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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197494366
Report Date: 07/02/2024
Date Signed: 07/02/2024 04:53:17 PM

Document Has Been Signed on 07/02/2024 04:53 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
EL SEGUNDO CC NORTH, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME:ESPANA FAMILY CHILD CAREFACILITY NUMBER:
197494366
ADMINISTRATOR/
DIRECTOR:		ESPANA, BLANCAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(323) 599-9232
CITY:LOS ANGELESSTATE: CAZIP CODE:
90016
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 6DATE:
07/02/2024
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
11:08 AM
MET WITH:Blanca Espana, LicenseeTIME VISIT/
INSPECTION COMPLETED:
05:00 PM
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Licensing Program Analysts (LPAs) Lilia Hernandez and Amelia Morales conducted an unannounced annual required inspection to the above facility on 07/02/2024. LPAs arrived at the facility at 11:08AM, identified self and met with Blanca Espana, Licensee who guided analyst on a tour of the facility. LPA provided Licensee with a copy of the LIC 126 Entrance Checklist to help facilitate the inspection.

Capacity as specified on the license is being maintained.

LPAs observed 3 infants and 3 children present upon arrival. There was also Staff #1, Staff #2 and adult son present.

Licensee was reminded that all adults 18 and over living or working in the home, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, 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 for a maximum of 5 days or, if the penalty is for a repeat violation, for a maximum of 30 days per person will be assessed if this regulation is violated.

Facility operation hours are Monday to Friday from 8:00AM to 5:30PM.

The family child care home is a 4 bedroom, 2 bathroom, living room, dining room, and kitchen. Current facility sketch reviewed, and Licensee confirmed that 1 bedroom, 1 bathroom and living room are used for providing care and are accessible to children. All other rooms are off-limits and made inaccessible by use of safety gate, and doors remain locked. Rooms inaccessible are also labeled off limits.
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SUPERVISORS NAME: Rita Ramos
LICENSING EVALUATOR NAME: Lilia Hernandez
LICENSING EVALUATOR SIGNATURE: DATE: 07/02/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/02/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 5
Document Has Been Signed on 07/02/2024 04:53 PM - It Cannot Be Edited


Created By: Lilia Hernandez On 07/02/2024 at 04:06 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: ESPANA FAMILY CHILD CARE
FACILITY NUMBER: 197494366

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/02/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
07/16/2024
Section Cited
CCR
102425(j)(2)

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(j) The provider shall supervise infants while they are sleeping and adhere to the following requirements(2) The provider shall check and document the following...
a. Date.
b. Infant’s name.
c. Time of each 15-minute check.
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Per Licensee, safe sleep 15 minute check documentation will be submitted for every infant in care beginning dates: 7/3/2024 - 07/15/2024. Documentation will be submitted via email to LPA by POC due date.
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This requirement is not met as evidenced by:
Based on record review, the licensee did not comply with the section cited above in Licensee was not able to provide documentation to verify that infants are physically checked on every 15 mins which poses a potential health, safety or personal rights risk to persons in care.
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Type B
07/16/2024
Section Cited
CCR102419(d)

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Admission Procedures and Parental and Authorized Representative's Rights. (d) At the time of acceptance of each child into care, the licensee shall provide the child's parent or authorized representative with a copy of the notice Family Child Care Home Notification of Parents’ Rights, LIC 995A...
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Per Licensee, copies of completed LIC995A will be submitted via email to LPA by POC due date.
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This requirement is not met as evidenced by:
Based on record review, the licensee did not comply with the section cited above in 2 of 5 record reviewed missing LIC995A which poses a potential health, safety or personal rights risk to persons 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:Rita Ramos
LICENSING EVALUATOR NAME:Lilia Hernandez
LICENSING EVALUATOR SIGNATURE:
DATE: 07/02/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/02/2024


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
EL SEGUNDO CC NORTH, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME: ESPANA FAMILY CHILD CARE
FACILITY NUMBER: 197494366
VISIT DATE: 07/02/2024
NARRATIVE
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Per Licensee, there is a firearm on the premises. LPAs observed a firearm in the facility and meets all lock and storage regulation requirements. All poisons are kept in a locked storage area. No poisons were observed during the inspection. Detergents, cleaning compounds, medication and other hazardous items are made inaccessible.

There is a working fire extinguisher that was purchased on 02/12/2024. LPAs observed a smoke detector and carbon monoxide detector in the home that were tested and operable.
LPAs also observed adequate heating and ventilation for safety and comfort.

An emergency fire/disaster drill was completed within the last 6 months. Last documented fire/disaster drill was on 02/09/2024.

There are currently 3 infants in care.

Licensee was not able to provide documentation to verify that infants are physically checked on every 15 mins.

LPAs discussed the safe sleep regulations with licensee 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.

LPAs 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. Licensee disclosed that infant equipment is replaced yearly.

Licensee was reminded that children in care are to be supervised at all times and made aware that children shall not be left in parked vehicles. Car seats are used for transportation purposes only and are not used for sleeping children.

The outdoor area accessible to children is the front yard. All other outdoor areas are inaccessible by a gate with a lock. LPAs observed no swimming pool or other bodies of water on the premises.
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SUPERVISORS NAME: Rita Ramos
LICENSING EVALUATOR NAME: Lilia Hernandez
LICENSING EVALUATOR SIGNATURE:

DATE: 07/02/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/02/2024
LIC809 (FAS) - (06/04)
Page: 3 of 5
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO CC NORTH, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME: ESPANA FAMILY CHILD CARE
FACILITY NUMBER: 197494366
VISIT DATE: 07/02/2024
NARRATIVE
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LPAs reviewed a sample of children’s files and observed files were complete with LI700 Identification and Emergency information, and LIC627 Consent for Emergency Medical Treatment. LPAs observed 2 of 5 children files missing LIC995A Notification of Parents Rights. Licensee has a current roster of the children enrolled.

Staff records were reviewed for approved Pediatric First Aid and CPR certification, LIC 9052- Employee Rights, Proof of immunization's 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. Licensee’s Mandated Reporter Training was completed on 04/04/2024. Licensee’s pediatric CPR/First Aid expires on 10/01/2025.

Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02-CCP. 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: https://www.ada.gov/resources/child-care-centers/.

Licensee was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain child care by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.

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.

Based on the LPA’s observations and records review, the following deficiencies listed on the attached LIC 809D (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.
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SUPERVISORS NAME: Rita Ramos
LICENSING EVALUATOR NAME: Lilia Hernandez
LICENSING EVALUATOR SIGNATURE:

DATE: 07/02/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/02/2024
LIC809 (FAS) - (06/04)
Page: 4 of 5
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO CC NORTH, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME: ESPANA FAMILY CHILD CARE
FACILITY NUMBER: 197494366
VISIT DATE: 07/02/2024
NARRATIVE
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During the exit interview, the Licensee, confirmed that there are no Registered Sex Offenders living in the facility and LPAs completed the RSO profile in FAS.

A notice of site visit was given and must remain posted for 30 days.
Exit interview conducted and report was reviewed with the Blanca Espana, Licensee.

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SUPERVISORS NAME: Rita Ramos
LICENSING EVALUATOR NAME: Lilia Hernandez
LICENSING EVALUATOR SIGNATURE:

DATE: 07/02/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/02/2024
LIC809 (FAS) - (06/04)
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