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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197416275
Report Date: 06/16/2022
Date Signed: 06/16/2022 11:39:53 AM

Document Has Been Signed on 06/16/2022 11:39 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, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME:CRUZ FAMILY CHILD CAREFACILITY NUMBER:
197416275
ADMINISTRATOR:CRUZ, MARGARITAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(310) 841-2158
CITY:LOS ANGELESSTATE: CAZIP CODE:
90034
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 11DATE:
06/16/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:15 AM
MET WITH:Margarita CruzTIME COMPLETED:
12:00 PM
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On 6/16/2022, Licensing Program Analyst (LPA) Lillian Casillas conducted an unannounced Annual Required Inspection and was met by Licensee, Margarita Cruz. Also present were Staff #1 (S1) and Staff #2 (S2). Days and hours of operation are Monday through Friday, 7:00AM to 6:00PM.

LPA toured the indoor and outdoor of the home and a census was taken. Current facility sketch reviewed and Licensee confirmed child care areas are: living room, living room nook, bathroom 1, and backyard. The kitchen, dining room, and visitor's room on the ground floor as well as the upstairs are off-limits and made inaccessible by use of child safety gate. There are no fireplaces or open face heaters in the home. There is a working fire extinguisher, smoke detector, carbon monoxide detector and adequate heating and ventilation for safety and comfort. LPA observed a 2A10BC fire extinguisher located in living room. Safe toys and play equipment are observed. The home has working telephone service and LPA confirmed the phone number is (310) 841-2158. The outdoor play area in the side yard is fenced and there are no hazards to children present.There is no swimming pool or other bodies of water on the premises. There are no firearms or ammunition on the premises. No poisons were observed during the inspection. Detergents, cleaning compounds, medication and other hazardous items are made inaccessible.

Capacity as specified on the license is being maintained. There are currently 2 infants in care. LPA discussed Safe Sleep Regulations with licensee. There is one crib or play yard for each infant in care, cribs and play yards are kept free from all loose articles and objects while infants are sleeping, and there are no objects hanging above or attached to the crib or play yard. Infants are not swaddled while in care. Provider physically checks on sleeping infants every fifteen minutes and documents any signs of distress which includes but is not limited to flushed skin color, increase in body temperature, restlessness and labored breathing. Infants can be visually observed through an open door if sleeping in a separate room. LPA informed licensee that Individual Infant Sleeping Plan is required for each infant up to 12 months of age. LPA informed Licensee that Infants up to 12 months of age are to be placed on their backs for sleeping. [CONTINUE ON PAGE 2]

SUPERVISORS NAME: Maureen Neal
LICENSING EVALUATOR NAME: Lillian J Casillas
LICENSING EVALUATOR SIGNATURE: DATE: 06/16/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/16/2022
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, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME: CRUZ FAMILY CHILD CARE
FACILITY NUMBER: 197416275
VISIT DATE: 06/16/2022
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Licensee ensures that children in care are supervised at all times and is aware children shall not be left in parked vehicles. Car seats are used for transportation purposes only and are not used for sleeping children.

LPA reviewed a sample of children’s files and observed files were complete with emergency information as required. Licensee’s Mandated Reporter Training was completed on 5/10/2021. Licensee’s and assistants' pediatric CPR/First Aid expires on 02/2024. A review of records indicates that all employees and/or volunteers have immunization records on file for influenza, pertussis and measles.

Licensee 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. There are no excluded individuals present at this home.

Incidental Medical Services (IMS) are not currently being provided. Licensee is aware that an IMS plan is required to be submitted to the licensing office if they provide any of these services. Information regarding Americans with Disability Act (ADA) can be obtained by contacting US Department of Justice toll free ADA Information line at (800) 514-0301(voice), (800) 514-0383 (TDD) and website link https://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.

Per Title 22, Division 12, Chapter 3, of the California Code of Regulations, no deficiencies are cited. A Technical Advisory was issued.

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, Margarita Cruz.

SUPERVISORS NAME: Maureen Neal
LICENSING EVALUATOR NAME: Lillian J Casillas
LICENSING EVALUATOR SIGNATURE:

DATE: 06/16/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/16/2022
LIC809 (FAS) - (06/04)
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