198400447-10-25-2022-54-CC-AMOY-CKK7RT-20221025215403

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 198400447
Report Date: 10/25/2022
Date Signed: 10/25/2022 09:54:22 PM

Document Has Been Signed on 10/25/2022 09:54 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:	RUBIO FAMILY CHILD CARE		FACILITY NUMBER:	198400447
ADMINISTRATOR:	ELMA RUBIO		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(323) 517-3951
CITY:	LOS ANGELES	STATE: CA	ZIP CODE:	90062
CAPACITY: 14	TOTAL ENROLLED CHILDREN: 7	CENSUS: 0	DATE:	10/25/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	01:15 PM
MET WITH:	Elma Rubio, Licensee		TIME COMPLETED:	03:30 PM

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Licensing Program Analyst (LPA) Alicia Mooberry conducted an unannounced Required Annual Inspection on this date. LPA explained the purpose of inspection and provided the inspection Entrance Checklist, LIC 126. Individuals residing in the home were discussed and noted. Per licensee hours of operation are Monday to Saturday, 6:00am to 6:00pm. Applicant states that she will care for children 0-13 years of age. Overnight care regulations were discussed with licensee. There were no children present during inspection.

This is a single story home which consists of 3 bedrooms, 1 bathroom, kitchen, living room, and laundry room. The home is located in the rear of a two-unit property. 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.

Areas accessible to children: Three bedrooms, bathroom, living room, kitchen and dining are, yard space in front of both units.

Areas off limits include: Laundry room in kitchen, back and sides of home, 2 storage units located on the side of the home between the 2 units. LPA observed gates on either side of home making the side and back of home inaccessible.
LPA observed that there is a wall heater in the living room that is made inaccessible by a screen surrounding the heater and anchored to the wall. Detergents, cleaning compounds, medicines, sharp objects and hazardous items that can pose a danger to children are inaccessible in areas designated for children. lPA observed locked cabinets that open with magnate. The facility has a first-aid kit mounted on the wall. The applicant states that there are no poisons in the home. The applicant was advised that any poisons must be locked with a key or combination lock.

LPA observed the facility license posted in the living room, Publication (PUB) 394- Notification of Parent Rights and Licensing Form (LIC) 9148- Earthquake Preparedness form. LPA observed completed facility records including; LIC 9040- Facility Roster, LIC 610- Facility Disaster Plan.

Page 1 – Report Continues

SUPERVISORS NAME: Valarie Cook
LICENSING EVALUATOR NAME: Alicia Mooberry
LICENSING EVALUATOR SIGNATURE:	DATE: 10/25/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/25/2022

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: RUBIO FAMILY CHILD CARE	FACILITY NUMBER: 198400447
	VISIT DATE: 10/25/2022

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Smoke and carbon monoxide detectors were tested and are operable. Fire extinguisher indicated fully charged however there was no receipt or service record. Licensee was reminded that fire extinguisher needs to be serviced yearly. The home maintains telephone service via cell phone.

The home is observed to be clean and orderly. There are toys and other age appropriate material available for children. LPA observed that cleaning compounds are in locked kitchen and abthroom inaccessible to children. The bathroom that children use is located in the observed to be clean and free of hazards.

Per Licensee there are no firearms or weapons stored in the home. Isolation area for sick children waiting to be picked up is in the kitchen area where they are supervised, away from the other children.

LPA discussed Safe sleep regulations, including LIC 9227 Infant Sleep Plan for infants under 12 months, 15-minute sleep check documentation for infants 0-24 months, and referred to PIN 20-24-CCP. Licensee states there are currently no infants in care. LPA observed play yard in middle bedroom, LPA advised licensee to never sleep infants in closed bedroom.

LPA 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. LPA 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.

Currently, children are using the back yard for outdoor play. The outdoor play area was observed to be fenced. LPA observed that the outdoor yard has toys and other materials for children to play with. LPA did not observe any objects that could be hazardous to children in care. Facility does not have a pool or similar bodies of water. LPA has 4 small dogs which are kept in the dog run on the side of the home inaccessible to children in care.

LPA remimded licensee to report any unusual incidents with in 24 hours.

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SUPERVISORS NAME: Valarie Cook
LICENSING EVALUATOR NAME: Alicia Mooberry
LICENSING EVALUATOR SIGNATURE:	DATE: 10/25/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/25/2022

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: RUBIO FAMILY CHILD CARE	FACILITY NUMBER: 198400447
	VISIT DATE: 10/25/2022

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Children’s records were reviewed for (LIC) 282- Affidavit Regarding Liability Insurance, Immunization's Records, LIC 700- Identification and Emergency Information, LIC 627- Consent for Medical Treatment, LIC 995A Notification of Parents’ Rights.

Licensee records were reviewed for approved Pediatric First Aid and CPR certification, Proof of immunizations against measles, pertussis and influenza or influenza declination, TB clearance or risk assessment, and current Mandated Reporter Training Certificate. LPA reminded licensee that all adults present during hours of operation must have a TB clearance on file.

LPA observed that licensee is implementing current COVID-19 recommendations, precautions and procedures.

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 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.

To improve the quality and value of the new inspection process, a survey will be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or tools, please send them by email to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/inspection-process.

Based on the LPA's observations and records review the following deficiencies will be cited today in accordance with California Title 22 Regulations.

A notice of site visit was given and must remain posted for 30 days.

Exit interview conducted and report was reviewed with the Licensee, Elma Rubio

SUPERVISORS NAME: Valarie Cook
LICENSING EVALUATOR NAME: Alicia Mooberry
LICENSING EVALUATOR SIGNATURE:	DATE: 10/25/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/25/2022

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 10/25/2022 09:54 PM - It Cannot Be Edited

Created By: Alicia Mooberry On 10/25/2022 at 02:58 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: RUBIO FAMILY CHILD CARE	FACILITY NUMBER: 198400447
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 10/25/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

102417(g)(1)

Operation of A Family Child Care Home

(g) The home shall be free from defects or conditions which might endanger a child. Safety precautions shall include but not limited to: (1) Fireplaces and open face heaters shall be screened to prevent access by children. The home shall contain a fire extinguisher and smoke detector device which meet standards established by the State Fire Marshall. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation, the licensee did not comply with the section cited above due to fire extingusher does not have a service record or purchase receipt within gthe last 12 months which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 11/01/2022
	Plan of Correction
1 2 3 4	Per licensee proof of correction will be sent to department by POC due date.

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:

Valarie Cook

LICENSING EVALUATOR NAME:

Alicia Mooberry

LICENSING EVALUATOR SIGNATURE:

DATE: 10/25/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/25/2022

LIC809 (FAS) - (06/04)

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