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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197418679
Report Date: 04/28/2022
Date Signed: 05/02/2022 10:54:09 AM

Document Has Been Signed on 05/02/2022 10:54 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:ABERGEL FAMILY CHILD CAREFACILITY NUMBER:
197418679
ADMINISTRATOR:ABERGEL, ANIESFACILITY TYPE:
810
ADDRESS:TELEPHONE:
3107792454
CITY:LOS ANGELESSTATE: CAZIP CODE:
90048
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 12DATE:
04/28/2022
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
01:31 AM
MET WITH:Anies Abergel, Licensee TIME COMPLETED:
03:31 PM
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On 5/2/2022 Licensing Program Analyst LPA Miranda amend this report regarding time began was 1:31pm and time completed was 3:31pm. A copy of this report will be scanned via e-mail to Ms. Abergel, who understands that an electronic “Read Receipt” and/or confirmation of receipt of the e-mail confirms receipt of the report and constitutes an electronic signature.

On 4/28/2022 11:35am Licensing Program Analyst (LPA) Miranda and LPA Ornelas arrived at Abergel Family Child Care for the purpose of the health and safety of the child care homes.

There were 12 children (3 who are infants) in care with the licensee and one licensee’s assistant during the inspection. LPAs verified that all adults present in the home have obtained criminal record clearances and are associated to the facility.

During this inspection, LPAs reviewed children’s file and observed that all 12 files were incomplete. Licensee was unable to produce a copy of the complete children’s file.

Licensee was unable to produce copy of the safe sleep log for the 3 infants in care. A Copy of the titlte 22 # 102425 – Infant Safe Sleep was provided to licensee.

Licensee was not able to provide copy of the children’s roster.

Per Title 22, Division 12, Chapter 3, of the California Code of Regulations, the following deficiency is being cited: (see next page, 809 D)

An exit interview was conducted and a copy of this report, appeal rights and Notice of Site Visit was provided to Anies Abergel, Licensee.

SUPERVISORS NAME: Claudia Escobedo
LICENSING EVALUATOR NAME: Denise Miranda
LICENSING EVALUATOR SIGNATURE: DATE: 04/28/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/28/2022
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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Document Has Been Signed on 04/28/2022 03:22 PM - It Cannot Be Edited


Created By: Denise Miranda On 04/28/2022 at 01:24 PM
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
, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245

FACILITY NAME: ABERGEL FAMILY CHILD CARE
FACILITY NUMBER: 197418679

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/28/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
05/06/2022
Section Cited
CCR
102421(a)

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102421 (a) Child Record (a) The licensee shall maintain, in each child's record, the signed and dated notice form required in Section 102419(d). This requirement is not met as evidenced by: 4/28/22 LPAs
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Licensee agreed to produce the 12 complete files for the childen's present today no later than 5/6/2022. Licensee willl mail or drop off in person at El Segundo Regional Office.
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Based on record review, the licensee did not comply with the section cited above. LPAs reviewed the children's files and the 12 files were incomplete.
This poses a potential H&S to children in care.
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LPA provided a business card with El Segundo Regional Office address was provided to Licensee.
Type B
04/29/2022
Section Cited
CCR102417(g)(8)

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102417 (g) (8) - Operation of a Family Child Care. Each family child care home shall have a current roster of children as specified in Health and Safety Code Section 1596.841.
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Licensee agreed to provide a copy of the children's roster no later then end of business on 4/29/2022.
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This requirement is not met as evidenced by: 4/28/22. Based on files review, Licensee was unable to provide copy of Chidlren's Roster. This poses a potential H&S 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:Claudia Escobedo
LICENSING EVALUATOR NAME:Denise Miranda
LICENSING EVALUATOR SIGNATURE:
DATE: 04/28/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/28/2022


LIC809 (FAS) - (06/04)
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Document Has Been Signed on 04/28/2022 03:22 PM - It Cannot Be Edited


Created By: Denise Miranda On 04/28/2022 at 01:52 PM
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
, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245

FACILITY NAME: ABERGEL FAMILY CHILD CARE
FACILITY NUMBER: 197418679

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/28/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
05/06/2022
Section Cited
CCR
102425(c)

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102425 Infant Safe Sleep (j) The provider shall supervise infants while they are sleeping...(2) The provider shall check and document ...(D) Documentation shall be maintained in the infant’s file and be available to
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Per Licensee, she created her safe sleep log today and will submit copy of safe sleep log for the 3 infants present today via email to LPA Miranda no later than 5/6/2022.
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the Department for review. Documentation shall include the following: a.Date, b.Infant’s name.c.Time of each 15-minute check. This requirement is not met as evidenced by: 4/28/22, Licensee was unable to provide copy of safe sleep of the infant in care. This poses a potential H&S 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:Claudia Escobedo
LICENSING EVALUATOR NAME:Denise Miranda
LICENSING EVALUATOR SIGNATURE:
DATE: 04/28/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/28/2022


LIC809 (FAS) - (06/04)
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