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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198001753
Report Date: 08/23/2022
Date Signed: 08/23/2022 02:06:53 PM

Document Has Been Signed on 08/23/2022 02:06 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
CCLD Regional Office, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME:VERA, ANA E. & MARIO FAMILY DAY CAREFACILITY NUMBER:
198001753
ADMINISTRATOR:VERA, ANA E. & MARIOFACILITY TYPE:
810
ADDRESS:TELEPHONE:
3232326833
CITY:LOS ANGELESSTATE: CAZIP CODE:
90011
CAPACITY: 12TOTAL ENROLLED CHILDREN: 12CENSUS: 11DATE:
08/23/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:39 AM
MET WITH:Ana Vera, LicenseeTIME COMPLETED:
02:16 PM
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On Tuesday, August 23 2022 at 10:39 a.m., Licensing Program Analyst (LPA) Mayra Rivera conducted an unannounced annual inspection and met with Licensee Ana Vera who guided LPA Rivera on a tour of the facility.

During the inspection, 2 infants and 3 preschool children were present and assistant. Family members residing in the home has been discussed with licensee and have obtained a criminal record clearance or exemption. Operating hours are Monday to Friday, 5:00 AM to 6:00 PM and care for children ages 0 to 13 years.

This facility is a one-story home that consists of three bedrooms, two bathrooms, kitchen, living room, front yard and backyard (fenced and gated). Areas that are accessible to children and identified on the facility sketch were inspected by LPA Rivera; living room, 2 bathrooms, bedroom #1 (across from kitchen) and backyard. Areas off limits to children include- bedroom, # 2 next to bedroom 1 and front yard.

At approximately 10:50 AM LPA Rivera inspected the facility for safety, comfort, cleanliness, ventilation and working phone (cell phone and land line). For ventilation, LPA Rivera observed central AC/heater and vents located on the top ceiling walls. LPA observed the furniture and children materials to be in good condition and age appropriate. LPA observed a safety gate barrier installed between the kitchen and living room to prevent children entering the kitchen area.

At approximately 11:04 AM, LPA Rivera entered the restrooms and observed toilets, hand washing sinks hand soap and paper towels. LPA observed personal items such as mouth wash, tooth paste, hydrogen peroxide on top of the shelf making it inaccessible for the preschool children to reach but reminded her school age children may be able to reach and advice to place the items behind the cabinet with a child proof lock. LPA observed the restroom to be in good condition

SUPERVISORS NAME: Karen Chambers
LICENSING EVALUATOR NAME: Mayra Rivera
LICENSING EVALUATOR SIGNATURE: DATE: 08/23/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/23/2022
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, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME: VERA, ANA E. & MARIO FAMILY DAY CARE
FACILITY NUMBER: 198001753
VISIT DATE: 08/23/2022
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At approximately 11:16 AM LPA observed cleaning compounds items stored inside the bottom kitchen sink cabinet. LPA observed child proof lock in place making it inaccessible to children to open the bottom sink cabinet. Knives LPA observed the items on top of the kitchen counter making it inaccessible for the preschool children to reach but reminded her school age children may be able to reach and advice to place the items behind the cabinet with a child proof lock. For drinking water, licensee provides sippy cups and water bottles.

LPA Rivera asked if there are any pet, firearms, weapons or bodies of water. Licensee stated she has no pets, no body of waters, no firearms, no weapons. LPA did not observe pets, firearms, weapons, nor bodies of water. Licensee was advised that if any poisons (ex; drano, rat poison or items with skull hazard symbol), firearms and weapons are purchased, it is required to be locked with a key or combination lock and firearm and ammunition must be stored separately.



At approximately 11:24 AM LPA Rivera observed the correct 2A10BC fire extinguisher located between the kitchen and living room and the valve on the green area indicating fully charged and serviced on 3/11/22. LPA tested the smoke detector located in the living room and also tested the carbon monoxide detector located in the hallway. LPA heard the sounds of the detectors. and are in operable condition. LPA observed emergency kit/first aid kit in the living room and hallway and the kits are fully equipped with bandages, adhesives, gauzes, roller bandages. LPA observed the fire/earthquake drill log and last drill conducted on 8/13/22.

At approximately 11:35 AM, LPA Rivera inspected the outdoor area used by children for safety, comfort and cleanliness. LPA observed play equipment to be in good condition and age appropriate. LPA observed two sheds closed and locked with a keypad lock. LPA also observed the side gate between the bbq area (behind wall) and neighbor wall to be broken. LPA advised to replace the gate to prevent child access to the area. The other side where the AC compressor is located, LPA advised to place a gate barrier to prevent children access to the area. LPA observed poisons such as weed killer solution inside the bbq area and reminded licensee poisons are stored in an area with a lock. Children did not have access to the bbq area because there is a gate barrier installed and preschool children cannot move the latch. LPA observed a water dispenser with disposable cups

LPA observed Licensees Ana and Mario Vera Pediatric First Aid/ CPR certification with expiration date 7/2024, Licensees has proof of immunization against Pertussis, MMR and Influenza declination. Licensee has completed the AB 1207 Child Abuse Mandated Certificate dated 8/20/22.

SUPERVISORS NAME: Karen Chambers
LICENSING EVALUATOR NAME: Mayra Rivera
LICENSING EVALUATOR SIGNATURE:

DATE: 08/23/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/23/2022
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, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME: VERA, ANA E. & MARIO FAMILY DAY CARE
FACILITY NUMBER: 198001753
VISIT DATE: 08/23/2022
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Licensee was advised that the mandated reporter training must be completed every 2 years, and is available at www.mandatedreporterca.com

At approximately 11:50 AM LPA reviewed the roaster, licensee, staff #1 and child #1 and child #2 files. LPA observed child # 1 file to be completed and child #2 missing safe sleep log and LIC 9227 Individual Infant Sleeping Plan. Staff #2 missing AB 1207 Child Abuse Mandated Reporter Certificate. LPA provided and explain the LIC 9227 Individual Infant Sleeping Plan and sleep log.

LPA observed LIC 610A Emergency Disaster Plan, Pub 394 Notification of Parents Rights, LIC 999 Facility sketch, child car seat law posted on a bulletin board located in the hallway.



Safe Sleep: LPA discussed the safe sleep regulations with licensee Ana Vera 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 licenser Ana Vera of the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at also explained to licensee that car seat, stroller are only and only for https://www.cpsc.gov/ and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment.

LPA Rivera also reviewed Sudden Infant Death Syndrome (SIDS), Never Shake A Baby, and Lead Exposure information with licensee. LPA transportation, highchair is only and only for feeding and stated items cannot be misused. No smoking, No infant walkers, No Johnny jumpers, No saucer chairs, No trampolines and any other item that falls into this category are not permitted in a family child care facility.



Medication: 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

SUPERVISORS NAME: Karen Chambers
LICENSING EVALUATOR NAME: Mayra Rivera
LICENSING EVALUATOR SIGNATURE:

DATE: 08/23/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/23/2022
LIC809 (FAS) - (06/04)
Page: 3 of 4
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME: VERA, ANA E. & MARIO FAMILY DAY CARE
FACILITY NUMBER: 198001753
VISIT DATE: 08/23/2022
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Criminal Record Statement: Licensee Ana Vera 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.

Licensee has been given technical violations for child #2 missing LIC 9221 Safe Sleep Plan and Sleep Log and staff #1 not having AB 1207 Child Abuse Mandated Reporting Certificate.

During the inspection, licensee installed a gate barrier to prevent children going to the side yard where the AC compressor is located and removed the weed solution and placed it inside the locked shed. LPA Rivera collected copies of Licensees Ana Vera and Mario Vera; Pediatric First Aid, CPR Adult-Child-Infant, AB 1207 Child Abuse Mandated Certificate, MMR, TDAP, Influenza Declination, LIC 9108 Statement of Acknowledging Requirement to Report Child Abuse, LIC 9151 Property Owner /Land loard Notification, LIC 508 Criminal Record Statement and proof of property ownership mortgage statement.

Approximately 1:30 p.,m 6 school age children arrived. Making it a capacity of 11 children present.

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

Exit interview conducted and report was reviewed with the licensee Ana Vera.

SUPERVISORS NAME: Karen Chambers
LICENSING EVALUATOR NAME: Mayra Rivera
LICENSING EVALUATOR SIGNATURE:

DATE: 08/23/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/23/2022
LIC809 (FAS) - (06/04)
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