197494397-4-9-2024-58-CC-LHEZ-D472V2-20240409174312

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 197494397
Report Date: 04/09/2024
Date Signed: 04/09/2024 05:43:17 PM

Document Has Been Signed on 04/09/2024 05:43 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:	RODRIGUEZ FAMILY CHILD CARE		FACILITY NUMBER:	197494397
ADMINISTRATOR/ DIRECTOR:	MIRIAM RODRIGUEZ		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(323) 868-1389
CITY:	NORHT HOLLYWOOD	STATE: CA	ZIP CODE:	91602
CAPACITY: 14	TOTAL ENROLLED CHILDREN: 14	CENSUS: 7	DATE:	04/09/2024
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	03:05 PM
MET WITH:	Miriam Rodriguez, Licensee		TIME VISIT/ INSPECTION COMPLETED:	05:50 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	Licensing Program Analyst (LPA) Lilia Hernandez conducted an unannounced annual required inspection to the above facility on 04/09/2025. LPA arrived at the facility at 3:05PM, identified self and met with Miriam Rodriguez, Licensee who guided analyst on a tour of the facility. Also present was Staff #1 (S1). LPA provided Licensee with a copy of the LIC126 Spanish Entrance Checklist to help facilitate the inspection. Facility operation hours are Monday to Sunday from 12:01 AM to 11:59 PM. The family child care home is a 4 bedroom, 2 bathroom, living room, dining room, and kitchen. LPA toured the home inside and outside and a census was taken. 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 door knobs. Per Licensee, there are no firearms or ammunition on the premises. 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 non operating fireplace located in the living room. The living room is made inaccessible by the use of a gate. Per Licensee, fireplace cannot be used and needs repair. LPA observed the fireplace covered with a bronzed fence. There is a working fire extinguisher, smoke detector, carbon monoxide detector and adequate heating and ventilation for safety and comfort. There is currently 1 infant in care. LPA 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. ---page 1 of 3

SUPERVISORS NAME: Rita Ramos
LICENSING EVALUATOR NAME: Lilia Hernandez
LICENSING EVALUATOR SIGNATURE:	DATE: 04/09/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/09/2024

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
EL SEGUNDO CC NORTH, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245

FACILITY NAME: RODRIGUEZ FAMILY CHILD CARE	FACILITY NUMBER: 197494397
	VISIT DATE: 04/09/2024

NARRATIVE

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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.

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 play area in the backyard is fenced and there are no hazards to children present. The outdoor areas accessible to children is accessible by through Room 2 identified as day care area. There is a garage converted ADU on the property with a separate entrance and separate yard. ADU is made inaccessible by a locked gate on the west side of the ADU. (photo taken) Licensee was advised to submit an updated facility sketch to include the off-limit ADU and separate areas in the back yard. LPA observed no swimming pool or other bodies of water on the premises.

Capacity as specified on the license is being maintained. LPA reviewed a sample of children’s files and observed files were complete with immunization records, LIC700 Identification and Emergency information, LIC627 Consent for Emergency Medical Treatment, and LIC995A Notification of Parents Rights . Licensee has a current roster of the children. An emergency fire/disaster drill has been completed and documented within the last 6 months (4/05/2024). Licensee’s Mandated Reporter Training was completed on 07/14/2022. Licensee’s pediatric CPR/First Aid expires on 08/09/2024.

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. All adults who reside or work in the home have a criminal record clearance or exemption. There are no excluded individuals present at this home.

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/. ---page 2 of 3

SUPERVISORS NAME: Rita Ramos
LICENSING EVALUATOR NAME: Lilia Hernandez
LICENSING EVALUATOR SIGNATURE:	DATE: 04/09/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/09/2024

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: RODRIGUEZ FAMILY CHILD CARE	FACILITY NUMBER: 197494397
	VISIT DATE: 04/09/2024

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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.

During the exit interview, the Licensee, confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS.

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.

There were no deficiencies cited during today’s visit.

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

Exit interview conducted and report was reviewed with the Miriam Rodriguez, Licensee.
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SUPERVISORS NAME: Rita Ramos
LICENSING EVALUATOR NAME: Lilia Hernandez
LICENSING EVALUATOR SIGNATURE:	DATE: 04/09/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/09/2024

LIC809 (FAS) - (06/04)

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