197495298-12-15-2023-30-CC-JLAO-CYJLS8-20231215080018

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 197495298
Report Date: 12/14/2023
Date Signed: 12/15/2023 08:00:29 AM

Document Has Been Signed on 12/15/2023 08:00 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:	MEDINA FAMILY CHILDCARE		FACILITY NUMBER:	197495298
ADMINISTRATOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY: 8	TOTAL ENROLLED CHILDREN: 8	CENSUS: 0	DATE:	12/14/2023
TYPE OF VISIT:	Prelicensing	UNANNOUNCED	TIME BEGAN:	12:15 PM
MET WITH:	Beatriz Medina, Applicant		TIME COMPLETED:	03:40 PM

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On 12/07/2023 Licensing Program Analysts (LPA)s Judy Laureano and Ranita Richmond conducted an announced inspection at the above mentioned home for the purpose of a pre licensing inspection. The purpose of this inspection is to ensure the standards for a Family Child Care Home are being met in accordance with California Tittle 22 Regulations and California Health and Safety Codes. LPAs met with applicant Beatriz Medina. Present during today’s inspection was applicant, applicant’s spouse D. Foster and one minor child. Inspection was completed in Spanish.

Per the application, at this time, the ages the applicant wishes to provide services for, are children 4 months to 5 years old- Monday through Friday from 7:00 a.m. to 5:30 p.m. Applicant is not available for overnight or weekend care. Applicant was informed that any changes to ages, hours and days of operation shall be submitted to the department for approval prior to initiation of changes. Applicant is applying for a Small Family Child Care License with a max capacity of 6. Landlord notification is on file.

LPAs toured the home inside and outside. The home is single family unit with a living room, dining room, bedroom 1 and bedroom 2, bathroom, kitchen and laundry room. LPAs observed an attached garage that will be used as extra activity space.

Families will enter the home through the main entrance. LPAs requested a parent board to be added to the living room. Applicant will rearrangement the living room/dining room space to incorporate materials for the day care. LPAs observed an open face heater in the living room and hallway that requires to be barricaded.

Bedroom 1 has been designated as day care space. LPA observed a carbon monoxide detector and smoke detector in the home. LPAs's observed age appropriate materials and toys in the space.

SUPERVISORS NAME: Claudia Escobedo
LICENSING EVALUATOR NAME: Judy Laureano
LICENSING EVALUATOR SIGNATURE:	DATE: 12/14/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/14/2023

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
CCLD Regional Office, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245

FACILITY NAME: MEDINA FAMILY CHILDCARE	FACILITY NUMBER: 197495298
	VISIT DATE: 12/14/2023

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A small hallway was observed that leads to the bathroom and bedroom 2. Bedroom 2 was observed and inspected, bedroom 2 has been designated as OFF LIMITS to the children in care. LPAs reminded applicant that any area designated as OFF LIMITS to the children will need to remain locked/closed during the hours of operations and/or while children are present.

The bathroom that children will use was observed and inspected. A toilet, sink and shower were observed. LPAs requested the toiletries in the shower to me moved up, safety latch added to the cabinet above the toilet, safety latch added to the top cabinet of the sink and remove all toiletries from the sink counter.

Kitchen was observed and inspected. All cabinets were observed to have safety latches. Under the sink cabinet was observed and inspected. Knives and sharp objects were observed in the kitchen drawer; all drawers were observed to have safety latches making the content inaccessible to the children in care. LPAs requested applicant to add stove knob covers. Applicant confirmed that families are responsible for providing meals and snacks. LPAs discussed the importance of making sure a system is in place where dietary restrictions and allergies are noted. LPAs encouraged applicant to contact their local resource and referral agency, Connections for Children, to inquire about local Food Programs and other resources in the community. The kitchen will be used as a walk way to access the garage area and the back yard.

Outside the kitchen the laundry room was observed and inspected. A safety gate was observed making the area inaccessible to the children in care.

The attached garage was observed and inspected. LPAs observed soft mats covering the floor and a variety of age-appropriate materials. Applicant confirmed that napping and eating will take place in the living/dining room area. The area was observed with 2 pack and play, a crib and changing table. Area was observed with high chairs and age appropriate materials.

The back outdoor space is access through the garage area. LPAs observed the back area with outdoor age appropriate toys. A variety of children’s bikes, riding toys and children’s tables and chairs. Shaded area was observed and covered with wood chips and the side needs additional woodchips.

The home is enclosed with a fence and applicant confirmed front yard will be used for day care space. The front yard was observed with a children’s plastic outdoor house and an adult seating area.

SUPERVISORS NAME: Claudia Escobedo
LICENSING EVALUATOR NAME: Judy Laureano
LICENSING EVALUATOR SIGNATURE:	DATE: 12/14/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/14/2023

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: MEDINA FAMILY CHILDCARE	FACILITY NUMBER: 197495298
	VISIT DATE: 12/14/2023

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LPAs discussed Safe Sleep Regulations with licensee and provided the Individual Infant Sleeping Plan LIC 9227 for reference.

The following requirements shall be submitted by 12/28/ 2023. The licensing determination of this application will be reviewed with Licensing Program Manager for final resolution.

The following corrections need to be completed prior to licensure:
1. Rearrange the living room and dining room area to incorporate daycare materials.
2. Add a barricade to the open face heater located in the living room/hallway area
3. Add a parent board to the living room/dining room space.
4. Safety latch added to the top drawer in the bathroom and top cabinet above the toilet.
5. Remove all toiletries from the bathroom counter and move the shower toiletries at a higher level.
6. Stove knob covered to be added.
7. Wood chips added to the outdoor area in the back of the home.

Exit interview was conducted with applicant Beatriz Medina.

Applicants was reminded that all adults 18 and over living in the home, persons who provide care and supervision to children, and staff who have contact with children, 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.

The applicant has not obtained a signed Property Owner/Landlord Consent form (LIC9149). Without this consent, the applicant understands that, once licensed, they can operate with a maximum capacity of 6 [or 12] children. If property owner/landlord consent is obtained in the future, the applicant is advised that a new Application for a Family Child Care Home License (LIC 279) must be submitted with a change of capacity fee of $25, to increase the capacity and provide care to 8 [or 14] children. PIN 22-05-CCP Page Seven

SUPERVISORS NAME: Claudia Escobedo
LICENSING EVALUATOR NAME: Judy Laureano
LICENSING EVALUATOR SIGNATURE:	DATE: 12/14/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/14/2023

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: MEDINA FAMILY CHILDCARE	FACILITY NUMBER: 197495298
	VISIT DATE: 12/14/2023

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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) or (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.

LPAs reviewed with applicant the LIC 311D, Forms/Records to Keep In Your Family Child Care Homes, children’s forms/records, facility forms/records, and information to be posted. Entrance Checklist was provided to the applicant. PIN 22-05-CCP Page Eight

LPA discussed 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. 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.

On this date, 7/24/2023, the California Attorney General - Megan’s Law website was searched for information on sex offenders required to register with local law enforcement under California's Megan's Law. No registered sex offenders were found at the facility addresses. Under state law, some registered sex offenders are not subject to public disclosure; therefore, they may not have been included in this search. However, the Department conducts a monthly cross reference of each address on record for all registered sex offenders against all CCLD facility addresses pursuant to information shared by California DOJ.

Applicant was informed of the MyChildCarePlan.org site, 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.

SUPERVISORS NAME: Claudia Escobedo
LICENSING EVALUATOR NAME: Judy Laureano
LICENSING EVALUATOR SIGNATURE:	DATE: 12/14/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/14/2023

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: MEDINA FAMILY CHILDCARE	FACILITY NUMBER: 197495298
	VISIT DATE: 12/14/2023

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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.

Annual fees must be paid promptly and by the due date or a late fee shall be assessed, and/or the License shall be terminated. (If paying by check please make sure to write facility number on check to ensure that payment is applied to your facility number) The fire extinguisher type 2A-10BC must be serviced annually or as often as necessary. Smoke and carbon monoxide detectors should be checked, and batteries should be replaced. 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

Community Care Licensing Division (CCLD) regularly sends information to licensed facilities, providers, and stakeholders by way of Provider Information Notices (PIN), Program Quarterly Update Newsletters and other important information communication platform. To receive important licensed-related information to licensed facilities, visit the CCLD Important Information website at https://www.cdss.ca.gov/inforesources/community-care-licensing/subscribe and select the Child Care option to receive email communication.

SUPERVISORS NAME: Claudia Escobedo
LICENSING EVALUATOR NAME: Judy Laureano
LICENSING EVALUATOR SIGNATURE:	DATE: 12/14/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/14/2023

LIC809 (FAS) - (06/04)

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