<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197495018
Report Date: 03/24/2022
Date Signed: 03/28/2022 08:15:45 AM

Document Has Been Signed on 03/28/2022 08:15 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:PADILLA FAMILY CHILD CAREFACILITY NUMBER:
197495018
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: DATE:
03/24/2022
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Cindy Padilla and Elva Rosa SanchezTIME COMPLETED:
01:00 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
On 3/24/2022 Licensing Program Analyst (LPA) Judy Laureano conducted an announced inspection with applicants Cindy Padilla and Elva Rosa Sanchez for the purpose of a pre-licensing inspection of 3502 W. 135th Street, Hawthorne, CA 90250. The purpose of this inspection is to ensure the standards for a Family Child Care Home are being met in accordance to California Tittle 22 Regulations and California Health and Safety Codes.

The applicants are applying for a Small Family Childcare License with a max capacity of 8. Rental Agreement and Landlord Notification is currently on file. Currently living in the home is applicants, two adults and one minor child. Applicants are both Spanish speakers and inspection was conducted in Spanish.

Per the application, currently, the ages the applicants wishes to provide services for children 2 months to 12 years old with the hours of operation of 7:00 a.m. to 5:30 p.m. Monday through Friday. Applicants were informed that any changes to ages, hours and days of operation shall be submitted to the department for approval prior to initiation of changes.

The home is a single home unit with 3 bedrooms, 1 bathroom, 1 kitchen, living room, dining room and laundry room. The home has a front yard and a back yard enclosed with black self-latching gate. Home is located in the corner of Cerise and 135th Street.

Parents will access the home through the main entrance. Entering the home through the main entrance, you are led to the living room and dining room that have been designated for the day care. Living room was observed to have a mounted television next to a parent board. A highchair and changing table were observed in the space. LPA observed the parent board with all the necessary posting. LPA observed children’s size tables and chairs, children’s cubbies and variety of age appropriate toys. LPA observed a variety of children’s books and musical toys in the space. Applicants confirmed that children will eat

SUPERVISORS NAME: Maureen Neal
LICENSING EVALUATOR NAME: Judy Laureano
LICENSING EVALUATOR SIGNATURE: DATE: 03/24/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/24/2022
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 6
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: PADILLA FAMILY CHILD CARE
FACILITY NUMBER: 197495018
VISIT DATE: 03/24/2022
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
26
27
28
29
30
31
32
Page 2
and nap in the living room/dining area. All electrical outlets were covered, and LPA observed applicants test the carbon monoxide and smoke detector.

Next to the dining room area, LPA observed Bedroom 1 which has been designated as OFF LIMITS to the children in care. Applicants confirmed that the bedroom door will remain locked during hours of operations.

Next to the dinning room, a small hallway leads you to bedroom 2 which has been designated to be used as a nap room for the younger children. LPA observed a dresser with a safety latch and a pack and play. LPA observed 6 napping cots in the area for the older children. LPA discuss Safe Sleep Regulations with applicants. LPA observed applicants test the carbon monoxide and smoke detector.

Next to bedroom 2, bedroom 3 was observed to be OFF LIMIT to the children in care. LPA observed a small terrier Mix dog in the space. Applicants confirmed the dog will be kept in the bedroom away from the children in care. Applicants provided LPA with proof of current Rabies Vaccination.

The bathroom that children will use is located next to bedroom 3. A toilet, sink, cabinets and shower were inspected. All electric outlets were covered and cabinets were secured with a safety latch. LPA discussed COVID-19 recommendation such as using paper towels and displaying a handwashing sign for children to view. LPA observed the First Aid kit located in the bathroom cabinets.

The kitchen was observed to have a safety gate making the area in accessible to the children in care. Kitchen cabinets were observed to have safety latches. The stove, refrigerator, sink and counter space area were observed and inspected. Knifes and sharp object were observed to be made inaccessible to the children in care. Applicant confirmed that home will be providing meals and snacks. LPA discuss food preparation, storage and ensuring a log and information regarding dietary restrictions and allergies are kept up to date. As a COVID precautions, LPAs advised applicants to use disposable paper goods. LPA observed the working fire extinguisher mounted in the doorway between the kitchen and laundry room.

SUPERVISORS NAME: Maureen Neal
LICENSING EVALUATOR NAME: Judy Laureano
LICENSING EVALUATOR SIGNATURE:

DATE: 03/24/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/24/2022
LIC809 (FAS) - (06/04)
Page: 4 of 6
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: PADILLA FAMILY CHILD CARE
FACILITY NUMBER: 197495018
VISIT DATE: 03/24/2022
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
26
27
28
29
30
31
32
Page 3
Next to the kitchen, laundry room was observed. LPA observed detergent and cleaning supplies in the top cabinet away from the reach of children.

Back yard was observed to be enclosed with a tall wooden gate that is kept locked during the hours of operation. LPA observed a variety of children’s outdoor toys such as plastic cars and other smaller trucks. The back yard is accessible through the laundry room. LPA observed a large wooden shed with a lock on the side of the home. Applicants confirmed the shed will remain locked during all times.

The front yard and side of the home will be used as outdoor space. The area was observed to be covered with grass and a variety of outdoor equipment was observed. In the front yard, LPA observed a patio set and a plastic shed that is used to store earthquake supplies.

The following areas are OFF LIMITS to the children in care:
1. Bedroom 1- door will remain locked during the hours of operations.
2. Bedroom 2- door will remain locked during hours of operations.
3. Wooden Shed located in the side of the home and front plastic shed.

No corrections were observed during today’s inspections. Exit interview was conducted with applicants Cindy Padilla and Elva Rosa Sanchez. The licensing determination of this application will be reviewed with Licensing Program Manager for final resolution.

The following was discussed with the applicant:


Applicant was made aware of The Child Care Advocate Program (CCAP) that is administered from within the Community Care Licensing Division. CCAP participates in many community activities and special projects in order to disseminate information on the State’s licensing role, provide information to the public and parents on childcare licensing, and provide many other helpful resources to the licensees and the public. CCAP’s direct contact information is as followed: Phone number: (916) 654-1541
Email Address: childcareadvocatesprogram@dss.ca.gov

Immunizations: Commencing September 1, 2016, SB 792, prohibits a person from being employed or volunteering at a childcare facility or family day care if he or she has not been immunized against influenza, pertussis and measles. LPA discussed the influenza waiver during the inspection.
SUPERVISORS NAME: Maureen Neal
LICENSING EVALUATOR NAME: Judy Laureano
LICENSING EVALUATOR SIGNATURE:

DATE: 03/24/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/24/2022
LIC809 (FAS) - (06/04)
Page: 6 of 6
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: PADILLA FAMILY CHILD CARE
FACILITY NUMBER: 197495018
VISIT DATE: 03/24/2022
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
26
27
28
29
30
31
32
Mandated Reporter Training: Beginning on January 1, 2018, AB 1207, requires all licensed providers, applicants, directors and employees to complete training as specified on their mandated reporter duties and to renew their training every two years. Volunteers are encouraged but not required to take the training. Website: www.mandatedreporterca.com. Licensee was reminded of their responsibility to report suspected child abuse.


Mandatory Forms for the children’s files and provider’s files were discussed. Applicant was referred to LIC 311D: Records To Keep in Your Family Child Care.

FORMS TO BE POSTED


LIC203 Facility License
LIC 610A Emergency Disaster Plan
LIC 9148 Earthquake Preparedness Checklist
PUB394 Notification of Parents Rights Poster
Children’s Records Requirements:
LIC 700 Identification and Emergency Information
LIC 627 Consent for Emergency Medical Treatment
LIC 282 Affidavit Regarding Liability Insurance
LIC 9150 Parent Notification Additional Children in Care
LIC 9166 Consent/Verification for Nebulizer Care
CDPH 286 (Immunization Blue Card) with Immunization record
PUB 72- Family Child Care Consumer Guide
LIC 995A Notification of Parent’s Rights
LIC 995E Caregiver Background Check Process
LIC 9212 Family Child Care Consumer Awareness Information
PM 286 California School Immunization Record (blue card)-http://www.dhs.ca.gov/publications/forms/immunization.htm
LIC 9224 Acknowledgement of Receipt of Licensing Report, if applicable.
SUPERVISORS NAME: Maureen Neal
LICENSING EVALUATOR NAME: Judy Laureano
LICENSING EVALUATOR SIGNATURE:

DATE: 03/24/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/24/2022
LIC809 (FAS) - (06/04)
Page: 2 of 6
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: PADILLA FAMILY CHILD CARE
FACILITY NUMBER: 197495018
VISIT DATE: 03/24/2022
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
26
27
28
29
30
31
32
Facility Records:
LIC 624B Unusual Incident/Injury Report
LIC 9040 Child Care Facility Roster
LIC 9052 Employee Rights,
LIC 9108 Statement Acknowledging Requirement to Report Child Abuse
LIC 9149 Landlord Consent Form, if you plan to care for more than 6 for Small or 12 for Large
LIC 9151 Property Owner/Landlord Notification Form
Personnel Records as required in Tittle 22, Division 12, Chapter 3, Section 102416.1, including but not limited to proof of current pediatric CPR and First Aid Certificates, Preventative Health certificate and criminal record information.
Copy of your deed or lease/rental agreement
Documentation of Fire and Disaster drill
Proof of immunization's against pertussis (TDAP), measles (MMR), and influenza
Mandated Reporter certificate – www.mandated reporterca.com – renewed every two years.

Licensee was made reminded that it is the licensee’s, as well as anyone who assists in providing care responsibility to know the regulations. Licensee was also encouraged to read the Child Care quarterly updates every season as they come out to stay informed of any changes or updates to statutes and regulations.

Applicant was advised that regulation prohibits the smoking of tobacco in a private residence licensed as a family childcare home during the hours of operation.



Applicant was made aware that state law prohibits baby walkers, bouncy seats, exer-saucers and any other items that fall into that category. Applicant was also reminded that only children who are eating may be in highchairs and that car seats are utilized only for transportation.

LPA discussed the safe sleep regulations with applicants Cindy and Elva 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.
SUPERVISORS NAME: Maureen Neal
LICENSING EVALUATOR NAME: Judy Laureano
LICENSING EVALUATOR SIGNATURE:

DATE: 03/24/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/24/2022
LIC809 (FAS) - (06/04)
Page: 3 of 6
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: PADILLA FAMILY CHILD CARE
FACILITY NUMBER: 197495018
VISIT DATE: 03/24/2022
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
26
27
28
29
30
31
32
LPA also informed applicants 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.

Incidental Medical Services (IMS) policy was discussed. 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 Centers and the ADA, available at: http://www.ada.gov/childqanda.htm

· Applicant 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.


· In the absence of the licensee a qualified adult must be present supervising the children; a qualified adult is an individual who has a valid and current adult/infant CPR & Pediatric First Aid certification and a valid criminal record clearance associated to the facility license. · A current roster of children enrolled must be available and maintained for a period of three years, even after children no longer are attending the facility.

· Changes should be reported the to the Department as soon as they occur such as construction and remodeling, telephone number changes and/or if you move from home.

· Reporting requirements: Applicant must report any unusual incident or injuries to the Child Care Regional office by telephone within 24 hours and in writing within 7 days. Applicant was provided with LIC 624 as a reference.

· Fire and safety drills must be performed every six months and documented for review by the Department.

· All adults living and working in the home shall be made of aware of the Departments right to inspection authority, which includes but not limited to the right to enter the home when children are being cared for, interview children and adults and review documentation.

· LPA advised the applicant how to access forms, regulations and quarterly updates on the Child Care Licensing website at: www.ccld.ca.gov

SUPERVISORS NAME: Maureen Neal
LICENSING EVALUATOR NAME: Judy Laureano
LICENSING EVALUATOR SIGNATURE:

DATE: 03/24/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/24/2022
LIC809 (FAS) - (06/04)
Page: 5 of 6