198015133-11-3-2023-54-CC-RNAO-CX8P76-20231103110324

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 198015133
Report Date: 11/03/2023
Date Signed: 11/03/2023 11:03:34 AM

Document Has Been Signed on 11/03/2023 11:03 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 CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME:	PULIDO FAMILY CHILD CARE		FACILITY NUMBER:	198015133
ADMINISTRATOR:	PULIDO, YOLANDA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(323) 262-6842
CITY:	LOS ANGELES	STATE: CA	ZIP CODE:	90023
CAPACITY: 14	TOTAL ENROLLED CHILDREN: 2	CENSUS: 2	DATE:	11/03/2023
TYPE OF VISIT:	Case Management - Licensee Initiated	UNANNOUNCED	TIME BEGAN:	09:20 AM
MET WITH:	Yolanda Pulido		TIME COMPLETED:	11:28 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 Analysts (LPAs) Raul Navarro and Anthony Padilla conducted a Case Management- Licensee initiated inspection in Spanish to the above facility on 11/03/2023. LPAs arrived at the facility at 09:20am and met with Licensee Yolanda Pulido. The purpose of this inspection is to remove the facility from inactive status. Per Licensee, the hours would be Monday through Friday from 7:30 AM to 5:00 PM. The Licensee states they will care for children ages, 0 to 12 years old. All areas identified on the facility sketch were inspected. This facility is single story home that consists of three bedrooms and two bathrooms. Areas that are accessible to children in care include: living room, one bathroom, front yard, and backyard (fenced). Areas off limits to children include: three bedrooms, one bathroom, kitchen, and garage. LPA observed all of the bedroom doors closed and have a door knob covers to prevent access. Licensee was reminded that off-limit areas must be made inaccessible during operating hours. At the time of the inspection, individuals residing in the home were discussed and noted. All individuals present in the home have obtained a criminal record clearance or exemption. All areas identified on the facility sketch that children use, were inspected for safety, comfort, cleanliness, telephone service, ventilation and heating (central). The following was observed and reviewed during this inspection. LPA reviewed required posted documentation for Facility License, Publication (PUB) 394- Notification of Parent Rights and Licensing Form (LIC) 9148, and LIC 610- Facility Disaster Plan. Facility records were reviewed for LIC 9040- Facility Roster, and Disaster drill log, last drill conducted in October 2023.. Smoke/carbon monoxide detector located in the living room was tested and is in operable condition. Fire extinguisher indicated fully charged and was serviced within the year. The home maintains telephone service via cell phone.

SUPERVISORS NAME: Karen Chambers
LICENSING EVALUATOR NAME: Raul Navarro
LICENSING EVALUATOR SIGNATURE:	DATE: 11/03/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/03/2023

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: PULIDO FAMILY CHILD CARE	FACILITY NUMBER: 198015133
	VISIT DATE: 11/03/2023

NARRATIVE

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The home is observed to be clean and orderly. There are toys and other age appropriate material available for children. LPAs observed that detergents, cleaning compounds and medication are inaccessible to children. Licensee was reminded that all poisons must be lock, not only inaccessible to children. Isolation area for sick children waiting to be picked up is in the front section of the living room, away from the other children. Per Licensee, there are no firearms or weapons stored in the home.

Currently Licensee cares for one infant. LPAs observed a play yard visible in the living room. Napping equipment does not block entrances or exits. Infant mattress was observed to be firm with tightly fitted sheets. LPAs did not observe loose object, bumpers, objects hanging, or objects attached to the play yard. There are currently no infants with pacifiers. Per Licensee wet or soiled sheets are changed and washed immediately. Each infant has their own play yard and bedding. Bedding is washed every three days or as needed. LPAs observed the 15 minute sleep check documentation for infants the infant in care. Per Licensee, no overnight care is provided.

Children are using the front and a portion of the backyard for outdoor play. The outdoor play area was observed to be fenced. LPAs observed that the outdoor yard has toys and other materials for children to play with. LPAs did not observe any objects that could be hazardous to children in care. There are no pools or spas, or other bodies of water.

Children’s records were reviewed for (LIC) 282- Affidavit Regarding Liability Insurance, Immunization Records, LIC 700- Identification and Emergency Information, LIC 627- Consent for Medical Treatment, LIC 995A Notification of Parents’ Rights, and documentation of 15-minute Infant Sleep Check (0-24 months)

Staff records were reviewed for approved Pediatric First Aid and CPR certification, LIC 508- Criminal Record Statement, Proof of immunization against measles, pertussis and influenza or influenza declination, TB clearance or risk assessment, and current Mandated Reporter Training Certificate.

During inspection all children were observed to be treated with dignity and respect, they were observed to be receiving safe, healthful and comfortable accommodations, furnishings and equipment, and free from corporal and/or unusual punishment.

SUPERVISORS NAME: Karen Chambers
LICENSING EVALUATOR NAME: Raul Navarro
LICENSING EVALUATOR SIGNATURE:	DATE: 11/03/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/03/2023

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: PULIDO FAMILY CHILD CARE	FACILITY NUMBER: 198015133
	VISIT DATE: 11/03/2023

NARRATIVE

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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 Center 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.

LPAs 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. LPAs 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.

At this time, the Licensee is in compliance with California Title 22 Regulations. Therefore, there are no citations being issued today. Exit interview conducted and report was reviewed with Licensee, Yolanda Pulido. A notice of site visit was given and must remain posted for 30 days.

SUPERVISORS NAME: Karen Chambers
LICENSING EVALUATOR NAME: Raul Navarro
LICENSING EVALUATOR SIGNATURE:	DATE: 11/03/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/03/2023

LIC809 (FAS) - (06/04)

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