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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198008304
Report Date: 05/12/2023
Date Signed: 05/12/2023 01:27:50 PM

Document Has Been Signed on 05/12/2023 01:27 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. DAY CARE-EAST, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME:MEDINA FAMILY CHILD CAREFACILITY NUMBER:
198008304
ADMINISTRATOR:MEDINA, SUSANAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(626) 793-8597
CITY:PASADENASTATE: CAZIP CODE:
91106
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 7DATE:
05/12/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:14 PM
MET WITH:Susana Medina - LicenseeTIME COMPLETED:
01:50 PM
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Licensing Program Analyst (LPA) Nolan Tcheng conducted an unannounced annual random inspection to the above facility. At 12:14pm, LPA met with licensee, Susana Medina. Also present during this inspection was the assistant, Licensee’s daughter. Licensee is primarily Spanish speaking, Assistant Brenda Medina assisted with inspection today. The licensee states that she currently has 14 children enrolled. A current children’s roster is available and is current. Licensee’s hours of operation are 6am-10pm, Monday-Sunday.

This is a one-story home which consists of 2 bedrooms, 2 bathrooms, kitchen, living room, infant room, front yard (fenced), side yard (fenced), garage and backyard (fenced). The children use living room, front bathroom, infant room, Bedroom #1 and side yard and front yard. Per licensee, areas off limits to children and parents include: back bathroom, kitchen, backyard, and garage. The licensee provides food for children in care.

The licensee states that 4 adults and 1 Minor currently live in the home. Persons living in home are identified on the attached LIC811. Licensee states that she currently has two assistants. Staff are identified on the attached LIC859. All individuals present in the home have obtained a criminal record clearance or exemption prior to working, residing or volunteering in a licensed home. Per licensee, there are no weapons, firearms or bodies of water on the premises.

PHYSICAL PLANT


At 12:25pm, LPA was lead on a tour of the facility by the licensee. Upon entry, the hallway was reviewed. Emergency Disaster Plan, Parent’s Rights Poster and the Facility License are observed to be posted to the left. During the time of inspection the facility was participating in nap time. There were 7 children present napping. Cots were observed for the children to nap on. At 12:30pm, A fire extinguisher was observed. The valve on the required 2A 10BC fire extinguisher indicates fully charged and was serviced on 08/11/2022, as indicated on service tag. Per State Fire Marshall standards, fire extinguishers shall be serviced annually.
REPORT CONTINUES PAGE 1 of 3
SUPERVISORS NAME: Claudia Guangorena
LICENSING EVALUATOR NAME: Nolan Tcheng
LICENSING EVALUATOR SIGNATURE: DATE: 05/12/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/12/2023
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 3
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
L.A. DAY CARE-EAST, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME: MEDINA FAMILY CHILD CARE
FACILITY NUMBER: 198008304
VISIT DATE: 05/12/2023
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Per licensee, hallway will be used as an area for an ill child until an authorized representative comes to pick up child. A cot is available for a child to rest on. The tour continued through to the bathroom at the end of the hallway where there was a bathroom for children in care to use. Bathroom was observed to be safe and free of any hazards. Smoke and carbon monoxide detectors were tested and are operable. There are first aid supplies available. Tour continued through the daycare (living room) where there are curriculum activities and age appropriate equipment for children in care to use. The infant room was reviewed. There are three play yards available and age appropriate toys and equipment. Per licensee, detergents, cleaning compounds, medications, and other items which could pose a danger are inaccessible to children in the off limit area of the house. The licensee states that a cell phone is used and stays at the facility during operating hours, landline is also available. 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.

At 12:40pm,LPA observed the side and front yard area. The outdoor play area was observed to be fenced. At this time, children are using the back yard for outdoor play time. There is an area in the side yard that has playhouses space for children to run, and a large tent. The tent allows shade and has library, toys, and equipment for the children to use. There is another fenced front section on the grass part of the yard that has play houses and slides for children to use. The licensee is observed to be operating within the license capacity limitations.

FACILITY RECORDS:


The licensee and other personnel have completed training on preventive health practices including Pediatric First Aid and CPR. The licensee's Pediatric First Aid and CPR expires on 09/2023. Licensee and other personnel have complete mandated reporter training that 12/02/2023 The licensee does have proof of immunization against influenza, tuberculosis, pertussis, and measles. Children’s records were reviewed, including but not limited to, a copy of the emergency information card that contains all the information specified by regulation.

Infant Care: Licensee states that they are currently caring for infants. LPA advised the licensee to sleep infants where they can be directly supervised at all times. Licensee states that infants sleep in the infant room. LPA provided the licensee with a copy of the Child Care Provider’s Guide to Safe Sleep, by American Academy of Pediatrics and Helping you to reduce the risk of SIDS. LPA consulted and explained Child Abuse Reporting, Updated Parent’s Rights Poster with Complaint Hotline information, Never Shake a Baby, Sudden Infant Death Syndrome (SIDS), and Safe Sleeping practices. PIN 20-24-CCP was provided and explained during the inspection. REPORT CONTINUES PAGE 2 of 3

SUPERVISORS NAME: Claudia Guangorena
LICENSING EVALUATOR NAME: Nolan Tcheng
LICENSING EVALUATOR SIGNATURE:

DATE: 05/12/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/12/2023
LIC809 (FAS) - (06/04)
Page: 3 of 3
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
L.A. DAY CARE-EAST, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME: MEDINA FAMILY CHILD CARE
FACILITY NUMBER: 198008304
VISIT DATE: 05/12/2023
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The following was discussed:
-Individuals who are 18 years of age or older living in the home must be finger print cleared prior to being in the presence of the children in care. Individuals within one month of their 18th birthday must be fingerprinted immediately.
-There are no pets on the premises.
-Infant Walkers, Johnny Jumpers, Saucer Chairs, and/or any other item that falls into these categories are not permitted in a family child care facility.
-Smoking is prohibited in a license family child care home.

Incidental Medical Services (IMS):


The licensee states that she will provide IMS. Per licensee, there are no children enrolled that require IMS at this time. 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.

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

LPA advised the licensee how to access forms, regulations and quarterly updates on line at: www.ccld.ca.gov. AB1207 Mandated Child Abuse Reporting – Implementation was discussed with Licensee. Website provided: http://mandatedreporterca.com/

At this time, the licensee is in compliance with California Code of Regulations Title 22. No deficiencies cited.

The Notice of Site Visit (LIC 9213) – must remain posted for 30 days during the hours of operation after each site visit made by a licensing representative.


Exit interview was conducted with Licensee Susan Medina and Brenda Medina, at 1:35pm. Copy of Report Provided. END OF REPORT PAGE 3 of 3
SUPERVISORS NAME: Claudia Guangorena
LICENSING EVALUATOR NAME: Nolan Tcheng
LICENSING EVALUATOR SIGNATURE:

DATE: 05/12/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/12/2023
LIC809 (FAS) - (06/04)
Page: 2 of 3