197495273-6-22-2023-30-CC-LCLN-CT2QE7-20230622120552

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 197495273
Report Date: 06/22/2023
Date Signed: 06/22/2023 12:06:02 PM

Document Has Been Signed on 06/22/2023 12:06 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:	MIRANDA FAMILY CHILDCARE		FACILITY NUMBER:	197495273
ADMINISTRATOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY: 8	TOTAL ENROLLED CHILDREN: 8	CENSUS: 0	DATE:	06/22/2023
TYPE OF VISIT:	Prelicensing	UNANNOUNCED	TIME BEGAN:	08:30 AM
MET WITH:	YURITZI MIRANDA, LICENSEE		TIME COMPLETED:	12:30 PM

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On 06/22/2023 Licensing Program Analyst (LPA) Lisa Clayton conducted an ANNOUNCED PRE-LICENSING INSPECTION with applicant Yuritzi Miranda. There were no children in care. The home was toured with the applicant for a health and safety inspection. Hours of operation are Monday through Friday 8am - 5pm. Applicant will provide water and and am/pm snacks as needed.

This is a single-family home which consists of the following: 4 bedrooms, 2 full bathrooms, living room, dining room, kitchen, laundry room, family room, fenced front and backyard, and detached garage.

The applicant has requested the OFF-LIMIT AREAS are as follows: the kitchen, bedroom #2 (office), laundry room, family room, bedroom #4, bathroom #2 and the detached garage all of which is inaccessible to children in care by child safety gates, closed and/or locked doors and visual supervision.

The Applicant has requested the following rooms be ON-LIMITS: the living room (day care room) dining room (day care eating room), bedroom #1 (day care class/nap room), bathroom #1, bedroom #3 (day care room), and the fenced back yard. The ISOLATION AREA will be in the living room.

The home is neat and clean with heating and ventilation for safety and comfort. Per applicant, there are no firearms in the home. A copy of the lease was reviewed and shows control of property. LPA Clayton confirmed the FCCH has a working phone 949-689-7079.

There are no pools, jacuzzi, hot tubs, ponds, or bodies of water on the premises. Any poisons, detergents/cleaning compounds, medication and hazardous items that can pose a danger to children are inaccessible.

see LIC 809C

SUPERVISORS NAME: Karren Starks
LICENSING EVALUATOR NAME: Lisa Clayton
LICENSING EVALUATOR SIGNATURE:	DATE: 06/22/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/22/2023

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: MIRANDA FAMILY CHILDCARE	FACILITY NUMBER: 197495273
	VISIT DATE: 06/22/2023

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The home has a fully charged 2A:10: BC Fire Extinguisher, and 2 smoke detectors. Applicant CPR/First Aid certificate is current and expires March 2025. The applicant’s Mandated Reporter Training requirement expires May 2025. The applicant is in compliance with the immunization law which pertains to day care providers.

LPA provided licensee with a copy of the the safe sleep regulations with applicant 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.

Safe Sleep Practices were discussed with the applicant. When putting infants down to nap or long periods of sleep, children must be placed on their backs, in a crib, on a firm mattress with nothing in the crib except for a fitted sheet over the mattress. The child must be physically monitored and documented every 15 minutes, check their temperature, color of skin, and breath.

LPA also informed applicant 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.

California Law requires Family Child Care Home applicants to report unusual incidents or injuries to children in care to child's parents and to the Department of Social Services using the Unusual Incident/Injury form (LIC 624). Incidents must be reported within 24 hours by phone, fax, or electronic mail. Roster of the children must be properly maintained, and fire/disaster drill every six months must be documented. Please report Telephone number changes and/or if you move from home.

The Applicant was informed 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 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 applicants and the public. CCAP’s direct contact information is as followed: Phone number: (916) 654-1541

Email: childcareadvocatesprogram@dss.ca.gov

SUPERVISORS NAME: Karren Starks
LICENSING EVALUATOR NAME: Lisa Clayton
LICENSING EVALUATOR SIGNATURE:	DATE: 06/22/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/22/2023

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: MIRANDA FAMILY CHILDCARE	FACILITY NUMBER: 197495273
	VISIT DATE: 06/22/2023

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Update on Incidental Medical Services (IMS):
Facilities that provide Incidental Medical Services (IMS) must identify those services in their facility’s Plan of Operation and submit an updated Plan of Operation to the Department.
IMS Include: Blood-Glucose Monitoring for Diabetic Children, Administering Inhaled Medication, Administering Epinephrine Auto-Injectors, Glucagon Administration, Gastrostomy Tube Care (G-tube care), Insulin Injections Administration, Anti-Seizure Administration, and Emptying an Ileostomy Bag. Incidental Medical Services (IMS) policy was discussed. For further 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

LPA Clayton discussed and provided applicant with the documents listed below:

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 9927 Individual Infant Sleeping Plan
· LIC 995A Notification of Parent’s Rights
· LIC 613A Personal Rights

Immunization Record

SUPERVISORS NAME: Karren Starks
LICENSING EVALUATOR NAME: Lisa Clayton
LICENSING EVALUATOR SIGNATURE:	DATE: 06/22/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/22/2023

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: MIRANDA FAMILY CHILDCARE	FACILITY NUMBER: 197495273
	VISIT DATE: 06/22/2023

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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 Property Owner/Landlord Consent Form
· LIC 9151 Property Owner/Landlord Notification Form
· Proof of current pediatric CPR and First Aid Certificates
· Copy of your deed or lease/rental agreement
· Documentation of Fire and Disaster drills
· Proof of immunizations against pertussis (TDAP), measles (MMR), and influenza
· Mandated Reporter certificate – www.mandatedreporterca.com – must be renewed every two (2) years.

FORMS TO BE POSTED

· LIC203 Facility License
· LIC 610A Emergency Disaster Plan
· LIC 9148 Earthquake Preparedness Checklist
· PUB394 Notification of Parents Rights Poster

In addition, LPA Clayton informed applicant of the following:

o There is an effective 24/7 ban on smoking tobacco in a home that is licensed as a family day care home, and in those areas of the family day care home where children are present.
o Children and Staff records must be maintained and updated as needed and must be available for review by the Department.
o Saucer chairs, bouncers, walkers, or any similar items are prohibited.
o 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.
o LPA provided and advised the applicant how to access forms, regulations and quarterly updates on the Child Care Licensing website at: www.ccld.ca.gov

SUPERVISORS NAME: Karren Starks
LICENSING EVALUATOR NAME: Lisa Clayton
LICENSING EVALUATOR SIGNATURE:	DATE: 06/22/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/22/2023

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: MIRANDA FAMILY CHILDCARE	FACILITY NUMBER: 197495273
	VISIT DATE: 06/22/2023

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The applicant is reminded any structural changes to the home or additions to the childcare facility must be reported to Community Care Licensing. Applicant was reminded of Departments inspection authority, with or without any notice.

Based on today's inspection the following is required prior to issuing a license:

*gate on the north side the home, in the back yard
*gate behind the garage
*carbon monoxide detector (kitchen and hallway)
* smoke detector in the hallway

Corrections inspection scheduled for Monday 06/26/2023.

An exit interview was conducted, and a copy of this report was provided to applicant. A notice of site visit was provided and must remain posted for 30 days.

SUPERVISORS NAME: Karren Starks
LICENSING EVALUATOR NAME: Lisa Clayton
LICENSING EVALUATOR SIGNATURE:	DATE: 06/22/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/22/2023

LIC809 (FAS) - (06/04)

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