<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198010798
Report Date: 10/28/2022
Date Signed: 10/28/2022 02:17:11 PM

Document Has Been Signed on 10/28/2022 02:17 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:CARDONA FAMILY CHILD CAREFACILITY NUMBER:
198010798
ADMINISTRATOR:CARDONA, VIRGINIAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(323) 231-5453
CITY:LOS ANGELESSTATE: CAZIP CODE:
90037
CAPACITY: 14TOTAL ENROLLED CHILDREN: 3CENSUS: 2DATE:
10/28/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:50 AM
MET WITH:Virginia Cardona, LicenseeTIME COMPLETED:
02:30 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
Licensing Program Analysts (LPAs) Alicia Mooberry and Austin Estrada conducted an unannounced annual required inspection to the above facility on 10/28/22. LPAs met with Virginia Cardona, Licensee, who guided analysts on a tour of the facility. Per Licensee, there are 3 children that are currently enrolled. There were two (2) children present upon arrival. Individuals who live in the home were discussed and notes. A current children’s roster was available for review.

This facility is is located on the lower level a duplex with separate address (820 1/2 W 41st st), LPA observed the entrance to the upper level is on the front porch of the home. This is a one-story home which consists of 3 bedrooms, 2 bathrooms, storage room, dining room, kitchen, living room, front yard and backyard (fenced). The main care area is in the living room, dining room areas, 1 bedroom in the rear used as playroom. The children use the bathroom in the hallway and they use the bathroom located in the playroom. Per Licensee, areas off limits to children and parents include: 2 bedroom, kitchen, storage room and backyard. The licensee provides food for children in care. Hours of operation are Mon- Fri. 5:00am-10:00pm. LPA discussed overnight care regulations with licensee.



The following was observed and reviewed during this inspection:
All areas identified on the facility sketch that are accessible for children to use were inspected for safety, comfort, and cleanliness. The following was observed and reviewed during this inspection:

LPA observed the facility license and required documentation posted in the living room in a location visible to parent/guardians of children in care. Including Publication (PUB) 394- Notification of Parent Rights and Licensing Form (LIC) 9148- Earthquake Preparedness form. LPA observed completed facility records including; LIC 9040- Facility Roster, LIC 610- Facility Disaster Plan.

Page 1 – Report Continues
SUPERVISORS NAME: Valarie Cook
LICENSING EVALUATOR NAME: Alicia Mooberry
LICENSING EVALUATOR SIGNATURE: DATE: 10/28/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/28/2022
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 5
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: CARDONA FAMILY CHILD CARE
FACILITY NUMBER: 198010798
VISIT DATE: 10/28/2022
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
Smoke and carbon monoxide detectors were tested and are operable. Fire extinguisher indicated fully charged and was serviced on 09/2022, Licensee was reminded that fire extinguisher needs to be serviced yearly. The home maintains telephone service via cell phone. There are toys and other age appropriate material available for children. LPA observed that cleaning compounds are in locked bathroom cabinet inaccessible to children. The bathrooms that children use are located in the hallway and in the playroom and observed to be clean and free of hazards.

Licensee states that there are no poisons stored in the home and understands that all poisons must be lock, not only inaccessible to children.


Per Licensee there are no firearms or weapons stored in the home. LPA observed 2 small dogs exiting the home upon arrival. LPA discussed safety and supervision while pets are present.
Isolation area for sick children waiting to be picked up is in living room, away from the other children.

LPAs observed that the crib used by 7-month old infant had blankets, pillows and toys. Per licensee, Child #1 sleeps with a blanket, which poses a potential risk to the health and safety of children in care. LPA informed licensee of the new Safe sleep regulations, and provided the LIC 9227 Infant Sleep Plan for infants under 12 months, and advised on 15-minute sleep check and documentation for infants 0-24 months, Infants sleep in the living room, each infant has their own crib. Per licensee infants are supervised for the duration of the nap and will document 15 minute checks.

LPA discussed the safe sleep regulations with licensee 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 licensee 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.

Currently, children are using the front and back yard for outdoor play including the corridor along the side of the home. The outdoor play area was observed to be fenced. LPA observed dog feces along the corridor on side of the home, which can pose a potential risk to the health and safety of children in care. Licensee was reminded to keep the out door space free of clutter. Per licensee, children are always visually supervised when they play outdoors. Facility does not have a pool or similar bodies of water.


-------------------Page 2 – Report Continues
SUPERVISORS NAME: Valarie Cook
LICENSING EVALUATOR NAME: Alicia Mooberry
LICENSING EVALUATOR SIGNATURE:

DATE: 10/28/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/28/2022
LIC809 (FAS) - (06/04)
Page: 2 of 5
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: CARDONA FAMILY CHILD CARE
FACILITY NUMBER: 198010798
VISIT DATE: 10/28/2022
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
Children’s records were reviewed and found Child#1, a 7 month old infant is missing LIC 9227 Infant Sleep Plan and the Infant Sleep Log which posed a potential risk for the health and safety of children in care.

Staff records were reviewed for approved Pediatric First Aid and CPR certification, LIC-501: Personnel Record, LIC 508-Criminal Record Statement, LIC 9052- Employee Rights, Proof of immunizations against measles, pertussis and influenza or influenza declination, TB clearance or risk assessment, LIC 9108- Statement Acknowledging Requirement to Report Child Abuse and current Mandated Reporter Training Certificate.

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

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.

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/inspection-process.

Based on the LPA's observations and records review the following deficiencies will be cited today in accordance with California Title 22 Regulations.

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

Exit interview conducted and report was reviewed with the Licensee, Virginia

SUPERVISORS NAME: Valarie Cook
LICENSING EVALUATOR NAME: Alicia Mooberry
LICENSING EVALUATOR SIGNATURE:

DATE: 10/28/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/28/2022
LIC809 (FAS) - (06/04)
Page: 3 of 5
Document Has Been Signed on 10/28/2022 02:17 PM - It Cannot Be Edited


Created By: Alicia Mooberry On 10/28/2022 at 01:53 PM
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 CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME: CARDONA FAMILY CHILD CARE
FACILITY NUMBER: 198010798

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/28/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102417(g)
Operation of A Family Child Care Home
(g) The home shall be free from defects or conditions which might endanger a child. Safety precautions shall include but not limited to:

This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on observation, the licensee did not comply with the section cited above due to dog feces was observed on the yard where children have acces to which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 10/28/2022
Plan of Correction
1
2
3
4
Licensee picked up the dog feces during inspection. Deficiency corrected.
Type B
Section Cited
CCR
102425(b)
Infant Safe Sleep
(b) Cribs or play yards shall be free from all loose articles and objects.

This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on observation, the licensee did not comply with the section cited above due crib where infant sleeps was observed to have blankets, pillows and toys which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 10/28/2022
Plan of Correction
1
2
3
4
Licensee removed all loose items from the crib. Deficiency corrected during inspection
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:Valarie Cook
LICENSING EVALUATOR NAME:Alicia Mooberry
LICENSING EVALUATOR SIGNATURE:
DATE: 10/28/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/28/2022


LIC809 (FAS) - (06/04)
Page: 4 of 5
Document Has Been Signed on 10/28/2022 02:17 PM - It Cannot Be Edited


Created By: Alicia Mooberry On 10/28/2022 at 01:53 PM
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 CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME: CARDONA FAMILY CHILD CARE
FACILITY NUMBER: 198010798

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/28/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)
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
1
2
3
4
Based on record review, the licensee did not comply with the section cited above in 1 out of 1 infant under 12 months of age did not have the LIC 9227 Infant sleep plan completed which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 11/04/2022
Plan of Correction
1
2
3
4
Per licensee the LIC 9227 will be completd and send to the departnment via email by POC due date
Section Cited
Deficient Practice Statement
1
2
3
4
POC Due Date:
Plan of Correction
1
2
3
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:Valarie Cook
LICENSING EVALUATOR NAME:Alicia Mooberry
LICENSING EVALUATOR SIGNATURE:
DATE: 10/28/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/28/2022


LIC809 (FAS) - (06/04)
Page: 5 of 5