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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197494794
Report Date: 03/07/2023
Date Signed: 03/08/2023 10:35:40 AM

Document Has Been Signed on 03/08/2023 10:35 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:RODRIGUEZ FAMILY CHILD CAREFACILITY NUMBER:
197494794
ADMINISTRATOR:DUNIA E RODRIGUEZFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(323) 338-8664
CITY:LOS ANGELESSTATE: CAZIP CODE:
90044
CAPACITY: 14TOTAL ENROLLED CHILDREN: 9CENSUS: 9DATE:
03/07/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:23 PM
MET WITH:Dunia Rodriguez, LicenseeTIME COMPLETED:
03:55 PM
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Licensing Program Analysts (LPA) Shandra Powell conducted an unannounced 1 Year required inspection at the above facility on 03/07/2023. .LPA arrived at the facility, identified self and met with Dunia Rodriquez, Licensee, LPA provided Licensee with a copy of the LIC 126 Entrance Checklist to help facilitate the inspection. This is a two story home. Licensee stated herself and husband are the only adults living in the home. Facility operation hours are Monday thur Friday 6am to 6pm. Licensee guided analysts on a tour of the facility. LPA observed nine children in care with one assistant whom has been cleared by Care Provider Management Bureau(CPMB)

This two -story home which consists of 3 bedrooms, one bathroom, kitchen, dining room, living room, front yard (fenced) and backyard (fenced). Per Licensee, areas off limits to children and parents include: The entire upstairs gated off at the bottom of the stairs. Licensee stated only an attic is located upstairs. Food is provided by Licensee. Licensee was reminded if children bring food from home it must be labeled with the child’s name and properly stored or refrigerated.

All areas identified on the facility sketch that are accessible for children to use were inspected for safety, comfort, and cleanliness. LPA notice the first bedroom off of the living room is now the main child care room. Children in care have access to the Main Child Care room (bedroom #1) and Bedroom #2 (napping room). Licensee stated Bedroom #3 is off-limits and is made inaccessible by a turn lock.
SUPERVISORS NAME: Karren Starks
LICENSING EVALUATOR NAME: Shandra Powell
LICENSING EVALUATOR SIGNATURE: DATE: 03/07/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/07/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.

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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: RODRIGUEZ FAMILY CHILD CARE
FACILITY NUMBER: 197494794
VISIT DATE: 03/07/2023
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The following was observed and reviewed during this inspection: LPA reviewed required posted documentation. Facility License, Publication (PUB) 394 and Earthquake Preparedness form. Facility records were reviewed for LIC 9040- Facility Roster, LIC 610- Facility Disaster Plan and Disaster and Drill Log, last drill conducted on March 2nd 2023. (Earthquake Drill).
Dual smoke and carbon monoxide detector located above the door way of Bedroom #1 and #2 tested and are operable. Fire extinguisher indicated fully charged however licensee stated does not remember the last time the fire extinguisher was serviced. LPA did not observe service tag and requested licensee to service fire extinguisher and or buy a new one. The home maintains telephone service via cell phone. The home is observed to be clean and orderly. There are toys and other age appropriate material available for children. LPA observed that detergents, cleaning compounds are stored in the kitchen in a locked cabinet, inaccessible to children. Licensee will store all medication in off limit kitchen cabinet with a lock at all time. Isolation area for sick children waiting to be picked up will be located in a separate room not utilized by other children.
Per Licensee there are no firearms or weapons stored in the home. The bathroom that children use is located off the hallway near the entrance of the home. Bathroom was observed to be clean and free of hazards. All sanitizing supplies were observed to be inaccessible to children
Infant Care: Licensee currently cares for infants. LPA informed licensee of the new Safe sleep regulations, including LIC 9227 Infant Sleep Plan for infants under 12 months, 15-minute sleep check documentation for infants 0-24 months, and provided PIN 20-24-CCP. Due to the licensee preferred language being Spanish LPA contacted peer LPA Judy Laureano to speak with licensee regarding Safe Sleep Regulations in Spanish during inspection. During inspection LPA observed a infant napping with a blanket wrapped around him. LPA requested licensee to removed blanket.
SUPERVISORS NAME: Karren Starks
LICENSING EVALUATOR NAME: Shandra Powell
LICENSING EVALUATOR SIGNATURE:

DATE: 03/07/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/07/2023
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
CCLD Regional Office, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME: RODRIGUEZ FAMILY CHILD CARE
FACILITY NUMBER: 197494794
VISIT DATE: 03/07/2023
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Currently, children are using the back yard for outdoor play. The outdoor play area was observed and is fenced. LPA observed that the outdoor yard has toys and other materials for children to play with. LPA observed chickens in located in the back yard maintained in a gated area. Side of the home is available for children to play a gate is located at the end of the side of the home which makes the front yard inaccessible. There are no pools or spas, or other bodies of water .on premises.

Children’s records were reviewed for (LIC) 282- Affidavit Regarding Liability Insurance, Immunizations Records, LIC 700- Identification and Emergency Information, LIC 627- Consent for Medical Treatment, LIC 995A Notification of Parents’ Rights

Licensee and Assistant both have updated Mandated Reporter Certification and CPR on hand. LAP observed during inspection. Facility has a completed roster available for review. LPA also observed the LIC610A Emergency Disaster Plan during inspection.


Incidental Medical Services (IMS):
Incidental Medical Services (IMS) policy was discussed. However the licensee is not providing IMS Services at this time. For IMS information see Evaluator Manual – Regulation Interpretations and Procedures for Family Child Care Homes Section 102417. 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 Center and the ADA, available at: http://www.ada.gov/childqanda.htm
SUPERVISORS NAME: Karren Starks
LICENSING EVALUATOR NAME: Shandra Powell
LICENSING EVALUATOR SIGNATURE:

DATE: 03/07/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/07/2023
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
CCLD Regional Office, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME: RODRIGUEZ FAMILY CHILD CARE
FACILITY NUMBER: 197494794
VISIT DATE: 03/07/2023
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Based on the LPA's observations and records review deficiencies will be cited today 03/07/2023.

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.

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 discussed the safe sleep regulations with licensee and 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. LPA also informed licensee [facility representative] 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.

The licensee is also reminded that Baby walkers, bouncers and similar items are not allowed in child care facilities.

SUPERVISORS NAME: Karren Starks
LICENSING EVALUATOR NAME: Shandra Powell
LICENSING EVALUATOR SIGNATURE:

DATE: 03/07/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/07/2023
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
CCLD Regional Office, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME: RODRIGUEZ FAMILY CHILD CARE
FACILITY NUMBER: 197494794
VISIT DATE: 03/07/2023
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LPA provided the licensee with The Department of Social Services - Community Care Licensing Division website: http://www.ccld.ca.gov.


A notice of site visit and appeal rights were given Notice of Site Visit must remain posted for 30 days.

Exit interview conducted and report was reviewed with licensee, Dunia Rodriquez.

SUPERVISORS NAME: Karren Starks
LICENSING EVALUATOR NAME: Shandra Powell
LICENSING EVALUATOR SIGNATURE:

DATE: 03/07/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/07/2023
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 03/08/2023 10:35 AM - It Cannot Be Edited


Created By: Shandra Powell On 03/07/2023 at 02:59 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: RODRIGUEZ FAMILY CHILD CARE
FACILITY NUMBER: 197494794

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/07/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102425(j)(2)(D)
Infant Safe Sleep
Documentation shall be maintained in the infant’s file and be available to the Department for review. Documentation shall include the following:

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, interview, and record review, the licensee did not comply with the section cited above which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 03/10/2023
Plan of Correction
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Licensee will complete a log for all Infants under the age of 2 years old and check on all infants every 15 mins. Licensee will send a copy of each childs log to LPA Powell by POC date of 03/10/2023.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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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:Karren Starks
LICENSING EVALUATOR NAME:Shandra Powell
LICENSING EVALUATOR SIGNATURE:
DATE: 03/07/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/07/2023


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