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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198003557
Report Date: 11/15/2022
Date Signed: 11/15/2022 01:50:10 PM

Document Has Been Signed on 11/15/2022 01:50 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 CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME:RODRIGUEZ FAMILY CHILD CAREFACILITY NUMBER:
198003557
ADMINISTRATOR:RODRIGUEZ, INGRIDFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(818) 802-6015
CITY:GLENDALESTATE: CAZIP CODE:
91202
CAPACITY: 14TOTAL ENROLLED CHILDREN: 9CENSUS: 6DATE:
11/15/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
08:45 AM
MET WITH:Ingrid Rodriguez, LicenseeTIME COMPLETED:
02:00 PM
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Licensing Program Analyst (LPA) Anomeh Eivazian conducted an unannounced annual inspection to the above facility on 11/15/2022. LPA arrived at the facility at 8:45 AM and met with Ingrid Rodriguez, Licensee who guided analyst on a tour of the facility. Also present during this inspection, was Jocelyne Rodriguez, Licensee’s Assistant. At 12:00 PM Cassaundra Rodriguez arrived to the facility. Per licensee, Ingrid Rodriguez facility hours are Monday to Friday from 7:00 a.m. to 5:30 p.m. LPA provided a copy of Entrance Checklist—Family Child Care Home (LIC126) to licensee.

This is a one story home located on the first level which consists of 2 bedrooms, 1 bathroom, kitchen, living room, converted garage in the backyard (playarea), front yard and back yard (fenced). The children use the living room, 1 bathroom in the main house, 1 bedroom, detached converted garage (daycare area), and backyard yard (fenced). Per licensee, areas off limits to children and parents include: 1 bedroom and front yard. Parents enter the facility through back door which leads to the backyard. LPA did not observe any stairs in the home during this inspection. During this inspection individuals who reside in the home were discussed with license at 9:00 AM and notes on Confidential Name List (LIC811) and attached to this report.

Upon LPA's arrival to the facility LPA observed 6 children were in the detached converted garage (daycare limited activity area) eating cheerios. LPA observed children napping cots and two pack n'plays in the detached garage. Per licensee, children sleep and eat in the detached converted garage. Licensee was advised that the converted garage cannot be used as a primary area to care for children due to not being permitted through the City of Glendale. Converted garage can only and only being used to limited activity only. Children are required to eat and sleep in the main home. Fire clearance to use the converted garage for limited activity only was granted on 10/16/19.
REPORT CONTINUES ON NEXT PAGE 1 of 5
SUPERVISORS NAME: Christina Gabelman
LICENSING EVALUATOR NAME: Anomeh Eivazian
LICENSING EVALUATOR SIGNATURE: DATE: 11/15/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/15/2022
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, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME: RODRIGUEZ FAMILY CHILD CARE
FACILITY NUMBER: 198003557
VISIT DATE: 11/15/2022
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All areas identified on the facility sketch that are accessible for children to use were inspected for safety, comfort, and cleanliness. At 9:10 a.m., Licensee took this LPA on a tour of the home. LPA was toured through the interior starting with the living room and observed children toys in the living room. Next LPA

All areas identified on the facility sketch that are accessible for children to use were inspected for safety, comfort, and cleanliness. At 9:10 a.m., Licensee took this LPA on a tour of the home. LPA was toured through the interior starting with the living room and observed children toys in the living room. Next LPA toured the one bedroom and observed two beds in the bedroom. Next LPA toured the one bathroom and did not observe any hazards. LPA observed a safety gate was installed to the kitchen to make the kitchen inaccessible to the children. Per licensee, children only walk through the kitchen to go to the backyard. Next LPA toured the kitchen and observed cleaning compounds and sharp times were placed on the top of the fridge. Next LPA toured the detached converted garage (limited activity space) and observed a changing table, children toys, tables, chairs, napping cots, and two pack n' plays in the detached converted garage. LPA observed the required 2A 10BC fire extinguisher was anchored to the wall in the detached garage. It was purchased on 11/02/2022 as read by LPA from the receipt. Licensee tested the carbon monoxide and smoke detectors in the detached garage. It sounded off the alarms and heard by LPA to be functional. Detergents, cleaning compounds, medications, and other items which could pose a danger to children were observed to be inaccessible to children. The licensee states that there are no poisons in the home and understands that storage areas for poisons must be locked with a key or combination lock. During this inspection three children were dropped off and total of 9 children, four being infants were present in the facility.

Next LPA toured the backyard fenced. Currently, children are using the back yard for outdoor play time. The outdoor play area was observed to be fenced. LPA observed that the outdoor yard has toys and other materials for children to play with. There is a play structure and swings in the backyard. LPA did not observe any objects that can pose a danger to children on the outdoor yard. Per licensee, children eat outside from time to time. The licensee states that supervision is always provided.

Per Licensee, Ingrid Rodriguez at 10:13 a.m there are no weapons, firearms, pools, spas, hot tubs, fish ponds, or similar bodies of water on the premises. There is a dog on the premises which is not accessible to the children.
The licensee was observed to be operating within the licensed capacity and is not exceeding the required limitations during this inspection. All adults present have obtained a criminal record clearance on Licensing Information System (LIS). Per licensee, currently she has 2 assistants.
REPORT CONTINUES ON NEXT PAGE 2 of 5
SUPERVISORS NAME: Christina Gabelman
LICENSING EVALUATOR NAME: Anomeh Eivazian
LICENSING EVALUATOR SIGNATURE:

DATE: 11/15/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/15/2022
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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 CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME: RODRIGUEZ FAMILY CHILD CARE
FACILITY NUMBER: 198003557
VISIT DATE: 11/15/2022
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 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.

The licensee and other personnel did not completed training on preventive health practices including Pediatric First Aid and CPR. The licensee's completed Pediatric First Aid and CPR on line and it will be expire on 04/12/21. LPA informed licensee that Pediatric First Aid and CPR training are required to be in person. . Licensee, Ingrid Rodriguez completed required mandated reporter training on 10/07/2019 which has not been renewed every two years. There are first aid supplies available on the premises in the detached garage. LPA advised licensee that if a child shows signs of illness he/she/they shall be separated from other children.

At 10:50 a.m., facility roster was reviewed and completed. Per licensee currently there are 9 children enrolled. LPA reviewed 5 children's records, including emergency information from 9 enrolled children, and all 5 reviewed files were completed.

The licensee has proof of immunization against influenza, pertussis, and measles. Licensee's assistant, Jocelyne Rodriguez is exempt from immunization. Licensee will submit a Doctor note by 12/16/202.

All homes shall conduct fire and disaster drills at least once every six months, and document the date and time of each drill. Last drill documented was conducted on 10/10/2022. Emergency Disaster Plan, Parent’s Rights Poster and the Facility License were observed to be posted at the wall by the entrance.

LPA did not observe the following items during the inspection: Infant Walkers, Johnny Jumpers, Saucer Chairs, Trampolines and/or any other item that fall into these categories are not permitted in a family child care facility. Smoking is prohibited in a licensed Family Child Care Home. Per Licensee, no one smokes in the home. There is telephone service via a cellphone that is used and the cellphone stays at the facility during operation hours. Per licensee she does not carry liability insurance or a bond in accordance with standard established by Family Child Care statue. Signed statements (LIC282) on 5 reviewed files.
REPORT CONTINUES ON NEXT PAGE 3 of 5
SUPERVISORS NAME: Christina Gabelman
LICENSING EVALUATOR NAME: Anomeh Eivazian
LICENSING EVALUATOR SIGNATURE:

DATE: 11/15/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/15/2022
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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 CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME: RODRIGUEZ FAMILY CHILD CARE
FACILITY NUMBER: 198003557
VISIT DATE: 11/15/2022
NARRATIVE
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INFANT CARE: Licensee states she provides care for infants. Per licensee, currently she has four infants enrolled in her daycare. Licensee states that infants sleep in the detached garage where they are constantly supervised. Appropriate sleeping arrangements and cribs were observed. (one crib for each infant in care was observed). Cribs or play yard did not hinder the entrance or exit from the sleeping space detached garage, mattresses shall be firm and covered with a fitted sheet that overlaps the underside so it cannot be dislodged. Cribs and play yards were observed to be free of loose articles and objects. No objects were observed to be hanging above or attached to the side of the crib. LPA did not observe any infants swaddled while in care. LPA advised the Licensee that infants shall be placed on their backs for sleeping and shall be supervised. Infants shall be checked on every 15 minutes and the time of each 15-minute check was not documented with child’s name and date. The LIC 9227 Individual Infant Sleeping Plan was not completed for each infant up to 12 months of age. A copy of the LIC 9227 was provided to Licensee. LPA provided the licensee with a copy of A Child Care Provider’s Guide to Safe Sleep, by American Academy of Pediatrics. LPA also consulted and explained Child Abuse Reporting, Never Shake a Baby, and Safe Sleeping practices.

SAFE SLEEP: LPA discussed the safe sleep regulations with licensee, and discussed the Child Care Licensing Safe Sleep webpage at http://www.cdss.ca.gov/inforescources/child-care-licensing/public-information-and-resoucrces/safe-sleep as an additional resource. LPA also informed licensee of the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at http://www/cpsc.gov/ and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment. Boppy recall: https://www.cpsc.gov/Recalls/2021/The-Boppy-Company-Recalls-Over-3-Million-Original-Newborn-Loungers-Boppy-Preferred-Newborn-Loungers-and-Pottery-Barn-Kids-Boppy-Newborn-Loungers-After-8-Infant-Deaths-Suffocation-Risk.
Medication: Incidental Medical Services (IMS) policy was discussed. The licensee states that she will provide IMS. Per licensee, there are no children enrolled that require IMS 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 Centers and the ADA, available at: http://www.ada.gov/childqanda.htm.
REPORT CONTINUES ON NEXT PAGE 4 of 5
SUPERVISORS NAME: Christina Gabelman
LICENSING EVALUATOR NAME: Anomeh Eivazian
LICENSING EVALUATOR SIGNATURE:

DATE: 11/15/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/15/2022
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 CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME: RODRIGUEZ FAMILY CHILD CARE
FACILITY NUMBER: 198003557
VISIT DATE: 11/15/2022
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LPA advised the licensee to access forms, regulations and quarterly updates online at: www.ccld.ca.gov.

The following deficiencies listed on the attached LIC 809 (deficiency page) are being cited in accordance with California Code of Regulations Title 22. Deficiencies that are being cited need to be cleared to protect the children’s health & safety.



LPA Anomeh Eivazian informed licensee, Ingrid Rodriguez that this report dated 11/15/2022 document(s) 1 Type A citation. Type A citation(s) which shall be posted for 30 consecutive days as there is/are immediate risk(s) to the health, safety, or personal rights of children in care.

Also, LPA Anomeh Eivazian informed the licensee, Ingrid Rodriguez to provide a copy of this licensing report dated 11/15/2022 that documents any Type A citation(s) to parents/guardians of all children currently enrolled by the next business day or the next day the children are in care, and to any newly enrolled parents/guardians for 12 months from the date of this report. A signed Acknowledgement of Receipt of Licensing Report (LIC 9224), or other written statement, must be placed in the child's file for verification.

The Notice of Site Visit (LIC 9213) was given and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

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 experienced. If you have any questions regarding the process or tools, please send them by email to inspectionprocess@dss.ca.gov. For additional information regarding inspection tools and methods, please visit the Program website at www.cdss.gov/inforesouces/community-care-liceinsing/inspection-process


Exit interview conducted and report was reviewed with the Licensee, Ingrid Rodriguez at 2:00 p.m..
REPORT END 5 of 5
SUPERVISORS NAME: Christina Gabelman
LICENSING EVALUATOR NAME: Anomeh Eivazian
LICENSING EVALUATOR SIGNATURE:

DATE: 11/15/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/15/2022
LIC809 (FAS) - (06/04)
Page: 5 of 8
Document Has Been Signed on 11/15/2022 01:50 PM - It Cannot Be Edited


Created By: Anomeh Eivazian On 11/15/2022 at 11:11 AM
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
, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME: RODRIGUEZ FAMILY CHILD CARE
FACILITY NUMBER: 198003557

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/15/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102425(j)(2)
Infant Safe Sleep
The provider shall supervise infants while they are sleeping and adhere to the following requirements: The provider shall check and document the following:

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on children files review and licensee's statement, the licensee did not comply with the section cited above did not document every 15 minutes of infants supervision while infants are sleeping which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 12/15/2022
Plan of Correction
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Per licensee, infants sleep under direct supervision of an adult all the times but did not know it required to be documented every 15 minutes. Per licensee, she will start document infants supervision every 15 minutes while they are sleeping and copies will be submitted to LPA Eivazian by plan of correction due date via email.
Type B
Section Cited
HSC
1596.8662(b)(1)
Administration of Child Day Care Licensing
(1) On or before March 30, 2018, a person who, on January 1, 2018, is a licensed child day care provider, administrator, or employee of a licensed child day care facility shall complete the mandated reporter training provided pursuant to paragraphs (2) and (3) of subdivision (a), and shall complete renewal mandated reporter training every two years following the date on which he or she completed the initial mandated reporter training.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on staff file review, the licensee did not comply with the section cited above and licensee and her assistant did not have current mandated reporter training certificate which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 12/15/2022
Plan of Correction
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Per licensee, her assistant and herself will complete required mandated reporter training by plan of correction due date and copies will be submitted to LPA Eivazian via email.
Licensee's mandated reporter training was completed on 10/07/2019 and has not be renewed every 2 years that is required.
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:Christina Gabelman
LICENSING EVALUATOR NAME:Anomeh Eivazian
LICENSING EVALUATOR SIGNATURE:
DATE: 11/15/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/15/2022


LIC809 (FAS) - (06/04)
Page: 6 of 8
Document Has Been Signed on 11/15/2022 01:50 PM - It Cannot Be Edited


Created By: Anomeh Eivazian On 11/15/2022 at 11:11 AM
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
, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME: RODRIGUEZ FAMILY CHILD CARE
FACILITY NUMBER: 198003557

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/15/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102416(c)
Personnel Requirements
(c) The licensee and other personnel as specified shall complete training on preventive health practices, including pediatric cardiopulmonary resuscitation and pediatric first aid, pursuant to Health and Safety Code Section 1596.866.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on staff file review, the licensee did not comply with the section cited above and licensee and her assistant completed Pediatric First Aid and CPR online course, expires 04/12/21 which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 12/15/2022
Plan of Correction
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Per licensee, her assistant and herself will complete required in-person Pediatric First Aid and CPR courses by plan of correction due date 12/15/2022 and copies will be submitted to LPA Eivazian via email.
Type B
Section Cited
CCR
102425(c)
Infant Safe Sleep
An Individual Infant Sleeping Plan [LIC 9227 (3/20)] shall be completed for each infant up to 12 months of age the provider has in care and included in the infant's file at the facility.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on children file reviews], the licensee did not comply with the section cited above and currently licensee has four infants enrolled, 2 being under 12 months old and did not have LIC 9227 on file which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 12/15/2022
Plan of Correction
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Per licensee, she did not know about LIC 9227. Per licensee, she will add the required LIC 9227, Individual Infant Sleep Plan form to infants under 12 months old files and copies will be submitted to LPA Eivazian by plan of correction due date, 12/15/22 via email.
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:Christina Gabelman
LICENSING EVALUATOR NAME:Anomeh Eivazian
LICENSING EVALUATOR SIGNATURE:
DATE: 11/15/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/15/2022


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Document Has Been Signed on 11/15/2022 01:50 PM - It Cannot Be Edited


Created By: Anomeh Eivazian On 11/15/2022 at 11:30 AM
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
, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME: RODRIGUEZ FAMILY CHILD CARE
FACILITY NUMBER: 198003557

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/15/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
HSC
1597.40(a)
Public policy to provide home environment; restriction governing real property
It is the intent of the Legislature that family day care homes for children should be situated in normal residential surroundings so as to give children the home environment which is conducive to healthy and safe development.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on LPA's observation on 11/15/2022, the licensee did not comply with the section cited above. Upon LPA's arrival to the facility, LPA observed 6 children were eating Cheerios in the converted garage( limited activity space), also per licensee children eat and sleep in the converted garage which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 11/16/2022
Plan of Correction
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Per licensee, due to Covid and flu season and considering family members health children have been eating and sleeping in the detached garage. Per licensee, she will ensure effective tomorrow children either eat outside or inside the main home in the living room and sleep in the main home in the living room and one bedroom.
Plan of correction will be cleared by an inspection.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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4
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:Christina Gabelman
LICENSING EVALUATOR NAME:Anomeh Eivazian
LICENSING EVALUATOR SIGNATURE:
DATE: 11/15/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/15/2022


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