198021111-10-18-2022-33-CC-MGAA-CKBNV4-20221018104719

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 198021111
Report Date: 10/18/2022
Date Signed: 10/18/2022 10:47:35 AM

Document Has Been Signed on 10/18/2022 10:47 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:	TRUJILLO FAMILY CHILD CARE		FACILITY NUMBER:	198021111
ADMINISTRATOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY: 8	TOTAL ENROLLED CHILDREN: 3	CENSUS: 0	DATE:	10/18/2022
TYPE OF VISIT:	Prelicensing	UNANNOUNCED	TIME BEGAN:	08:45 AM
MET WITH:	Applicant/Licensee, Maria de los Angeles Trujillo		TIME COMPLETED:	10:55 AM

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*****************This inspection was conducted in Spanish****************

Licensing Program Analyst (LPA) Mireya Garcia conducted a pre-licensing inspection today to inspect and evaluate facility for a Family Child Care Home relocation. Applicant was previously licensed for a Family Child Care Home (LIC#197493722) at 3420 Raymond Ave Los Angeles, CA 90007. Due to COVID- 19 precautionary measures were taken, individuals present during inspection wore appropriate personal protective equipment.

At 8:45 a.m., LPA met with Maria, Applicant/Licensee who guided analyst on a tour of the facility. Per applicant, there is two adults and three minor children residing in the home. The Applicant/Licensee is requesting a small family childcare home license. Per applicant, operation hours will be Monday to Friday, 6:00AM to 5:00PM. Applicant states that she will care for children 0-13 years of age.

At 9:15 a.m., LPA Garcia toured the interior of the home. This is a one-story home which consist of three (3) bedrooms, one (1) restroom, living room/dining room (main day care room), kitchen, laundry room, front yard (fenced), and driveway.

All areas identified on the facility sketch were inspected. Areas that are accessible to daycare children will be the living room/dining room (main day care area), restroom (located in bedroom #2), bedroom #2, kitchen and driveway. Based on the Facility Sketch submitted, areas off-limits to children and parents will be two (2) bedrooms, laundry room, front yard (fenced).

REPORT CONTINUES ON NEXT PAGE 1 OF 6.

SUPERVISORS NAME: Brandi VanOosten
LICENSING EVALUATOR NAME: Mireya Garcia
LICENSING EVALUATOR SIGNATURE:	DATE: 10/18/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/18/2022

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 6

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: TRUJILLO FAMILY CHILD CARE	FACILITY NUMBER: 198021111
	VISIT DATE: 10/18/2022

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**Rooms that are off-limits need to be made inaccessible during operating hours** The Applicant/Licensee does understand that licensing staff may have access to off-limit areas during inspection visit if necessary.

LPA did not observe any hazards inside the home. LPA asked to be shown the electrical outlets in the areas used by the children and observed to be covered. There is a wall heater in the dining room that is covered. Detergents, cleaning compounds, medicines, sharp objects, and hazardous items that can pose a danger to children was observed inaccessible in areas designated for children. The Applicant/Licensee states that there are no poisons in the home. The Applicant/Licensee was advised that any poisons must be locked with a key or combination lock. LPA also observed appropriate equipment, toys, and games for children.

The valve on the required 2A 10BC fire extinguisher indicates fully charged with a service tag dated 09/15/2022. There is a first aid kit located in the living room. There are smoke detectors throughout the home and a carbon monoxide detector located in the dining room. At 9:26 am, LPA Garcia tested both alarms and found them to be operational.

At 9:50 am., LPA toured through the exterior of the home. Per applicant, children will not use the outdoor area. LPA obtained a Declaration (LIC855) from applicant/licensee which explains the outdoor activity plan and also states that children will be supervised at all times.

Per Applicant/Licensee, there is one cat, no firearms and no weapons on the premises.

The applicant/licensee states she will provide food for children in care. Applicant/licensee was advised that if food is brought from the children’s homes, all containers must be labeled with child’s name and properly stored or refrigerated.

REPORT CONTINUES ON NEXT PAGE 2 OF 6.

SUPERVISORS NAME: Brandi VanOosten
LICENSING EVALUATOR NAME: Mireya Garcia
LICENSING EVALUATOR SIGNATURE:	DATE: 10/18/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/18/2022

LIC809 (FAS) - (06/04)

Page: 2 of 6

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: TRUJILLO FAMILY CHILD CARE	FACILITY NUMBER: 198021111
	VISIT DATE: 10/18/2022

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The applicant/licensee has completed the required Health and Safety Training, Nutrition Training, and Pediatric First Aid and CPR. The applicant’s Pediatric First Aid and CPR expires on 12/2023. The applicant/licensee has completed the required Mandated Reporter Training on 11/29/2021.

The following was discussed with the applicant:

-Individuals who are 18 years of age or older living in the home must obtain a criminal record clearance. Individuals within one month of their 18th birthday must be fingerprinted immediately. Civil Penalty will be assessed if not in compliance.
-In the absence of the licensee a qualified adult must be present supervising the children; a qualified adult is an individual who has a valid and current adult/infant CPR & Pediatric First Aid certification and a valid criminal record clearance associated with the facility license.
-A current roster of children enrolled must be available and maintained for a period of three years, even after children no longer are attending the facility.
-Annual fees must be paid promptly and by the due date or a late fee shall be assessed, and/or the License shall be terminated.
-The fire extinguisher type 2A-10BC must be serviced annually or as often as necessary and smoke and carbon monoxide detectors should be checked, and batteries replaced as needed.
-Changes should be reported to the Department as soon as they occur such as construction, remodeling, telephone number changes, and/or if you move from your home.
-Any unusual incidents or injuries must be reported to the Department within 24 hours via telephone and within seven (7) days in writing. (use LIC624B for written report)
-Fire and safety drills must be performed every six months and documented for review by the Department.
-Smoking is prohibited in a family childcare home.

REPORT CONTINUES ON NEXT PAGE 3 OF 6.

SUPERVISORS NAME: Brandi VanOosten
LICENSING EVALUATOR NAME: Mireya Garcia
LICENSING EVALUATOR SIGNATURE:	DATE: 10/18/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/18/2022

LIC809 (FAS) - (06/04)

Page: 3 of 6

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: TRUJILLO FAMILY CHILD CARE	FACILITY NUMBER: 198021111
	VISIT DATE: 10/18/2022

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The following was discussed with the applicant:
-Children and Staff records must be maintained and updated as needed and must be available for review by the Department.
- No smoking, No infant walkers, No Johnny jumpers, No saucer chairs, No trampolines, and any other item that falls into that category are not permitted in the facility.
-All adults living and working in the home shall be made aware of the Department's right to inspection authority, which includes but is not limited to the right to enter the home when children are being cared for, interview children and adults, and review documentation.
- Licensees shall reveal each facility license number in all advertisements, publications, or announcements with the intent to attract clients.
- Emergency Disaster Plan, Parent’s Rights Poster, and the Facility License are required to be posted.

Infant Care: Applicant states that at this time she does not plan to care for infants however will provide infant care if the need arises. LPA did not observed infant equipment during this inspection. Licensing staff advise if the applicant does decide to care for infants to sleep infants where they can be directly supervised and advised against sleeping infants in a separate room. Infants under 12 months should sleep mouth up, on their backs, free of clutter surrounding their sleeping space. LIC 9227 (Individual Sleeping Plan) for infants up to 12 months and PIN 20-24-CCP: Recently Approved Safe Sleep Regulations in Effect was explained and issued to the applicant. Title 22 Regulation Section 102425(j) Infant Safe Sleep was discussed with the applicant, including but not limited to documentation that shall be maintained.

REPORT CONTINUES ON NEXT PAGE 4 OF 6.

SUPERVISORS NAME: Brandi VanOosten
LICENSING EVALUATOR NAME: Mireya Garcia
LICENSING EVALUATOR SIGNATURE:	DATE: 10/18/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/18/2022

LIC809 (FAS) - (06/04)

Page: 4 of 6

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: TRUJILLO FAMILY CHILD CARE	FACILITY NUMBER: 198021111
	VISIT DATE: 10/18/2022

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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 the publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: http://www.ada.gov/childqanda.htm

Per Applicant/Licensee, she carries liability insurance in accordance with the standard established by the Family Child Care statute. The law requires a Family Child Care provider to carry liability insurance or bond in the amount of $300,000 annually or to maintain the signed statement in the facility file. Signed statements (LIC282) shall be in the children’s files.

LPA Garcia consulted and explained Child Abuse Reporting, Effects of Lead Exposure Flyer, Updated Patent’s Rights Poster with Complaint Hotline information, Capacity Handout (Small & Large) was provided during this inspection. LPA Garcia advised the applicant/licensee how to access forms, regulations and quarterly updates, and Provider Information Notices (PIN) on the Child Care Licensing website at: www.ccld.ca.gov. LPA reviewed and issued the Forms/Records to Keep in Your Family Child Care Home (LIC 311D) and provided the following forms: Children forms/records, Facility forms/records, facility forms/ records, and Information to be posted in the Family Child Care Home.

During this inspection, Licensing staff consulted with applicant regarding COVID-19 health and safety guidelines on this date. Per applicant, the following safety precautionary measures will be taken during the pickup/drop off of children: Children will be picked up and dropped off in front of the home where daily health checks; temperature checks and screening upon entry will be conducted by Licensee.

REPORT CONTINUES ON NEXT PAGE 5 OF 6.

SUPERVISORS NAME: Brandi VanOosten
LICENSING EVALUATOR NAME: Mireya Garcia
LICENSING EVALUATOR SIGNATURE:	DATE: 10/18/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/18/2022

LIC809 (FAS) - (06/04)

Page: 5 of 6

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: TRUJILLO FAMILY CHILD CARE	FACILITY NUMBER: 198021111
	VISIT DATE: 10/18/2022

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At this time, the licensee home meets the description of a safe and healthy environment for children as described in Chapter 1, Division 12, Title 22 of the California Code of Regulations, and will be submitted for approval to be licensed as a Small Family Child Care Home.

Once licensed, the applicant/licensee is required to adhere to the terms and limitations stated on the license. A copy of this report and all other Licensing reports must be made available to the public for 3 years.

At 10:30 am, an exit interview conducted, and report was reviewed with Applicant/Licensee, Maria de los Angeles Trujillo.

REPORT ENDS HERE PAGE 6 OF 6.

SUPERVISORS NAME: Brandi VanOosten
LICENSING EVALUATOR NAME: Mireya Garcia
LICENSING EVALUATOR SIGNATURE:	DATE: 10/18/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/18/2022

LIC809 (FAS) - (06/04)

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