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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197419868
Report Date: 06/06/2023
Date Signed: 06/06/2023 01:14:28 PM

Document Has Been Signed on 06/06/2023 01:14 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
L.A. DAYCARE-NO.WEST, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME:CERVANTES FAMILY CHILD CAREFACILITY NUMBER:
197419868
ADMINISTRATOR:CERVANTES, PAOLAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(310) 572-6470
CITY:LOS ANGELESSTATE: CAZIP CODE:
90066
CAPACITY: 12TOTAL ENROLLED CHILDREN: 12CENSUS: 12DATE:
06/06/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:PAOLA CERVANTES, LICENSEETIME COMPLETED:
01:30 PM
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On 06/06/2023 Licensing Program Analyst (LPA), Lisa Clayton, arrived at the FCCH unannounced, to conduct an Annual Inspection and was met by Licensee Paola Cervantes and her fingerprint cleared assistant Susy Lau. LPA Clayton observed 12 children, being supervised, and cared for appropriately. Operating hours are Monday – Friday, 8am – 5pm. Licensee provides am/pm snacks.

LPA Clayton toured the inside and outside of the home for a Health and Safety inspection. The home consists of the following: 3 bedrooms, 2 bathrooms, living room, kitchen, family room, detached garage, and fenced back yard.

The ON LIMIT areas are as follows: bedroom #2 (napping and activity room), the living room (activity/napping area), attached garage (day care activity room), fenced backyard and bathroom #1 and #2.

The OFF-LIMIT areas are: bedrooms #1, bedroom #3 and bedroom#4, bathroom #3 (in the master bedroom), and the kitchen, all of which are to be made inaccessible by locked doors, child safety gates, and supervision. Licensee is aware that children are not to sleep/nap or eat in the detached garage.

The home has 2 working smoke detectors and a carbon monoxide/smoke detector combo, and a fully charged 2A10BC fire extinguisher. The home has adequate heating and ventilation for safety and comfort. LPA Clayton observed toys and play equipment that are safe. The home has working telephone service and LPA confirmed the phone number is (310) 570-6470.

SUPERVISORS NAME: Karren Starks
LICENSING EVALUATOR NAME: Lisa Clayton
LICENSING EVALUATOR SIGNATURE: DATE: 06/06/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/06/2023
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
L.A. DAYCARE-NO.WEST, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME: CERVANTES FAMILY CHILD CARE
FACILITY NUMBER: 197419868
VISIT DATE: 06/06/2023
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Per the licensee, there are no firearms in the home. There are no swimming pools, ponds, or other bodies of water on the property. Any detergents, cleaning compounds, medication, poisons, and other hazardous items are made inaccessible to children.

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.

Licensee is to submit proof of completion CPR First Aid today, and Mandated Reporter Training no later than 06/09/2023.

LPA Clayton reviewed both Children’s and facility files.

Incidental Medical Services (IMS) are not being provided at this time. When any IMS is provided, a Plan for Providing IMS must be submitted to the Department. LPA Clayton provided licensee with an IMS Plan sample. 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

For licensing updates email childcareadvocatesprogram@dss.ca.gov and ask to be added to the email list.

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.

LPA Clayton provided licensee with a copy of the the safe sleep regulations with and discussed the Child Care Licensing Safe Sleep web page 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.

SUPERVISORS NAME: Karren Starks
LICENSING EVALUATOR NAME: Lisa Clayton
LICENSING EVALUATOR SIGNATURE:

DATE: 06/06/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/06/2023
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
L.A. DAYCARE-NO.WEST, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME: CERVANTES FAMILY CHILD CARE
FACILITY NUMBER: 197419868
VISIT DATE: 06/06/2023
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Technical Violations were cited today, Per Title 22, Division 12, Chapter 3, of the California Code of Regulations (see LIC 809D) and TV notes.

LPA Clayton reviewed the Deficiencies and Technical Advisories with licensee. LPA Clayton provided licensee with the LIC 311 (Forms/Records to be kept in Your Family / Child Care Home), and discussed the documents required.

An exit interview was conducted, a copy of this report was read and provided to the Licensee Paola Cervantes. This report shall be made available to the public upon request. LIC 9213 Notice of Site Visit was provided and required to be posted for 30 days.

SUPERVISORS NAME: Karren Starks
LICENSING EVALUATOR NAME: Lisa Clayton
LICENSING EVALUATOR SIGNATURE:

DATE: 06/06/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/06/2023
LIC809 (FAS) - (06/04)
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