day Care Room 1 and Day Care Room 2. Areas used by the children include the Day Care Room 1 (located to the right upon entry), Day Care Room 2 (located to the left upon entry), Bathroom 1 (located down hallway to the right), and Kitchen (located down hallway to the right). Per Licensee, areas off limits to children and parents include entire upstairs which has Bedrooms 2-4 and Bathroom 2-3. At 1:06 PM, LPA observed entire upstairs completely blocked by wood paneling making it off limits to children in care. LPA observed Bedroom 1, which is only downstairs bedroom, to be locked at time of inspection making it off limits to children in care. All areas identified on the facility sketch as accessible to children were inspected to ensure that they are clean and orderly with ventilation and heating for the safety of the children. At 1:10 PM, LPA observed a wall heater down hallway with tag from Gas Co. indicating gas to be shut off. There is a working telephone maintained in the home. At 1:03 PM, LPA observed Day Care Room 1 to have open shelving filled age appropriate toys free of loose and sharp parts, child size tables and chairs, and toddler bed in corner of room. At 1:04 PM, LPA Day Care Room 2 to have child size table and chairs and age appropriate toys, free Report Continues- Page 1 of 3

SUPERVISORS NAME: Denise Gibbs
LICENSING EVALUATOR NAME: Katrina Chicote
LICENSING EVALUATOR SIGNATURE:	DATE: 09/01/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/01/2023

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
MONTEREY PARK SW RO, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME: PEREZ FAMILY CHILD CARE	FACILITY NUMBER: 197413650
	VISIT DATE: 09/01/2023

NARRATIVE

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of loose and sharp parts available for children. At 1:07 PM, LPA observed Bathroom 1 to have operable toilet and sink, adequate supplies, and to have general area safety and sanitation. LPA observed all drawers and cabinets in Bathroom 1 to be free of hazards at time of inspection. Per A1, they provide food to children in care and eat in Kitchen or Day Care Rooms. At 1:08 PM, LPA observed Kitchen to have adequate supplies. Detergents, cleaning compounds, medications, and other items which can pose a danger to children are inaccessible. The Licensee was advised that inaccessibility of hazards must be constantly reassessed depending on the children in care.

Per Licensee, the children will not have access to an outdoor play area at the facility. Licensee states she has one chihuaha kept in the back that is kept separate from the children in care. LPA did not observe dog with the children during inspection and did not hear the dog during entire inspection. Licensee states isolation for sick children is flexible depending on which area is not being used by the children at the time.

Per Licensee, there are no weapons, firearms in the home and there are no bodies of water around the premises. LPA observation did not see any bodies of water around the premises or firearms/weapons at time of inspection.

At 1:14 PM, LPA observed the valve on the required 2A-10BC fire extinguisher indicates fully charged with service tag dated 02/15/2022. LPA discussed requirement for annual service of fire extinguisher with Licensee. At 1:16 PM, LPA tested smoke and carbon monoxide detectors and observed to be in operable condition at time of inspection. LPA observed First Aid kit hung in hallway near Bathroom 1 and inventoried for supplies. The Licensee and Assistant has current Pediatric First Aid and CPR valid until 01/2025. Proof of immunization against influenza, pertussis, and measles was readily available during today’s inspection. The Licensee and Assistant also taken the required AB1207 Mandated Reporter training completed on 01/14/2022. Personal Rights of children were observed by LPA.
—Children records and required licensing forms were discussed as well as mandated child abuse reporting and criminal record clearance requirement.

The following were discussed:
Rooms that are off-limits need to be made inaccessible during operating hours. NO smoking, NO infant walkers, NO Johnny jumpers, NO saucer chairs, NO incline sleepers and any other item that falls into that category are permitted in the facility.

Report Continues - Page 2 of 3

SUPERVISORS NAME: Denise Gibbs
LICENSING EVALUATOR NAME: Katrina Chicote
LICENSING EVALUATOR SIGNATURE:	DATE: 09/01/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/01/2023

LIC809 (FAS) - (06/04)

Page: 2 of 4

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

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

FACILITY NAME: PEREZ FAMILY CHILD CARE	FACILITY NUMBER: 197413650
	VISIT DATE: 09/01/2023

NARRATIVE

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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, 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

Licensee (or facility representative) 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 and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPA also informed Licensee 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.

To improve the quality and value of the new inspection process, a survey may 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 CARE tools, please send email inquiries 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/inspection-process.

The facility was found in compliance per Title 22 regulations, there will be no deficiencies cited today only advisories given.

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

Exit interview was conducted and report was reviewed with the Licensee, Ana Perez, with assistance of Licensee's Assistance for translation.
Report Ends - Page 3 of 3

SUPERVISORS NAME: Denise Gibbs
LICENSING EVALUATOR NAME: Katrina Chicote
LICENSING EVALUATOR SIGNATURE:	DATE: 09/01/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/01/2023

LIC809 (FAS) - (06/04)

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