198013023-3-11-2022-33-CC-NTCG-CCEQNA-20220311111850

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 198013023
Report Date: 03/11/2022
Date Signed: 03/11/2022 11:19:07 AM

Document Has Been Signed on 03/11/2022 11:19 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, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME:	MANZANERO FAMILY CHILD CARE		FACILITY NUMBER:	198013023
ADMINISTRATOR:	MARTHA MANZANERO		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(626) 844-4662
CITY:	PASADENA	STATE: CA	ZIP CODE:	91107
CAPACITY: 14	TOTAL ENROLLED CHILDREN: 14	CENSUS: 7	DATE:	03/11/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	08:55 AM
MET WITH:	Martha Manzanero - Licensee		TIME COMPLETED:	11:27 AM

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 Analyst (LPA) Nolan Tcheng conducted an unannounced annual random inspection to the above facility. At 8:55am, LPA met with licensee, Martha Manzanero. Also present during this inspection, were licensee's assistants, noted on the attached LIC811. Inspection was conducted with Licensee's Assistant who interpreted the visit to Licensee who is Spanish speaking. The licensee states that she currently has 11 children enrolled. A current children’s roster is available and is current. Licensee’s hours of operation are 6am-7pm, Monday-Friday. This is a two-story home which consists of 4 bedrooms, 3 bathrooms, kitchen, dining room, living room, family room, garage, front yard and backyard (fenced). The children use living room, bathroom by kitchen, dining room area, kitchen and backyard. Per licensee, areas off limits to children and parents include: 4 bedrooms, 2 bathrooms, garage, and family room. The licensee provides food for children in care. The licensee states that 4 adults and 0 children currently live in the home. Licensee states that she currently has two assistants. 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 9:00am, LPA was lead on a tour of the facility by the licensee. Emergency Disaster Plan, Parent’s Rights Poster and the Facility License are observed to be posted by the front door of the house. The living room is the first available room for children in care to use. There were children present at the time of inspection in the living room watching television. There are first aid supplies available in the living room. At 9:10am, LPA observed a fireplace in the living room that was locked and made inaccessible to children in care. Next, the bathroom for children in care was observed. Cabinets and drawers were observed to have child safety locks on them. REPORT CONTINUES PAGE 1 of 4

SUPERVISORS NAME: Claudia Guangorena
LICENSING EVALUATOR NAME: Nolan Tcheng
LICENSING EVALUATOR SIGNATURE:	DATE: 03/11/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/11/2022

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 CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME: MANZANERO FAMILY CHILD CARE	FACILITY NUMBER: 198013023
	VISIT DATE: 03/11/2022

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Detergents, cleaning compounds, medications, and other items which could pose a danger are 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. At 9:15am, LPA a fire extinguisher was observed. The valve on the required 2A 10BC fire extinguisher indicates fully charged and was serviced on 08/14/2020, as indicated on service tag. Per State Fire Marshall standards, fire extinguishers shall be serviced annually. LPA discussed with licensee the need for it to be serviced annually or replaced. Licensee states that last year during COVID was very difficult for the family and they forgot to have it replaced. A Technical Violation is being provided to the facility. Smoke and carbon monoxide detectors were tested and are operable. The licensee states that there is a land line on the premises. The kitchen was reviewed and LPA observed sharp knives being kept out of reach of children in a high cabinet next to the sink. Food storage was reviewed. LPA observed napping equipment in the form of cots. Equipment is stored in living room.

At 9:20am, LPAs observed the back 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 were playhouses, cars, and age appropriate toys for the children in care to use outside. 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 02/2024. Licensee and other personnel have complete mandated reporter training that expires 02/17/2024. 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. At 9:50am, during children's file review, LPA observed that 3 of 7 children's files were missing a completed LIC627 Consent for Emergency Medical Treatment. LPA discussed the importance of having this form completed by authorized representative before starting care for child.

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.
REPORT CONTINUES PAGE 2 of 4

SUPERVISORS NAME: Claudia Guangorena
LICENSING EVALUATOR NAME: Nolan Tcheng
LICENSING EVALUATOR SIGNATURE:	DATE: 03/11/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/11/2022

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: MANZANERO FAMILY CHILD CARE	FACILITY NUMBER: 198013023
	VISIT DATE: 03/11/2022

NARRATIVE

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-There are 3 pets on the premises. Two turtles for children to play with and one dog who stays in the off limit area of the house.
-Infant Walkers, Johnny Jumpers, Saucer Chairs, Trampolines 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.

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 and advised the licensee against sleeping infants in a separate room. Licensee states that infants sleep in the living 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.

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.

During this inspection LPA discussed PIN 20-06 CCP, Social And Physical Distancing Guidance And Healthy Practices For Child Care Facilities In Response To The Global Coronavirus (COVID-19) Pandemic Written In Collaboration With The California Department Of Education and reviewed Child Care Covid-19 Self Assessment.

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/

REPORT CONTINUES PAGE 3 of 4

SUPERVISORS NAME: Claudia Guangorena
LICENSING EVALUATOR NAME: Nolan Tcheng
LICENSING EVALUATOR SIGNATURE:	DATE: 03/11/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/11/2022

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: MANZANERO FAMILY CHILD CARE	FACILITY NUMBER: 198013023
	VISIT DATE: 03/11/2022

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Based on the LPA’s observations and records review, 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

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 Martha Manzanero, at 11:10am, and Plan of Corrections were reviewed and developed. A copy of the report was provided.

END OF REPORT PAGE 4 of 4

SUPERVISORS NAME: Claudia Guangorena
LICENSING EVALUATOR NAME: Nolan Tcheng
LICENSING EVALUATOR SIGNATURE:	DATE: 03/11/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/11/2022

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 03/11/2022 11:19 AM - It Cannot Be Edited

Created By: Nolan Tcheng On 03/11/2022 at 10:49 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: MANZANERO FAMILY CHILD CARE	FACILITY NUMBER: 198013023
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 03/11/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

102417(g)(7)

Operation of A Family Child Care Home

(7) An emergency information card shall be maintained for each child and shall include the child's full name, telephone number and location of a parent or other responsible adult to be contacted in an emergency, the name and telephone number of the child's physician and the parent's authorization for the licensee or registrant to consent to emergency medical care. 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 3 out of 7 children's files, Child #1, 4, & 5, did not have a completed and signed LIC627 Consent for Emergency Medical Treatment, which poses a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 03/18/2022
	Plan of Correction
1 2 3 4	Per licensee, they will have parents of Child #1, 4, & 5 sign and complete the LIC627 Consent for Emergency Medical Treatment. Licensee will send proof of completion to LPA by POC 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:

Claudia Guangorena

LICENSING EVALUATOR NAME:

Nolan Tcheng

LICENSING EVALUATOR SIGNATURE:

DATE: 03/11/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/11/2022

LIC809 (FAS) - (06/04)

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