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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198021544
Report Date: 09/09/2024
Date Signed: 09/09/2024 05:12:30 PM

Document Has Been Signed on 09/09/2024 05:12 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 CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME:EDIRIMUNI FAMILY CHILD CAREFACILITY NUMBER:
198021544
ADMINISTRATOR/
DIRECTOR:		FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 0CENSUS: 0DATE:
09/09/2024
TYPE OF VISIT:PrelicensingANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
02:00 PM
MET WITH:Tenuri EdirimuniTIME VISIT/
INSPECTION COMPLETED:
05:30 PM
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On 9/9/2024 at 2:00 pm, Licensing Program Analyst (LPA) Carolyn Tuba conducted an announced pre-licensing inspection for the above address. LPA met with applicant; Tenuri Edirimuni and an adult who lives in the home and will be assisting the applicant. There were no children present during the visit. A Covid risk assessment was conducted. Applicant guided LPA on a tour of the home. Individuals residing in the home were discussed and noted. Per applicant, hours of operation will be from 6:00AM to 6:00 PM Monday to Friday and will not exceed 24-hour care at any time. Applicant states that she will care for children birth to 12 years of age.

This is a single-family home which consists of 3 bedrooms, 2.5 bathrooms, dining area, living room (Daycare), kitchen, front yard, back yard, enclosed side yard, and garage. The children will use the living room (Daycare), the ½ bathroom, enclosed side yard, and dining area. The pillow area in the living room (Daycare) will be used as isolation space for ill children. Areas off limits to children include the front yard, back yard, 3 bedrooms, 2 bathrooms kitchen and garage. The home was inspected for safety, comfort, cleanliness, telephone service, heating and ventilation, inaccessibility to poisons, detergents, cleaning compounds, medicines, and hazardous items that can pose a danger to children. Knives and other sharp utensils are in a high shelf in the kitchen cabinet. Cleaning products will be kept in a cabinet under the kitchen sink and applicant will be adding a child proof latch. Electrical Outlets have child proof covers. Poisons and chemicals are kept in the garage which will be locked during operating hours.

During the visit applicant provided an updated application adding an additional phone number. LPA will be updating in the system. LPA provided applicant with prelicensing packet, safe sleep document, sample 15-minute sleep log, sample emergency drill, Safe Sleep Infant Plan and Unusual Incident Report (UIR).

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SUPERVISORS NAME: Ana Chico
LICENSING EVALUATOR NAME: Carolyn Tuba
LICENSING EVALUATOR SIGNATURE: DATE: 09/09/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/09/2024
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: EDIRIMUNI FAMILY CHILD CARE
FACILITY NUMBER: 198021544
VISIT DATE: 09/09/2024
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Per applicant, she will be enrolling in a food program and will provide breakfast, lunch, PM snack, as well as formula and baby food and will allow parents to also provide meals for their child if they so desire. LPA advised to contact the Resource and Referral Program for her area.

Applicant has completed the required health and safety training, mandated reporting training and the Pediatric First Aid and CPR which expires: 5/2025. Applicant has provided proof of immunizations, TB and against pertussis (Tdap) and measles, mumps & rubella (MMR) and influenza waiver.

Applicant states there are two cats and will be kept in enclosed patio near the back yard or in one of the off-limit bedrooms separate from children in care.

No were no bodies of water observed.

LPA observed a small play structure in the enclosed side yard along with toys. LPA took photos. The patio where children are playing is enclosed with a 6-foot gate and cement wall. The area has artificial grass to absorb falls.

LPA observed age-appropriate toys and learning materials. A fire extinguisher was observed (3A:10BC) and was purchased August 24, 2024. First Aid kit is available, but applicant will be purchasing a new one as some items needed were missing. Per Applicant, there no weapons or firearms in the home. There is central heating and air in the home. Smoke detector and carbon monoxide located in the hallway and dining area were tested and observed to be operable.

Per applicants’ children and infants will nap in the living room (daycare) (LPA observed napping mats). LPA observed 2 play yards in the dining area for the infants to nap. LPA provided safe sleep information with applicant 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. LPA also informed the applicant of the importance of checking for recalled infant
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SUPERVISORS NAME: Ana Chico
LICENSING EVALUATOR NAME: Carolyn Tuba
LICENSING EVALUATOR SIGNATURE:

DATE: 09/09/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/09/2024
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: EDIRIMUNI FAMILY CHILD CARE
FACILITY NUMBER: 198021544
VISIT DATE: 09/09/2024
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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. LPA reviewed with applicant that napping equipment should not block entrances or exits. Infant mattresses must be firm with tightly fitted sheets. Loose objects, bumpers, objects hanging, or objects attached to the cribs/play yards are not allowed. Each infant should have their own crib/play yard and bedding. LPA provided applicant of the regulations, including LIC 9227 Infant Sleep Plan for infants under 12 months, 15-minute sleep check documentation for infants 0-24 months, and advised of the PIN 20-24-CCP.

LPA observed Parent Board with PUB394 Notification of Parents Rights, LIC 610A Emergency Disaster Plan and LIC9148 Earthquake Preparedness and room for Facility License located near the entrance of the front door.

Applicant Corrections are the following:
Childproof gates near the kitchen and the hallway leading to the bedrooms will be installed.
Latch for the cabinet under the kitchen sink will be installed.
Cover foe the opening of the fireplace in the Livingroom (Daycare) will be installed.
Rubber foam will be added around the brick wall of the fireplace in the dining area.
Applicant will be purchasing surgical scissors to be added to the first aid kit.
Per applicant the corrections will provided no later then September 11, 2024 via photos to LPA’s email address.


The following was discussed with the applicant:
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, TB clearance, immunizations, Mandated Reporter training certificate www.mandatedreporterca.gov, and a valid criminal record clearance associated to 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. Reporting Requirements: Any unusual incidents or injuries must be reported to the Department within 24 hours via
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SUPERVISORS NAME: Ana Chico
LICENSING EVALUATOR NAME: Carolyn Tuba
LICENSING EVALUATOR SIGNATURE:

DATE: 09/09/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/09/2024
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: EDIRIMUNI FAMILY CHILD CARE
FACILITY NUMBER: 198021544
VISIT DATE: 09/09/2024
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telephone and within seven (7) days in writing. 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. Children and Staff records must be maintained and updated as needed and must be available for review by the Department. No infant walkers, No Johnny jumpers, No saucer chairs, and any other item that falls into that category are not permitted in the facility.

Inspection Authority: All adults living and working in the home shall be made of aware of the Department’s right to inspection the home, 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.

The facility license number must be on all advertisements, publications, social media or announcements with the intent to attract clients.

Isolation for Ill children: When a child is ill, he/she shall be separated from other children (reference 102417(e) Operation of a Family Child Care Home). The isolation area for a sick child waiting to be picked up will be in the on-limit area of the living room of the home.

Liability Insurance was discussed; LPA advised applicant to review Title 22 Regulation 102417(m)(1) for additional information. Licensee states she does not have liability insurance.

OTHER INFORMATION THAT WAS DISCUSSED:
Never Shake a Baby, Sudden Infant Death Syndrome (SIDS) and Safe Sleeping practices.
Per applicants, there are no dual licenses at this address.

Applicant was reminded that all adults 18 and over living in the home, persons who provide care and supervision to children, and staff who have contact with children, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, 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 for a maximum of 5-days or, if the penalty is for a repeat violation, for a maximum of 30-days per person will be assessed if this regulation is violated.
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SUPERVISORS NAME: Ana Chico
LICENSING EVALUATOR NAME: Carolyn Tuba
LICENSING EVALUATOR SIGNATURE:

DATE: 09/09/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/09/2024
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: EDIRIMUNI FAMILY CHILD CARE
FACILITY NUMBER: 198021544
VISIT DATE: 09/09/2024
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The applicant provided proof of control of property.

Because the applicant rents/leases the home, proof of landlord notification is required. The LPA observed the Property Owner/Landlord Notification form (LIC9151) that the applicant confirms was provided to the property owner/landlord. The applicant obtained a signed Property Owner/Landlord Consent form (LIC 9149).

Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02-CCP. 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) or (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.

LPA reviewed with applicant the LIC 311D, Forms/Records to Keep In Your Family Child Care Homes, children’s forms/records, facility forms/records, and information to be posted. Entrance Checklist was provided to the applicant.

LPA discussed the safe sleep regulations with [applicant, licensee, or facility representative] 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. LPA also informed [applicant, licensee, or facility representative] 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.

On this date, 08/02/2024, the California Attorney General - Megan’s Law website was searched for information on sex offenders required to register with local law enforcement under California's Megan's Law. No registered sex offenders were found at the facility addresses. Under state law, some registered sex offenders are not subject to public disclosure; therefore, they may not have been included in this search. However, the Department conducts a monthly cross reference of each address on record for all registered sex offenders against all CCLD facility addresses pursuant to information shared by California DOJ.
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SUPERVISORS NAME: Ana Chico
LICENSING EVALUATOR NAME: Carolyn Tuba
LICENSING EVALUATOR SIGNATURE:

DATE: 09/09/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/09/2024
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: EDIRIMUNI FAMILY CHILD CARE
FACILITY NUMBER: 198021544
VISIT DATE: 09/09/2024
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Applicant was informed of the MyChildCarePlan.org site, a consumer education website that helps families obtain child care by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.

Community Care Licensing Division (CCLD) regularly sends information to licensed facilities, providers, and stakeholders by way of Provider Information Notices (PIN), Program Quarterly Update Newsletters and other important information communication platforms.

To receive important licensed related information to licensed facilities, visit the CCLD Important Information website at https://www.cdss.ca.gov/inforesources/community-care-licensing/subscribe and select the Child Care option to receive email communication.

Exit interview conducted and report was reviewed with the applicant, Tenuri Edirimuni.
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SUPERVISORS NAME: Ana Chico
LICENSING EVALUATOR NAME: Carolyn Tuba
LICENSING EVALUATOR SIGNATURE:

DATE: 09/09/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/09/2024
LIC809 (FAS) - (06/04)
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