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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198019118
Report Date: 07/26/2021
Date Signed: 07/26/2021 05:26:17 PM

Document Has Been Signed on 07/26/2021 05:26 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:BARCELO & GRIMALDO FAMILY CHILD CAREFACILITY NUMBER:
198019118
ADMINISTRATOR:A BARCELO & J GRIMALDOFACILITY TYPE:
810
ADDRESS:TELEPHONE:
3236410497
CITY:LOS ANGELESSTATE: CAZIP CODE:
90007
CAPACITY: 14TOTAL ENROLLED CHILDREN: 0CENSUS: DATE:
07/26/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
02:05 PM
MET WITH:Angelica Barcelo, LicenseeTIME COMPLETED:
05:35 PM
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Prior to entrance to the facility, LPA Mayra Rivera conducted a Covid 19 assessment and based on the licensee responses to the facility assessment questions, LPA Rivera determined safe to proceed. On Monday, July 26, 2021 at 2:05 PM, Licensing Program Analyst (LPA) Mayra Rivera conducted an unannounced annual inspection and met with Licensee Angelica Barcelo who guided LPA Rivera on a tour of the facility.

During the inspection,nine children ( two infants, four preschool and three school age) and assistant Irma Beltran were present. LPA Rivera observed 9 children napping. Two infants ages 14-18 months were sleeping inside a playpen individually. The preschool and school age were sleeping in cots. Family members residing in the home was been discussed with licensee and are cleared. Operating hours are Monday to Friday, 6:00 AM to 6:00 PM and care for children ages 0 to 12 years.

This facility is a one-story home that consists of two bedrooms, one bathroom, kitchen, living room, dinning room,and front yard (gated). Areas that are accessible to children and identified on the facility sketch were inspected by LPA Rivera; living room, kitchen, dining room, bathroom and daycare room.

Areas off limits to children include: master bedroom, kitchen, and front. At 2:10 PM, LPA observed a safety gate barrier in place between the dinning room and kitchen to prevent children entering the kitchen. LPA observed a safety round ball on the master's bedroom door knob making it inaccessible to children to open the door.

At 2:13 PM LPA Rivera entered the daycare room area to inspect for safety, comfort, cleanliness, ventilation and working phone (land line). For ventilation, LPA Rivera observed wall AC units in the living room and daycare room. Both heaters were inspected by the fire department. An orange tag on each heater shows that the heater is turned off and not in use. Dated noted on tag is 5/25/16. A barrier is placed over the bottom opening of each of the heaters to prevent access by children. There is a fake fireplace, that is not functional, in the living room. Portable heater is used during cold days and place in the dinning room.
SUPERVISORS NAME: Karen Chambers
LICENSING EVALUATOR NAME: Mayra Rivera
LICENSING EVALUATOR SIGNATURE: DATE: 07/26/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/26/2021
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: BARCELO & GRIMALDO FAMILY CHILD CARE
FACILITY NUMBER: 198019118
VISIT DATE: 07/26/2021
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LPA observed a cubby storage with children personal belongings, two other cubbies with children materials such as art supplies, puzzles, and manipulative. LPA observed the furniture and children materials to be in good condition and age appropriate.

At 2:19 PM, LPA Rivera entered the restroom and observed the toilet, running water, hand soap and paper towels. LPA observed the bottom cabinets closed and with a child proof lock in place making it inaccessible to children to open the cabinet doors. LPA observed the restroom to be in good condition.

At 2:25 PM LPA observed cleaning compounds items stored inside the cabinets above the stove cabinet and the detergents inside the bottom kitchen cabinet with a child proof lock in place making it inaccessible to children. Licensee understands that any poisons or firearms must be locked with a key or combination lock. For drinking water, LPA observed water jugs and individual cups.

LPA Rivera asked if there are any pets, poisons, firearms, weapons or bodies of water. Licensee stated she has no pets. firearms, or weapons. LPA did not observe firearms or weapons. Licensee was advised that if any poisons (ex; drano, rat poison or items with skull hazard symbol), firearms and weapons are purchased, it is required to be locked with a key or combination lock and firearm and ammunition must be stored separately.



At 2:36 PM LPA Rivera observed the required 2A10BC fire extinguisher located in the hallway and the valve on the green area indicating fully charged and serviced on 9/8/2020. LPA also observed the fire alarm in the hallway. At 3:30 PM LPA asked licensee to press on the smoke detector and carbon monoxide located in the hallway LPA heard the sound of the smoke alarm and observed the green flashing light on the carbon monoxide alarm. The alarms are operating.

LPA did not inspect outdoor since the outdoor is off limits.

LPA observed licensee pediatric First Aid/CPR certification (expires July 17, 2022) and has proof of immunization against pertussis, and LPA received influenza declination dated 7/26/2021. Licensee missing measles immunization. Licensee has completed the preventative health and safety training on October 29, 2016 and mandated reporter (AB 1207) training on April 5, 2021. Licensee was advised that the mandated reporter training must be completed every 2 years, and is available at www.mandatedreporterca.com.

At 3:35 PM LPA observed on the bulletin wall the children's facility roaster, LIC 610 Emergency Disaster plan, Parents Rights, License, facility sketch and earthquake/fire drill log and last drill conducted on 7/1/2021.

SUPERVISORS NAME: Karen Chambers
LICENSING EVALUATOR NAME: Mayra Rivera
LICENSING EVALUATOR SIGNATURE:

DATE: 07/26/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/26/2021
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: BARCELO & GRIMALDO FAMILY CHILD CARE
FACILITY NUMBER: 198019118
VISIT DATE: 07/26/2021
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The following was discussed:
INFANT CARE: LPA Rivera reviewed and discussed Safe Sleeping Practices information with licensee and a plan for supervising sleeping infants. LPA advised the licensee to sleep infants in an area where infants can be directly supervised. Place infants on their backs to sleep, on a firm mattress with fitted sheet that fits snugly in crib or play yard. LPA also advised against sleeping infants in a separate room with no direct supervision and no pillows, crib bumpers, swaddling, head covered, and pacifiers must not have anything attached. Safe sleep brochure was provided.

LPA Rivera also reviewed Sudden Infant Death Syndrome (SIDS), Never Shake A Baby, and Lead Exposure information with licensee. LPAs also explained to licensee that car seat, stroller are only and only for transportation, highchair is only and only for feeding and stated items cannot be misused. No smoking, No infant walkers, No Johnny jumpers, No saucer chairs, No trampolines and any other item that falls into this category are not permitted in a family child care facility.



Medication: 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

LPAs advised the licensee how to access forms, regulations and quarterly updates , and Providers Information Notices (PIN) online at: www.ccld.ca.gov



Licensee Angelica and Jose are missing MMR (measles), assistant missing Employee Rights (LIC 9052) form and Statement Acknowledging Requirement to Report Suspected Child Abuse (LIC 9108). A technical violation has been given for missing MMR. Plan of correction is to submit proof by August 6, 2021. Child # 3 missingLIC 613A and LIC 995.

LPA issued the Confidential Names List (LIC 811) and Children's Record Review (LIC 857) to licensee during the inspection. The Confidential Names List documents the children’s and staff files that were reviewed during this inspection. LPA did not observe licensing form LIC 9150 Parent notification additional children in care, LIC 700 Identification and emergency information, and LIC 995A receipt of Notification of parent’s rights in the children files.

SUPERVISORS NAME: Karen Chambers
LICENSING EVALUATOR NAME: Mayra Rivera
LICENSING EVALUATOR SIGNATURE:

DATE: 07/26/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/26/2021
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: BARCELO & GRIMALDO FAMILY CHILD CARE
FACILITY NUMBER: 198019118
VISIT DATE: 07/26/2021
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The Notice of Site Visit (LIC 9213) – must remain posted for 30 days during the hours of operation after each site visit by a licensing representative. Failure to maintain posting as required will result in a civil penalty of $100.00.

Licensee has been given a technical violation listed on the following pages. Exit interview was conducted and plans of correction were reviewed and developed with Licensee Angelica Barcelo. Appeal rights explained & provided. A copy of this report and appeal rights were discussed and left with licensee, Kelly Luckey whose signature on this form confirms receipt of these documents.
SUPERVISORS NAME: Karen Chambers
LICENSING EVALUATOR NAME: Mayra Rivera
LICENSING EVALUATOR SIGNATURE:

DATE: 07/26/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/26/2021
LIC809 (FAS) - (06/04)
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