198017282-6-2-2022-54-CC-KCHE-CEZVDX-20220602162127

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 198017282
Report Date: 06/02/2022
Date Signed: 06/02/2022 04:22:18 PM

Document Has Been Signed on 06/02/2022 04:22 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:	ONTIVEROS FAMILY CHILD CARE		FACILITY NUMBER:	198017282
ADMINISTRATOR:	JUAN ONTIVEROS		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(323) 742-4937
CITY:	LOS ANGELES	STATE: CA	ZIP CODE:	90002
CAPACITY: 14	TOTAL ENROLLED CHILDREN: 4	CENSUS: 0	DATE:	06/02/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	01:20 PM
MET WITH:	Juan Ontiveros, Licensee		TIME COMPLETED:	04:45 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 Analyst (LPA)Katrina Chicote conducted an Unannounced Required – 1 Year inspection to the above facility on 06/02/2022 at 1:20 PM. Upon arrival, LPA disclosed the purpose of the inspection and met with Licensee, Juan Ontiveros, who guided the LPA on a tour of the facility. Adults in the home were discussed and all have criminal record clearance. There were no day care children present during today’s inspection. Licensee states that there are currently four children enrolled. The children's roster was reviewed and is current. Per Licensee, the facility’s hours of operation are 23 hours, 7 days week. Licensee states he does not have any overnight care children enrolled at this time. Emergency Disaster Plan, License, and Parents’ Rights were posted at the time of inspection. Disaster drill log was also available during today’s inspection, last disaster drill conducted on 05/2022. This is a single-story home which consists of three bedrooms and one bathroom, kitchen, and living room. Facility is front unit of duplex property, back unit address is 1429 E. 90th St. Areas used by the children include the living room (located upon entry), kitchen (located next to Living Room) one restroom (located down rear hallway to the left), and backyard. Per Licensee, areas off limits to children and parents include all bedroom. Per Licensee, off limit areas are locked during operating hours, LPA observed doors to be locked. All areas identified on the facility sketch as accessible to children were inspected to ensure that they are clean and orderly with ventilation and heating for the safety of the children. At 1:22 PM, LPA observed back hallway with wall heater that is barricaded making it inaccessible to children in care at time of inspection. There is a working telephone maintained in the home. LPA observed a small white dog in Report Contiues - Page 1 of 3

SUPERVISORS NAME: Trevino Cochran
LICENSING EVALUATOR NAME: Katrina Chicote
LICENSING EVALUATOR SIGNATURE:	DATE: 06/02/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/02/2022

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 CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME: ONTIVEROS FAMILY CHILD CARE	FACILITY NUMBER: 198017282
	VISIT DATE: 06/02/2022

NARRATIVE

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the home that Licensee moved to off limits bedroom upon arrival to facility. Per Licensee, dogs are kept in off limits bedroom when children are present. Detergents, cleaning compounds, medications, and other items which can pose a danger to children are inaccessible. At 1:56 PM, LPA observed these items to be stored in Kitchen cabinets with operable child safety locks making it inaccessible at time of inspection. The Licensee states that there are no poisons in the home. The Licensee does understand that poison must be locked with a key or combination lock. Per Licensee, they provide food for children in care.

Per Licensee, the children will have access to backyard area. At 1:29 PM, LPA observed backyard is accessible through front door and walking to back. LPA observed another large dog being kept in backyard area. Licensee states dog is kept separate from children during daycare hours. LPA observed backyard has concrete area and adequate perimeter fencing through-out the yard. LPA observed bicycles, basketball court with hoop, two plastic playhouses, and large wooden play structure with wood chips below to absorb fall.

Per Licensee, there are no weapons, firearms in the home and there are no bodies of water around the premises. LPA observation did not see any bodies of water around the premises.

At 1:27 PM, LPA observed the valve on the required 2A 10BC fire extinguisher indicates fully charged. with service tag observed dated 06/16/2021. At 1:28 PM, LPA observed smoke and carbon monoxide detectors are in operable condition at time of inspection. Per Licensee, First Aid kit is kept in the Kitchen, LPA observed First Aid kit. The Licensee has current Pediatric First Aid and CPR. Licensee does not have proof of immunization against influenza, pertussis, and measles during today’s inspection. The Licensee has also taken the Mandated Reporter Training
—CPR Card valid until: 10/03/2022
—Mandated Reporter AB1207 Completed: 09/09/2021
Report Continues - Page 2 of 3

SUPERVISORS NAME: Trevino Cochran
LICENSING EVALUATOR NAME: Katrina Chicote
LICENSING EVALUATOR SIGNATURE:	DATE: 06/02/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/02/2022

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 CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME: ONTIVEROS FAMILY CHILD CARE	FACILITY NUMBER: 198017282
	VISIT DATE: 06/02/2022

NARRATIVE

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The following were discussed:
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 (or facility representative) 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.

Rooms that are off-limits need to be made inaccessible during operating hours. NO smoking, NO infant walkers, NO Johnny jumpers, NO saucer chairs, NO incline sleepers and any other item that falls into that category are permitted in the facility. The Licensee was advised that inaccessibility of hazards must be constantly reassessed depending on the children in care.

Senate Bill 792: this bill, commencing September 1, 2016, prohibits a person from being employed or volunteering at a child care facility or family day care if he or she has not been immunized against influenza, pertussis and measles. LPA discussed the influenza waiver during the visit.

Based on this information, the following deficiencies on the attached LIC 809D are being cited in accordance with California Code of Regulations Title 22.

A notice of site visit was given and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

Exit interview was conducted and report was reviewed with the Licensee (or facility representative), Juan Ontiveros. Report ends - Page 3 of 3

SUPERVISORS NAME: Trevino Cochran
LICENSING EVALUATOR NAME: Katrina Chicote
LICENSING EVALUATOR SIGNATURE:	DATE: 06/02/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/02/2022

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 06/02/2022 04:22 PM - It Cannot Be Edited

Created By: Katrina Chicote On 06/02/2022 at 02:20 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: ONTIVEROS FAMILY CHILD CARE	FACILITY NUMBER: 198017282
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 06/02/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

HSC

1597.622(a)(1)

General Provisions and Definitions

(1) Commencing September 1, 2016, a person shall not be employed or volunteer at a family day care home if he or she has not been immunized against influenza, pertussis, and measles. Each employee and volunteer shall receive an influenza vaccination between August 1 and December 1 of each year. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on LPA record review and interview, at 2:00 PM LPA did not observe immunization records and Licensee statement confirms he did not have it. This is a potential health, safety, and personal rights risk to children.
	POC Due Date: 06/09/2022
	Plan of Correction
1 2 3 4	Licensee states he will obtain his immunization records by POC date via email to LPA.

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:

Trevino Cochran

LICENSING EVALUATOR NAME:

Katrina Chicote

LICENSING EVALUATOR SIGNATURE:

DATE: 06/02/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/02/2022

LIC809 (FAS) - (06/04)

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