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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198400471
Report Date: 07/31/2024
Date Signed: 07/31/2024 11:53:25 AM

Document Has Been Signed on 07/31/2024 11:53 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
MONTEREY PARK SW RO, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME:JIMENEZ FAMILY CHILD CAREFACILITY NUMBER:
198400471
ADMINISTRATOR/
DIRECTOR:		JIMENEZ, TANIAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(818) 471-2534
CITY:LOS ANGELESSTATE: CAZIP CODE:
90018
CAPACITY: 14TOTAL ENROLLED CHILDREN: 6CENSUS: 2DATE:
07/31/2024
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:45 AM
MET WITH:Tania Jimenez, LicenseeTIME VISIT/
INSPECTION COMPLETED:
12:15 PM
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On 07/31/2024 at 9:10 AM, Licensing Program Analysts (LPAs)Katrina Chicote and Peter Bishop conducted an Unannounced Annual/Random to the above facility. Upon arrival, LPAs disclosed the purpose of the inspection and met with Licensee, Tania Jimenez, who allowed entry to facility. Adults in the home were discussed and all have criminal record clearance. Also present was volunteer, LPAs discussed conditions of exceptions for clearance for volunteers at time of inspection. There were two day care children, which includes one infant, present during today’s inspection. Licensee states that there are currently six children enrolled, LPAs record review of Facility Roster corroborate information provided. Per Licensee, the facility’s hours of operation are Monday thru Friday 7:30 AM to 6:00 PM. Required postings were observed posted upon entry to facility. Disaster drill log was also available during today’s inspection, record review shows last drill conducted on 07/31/2024. Licensee confirms this information to be accurate. LPAs singularly toured facility. LIC 126 was provided.

This is a single story home which consists of two bedrooms and one bathroom, Kitchen, Den, and Day Care Space. Areas used by the children include the Den (located upon entry), Day Care Space (located through front entrance from Den), and Bathroom (located through door to the right of Day Care Space). Per Licensee, areas off limits to children and parents include Kitchen and bedrooms. LPAs observed that there is an operable baby gate separating Kitchen from Day Care Space and off limits bedrooms to have child safety door knob covers making these areas off limits at time of inspection. Per Licensee, she only uses Kitchen as walkway to access backyard when it is raining outside.

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. LPAs observed ceiling fans on ceiling of Day Care Space. There is a working telephone maintained in the home. At 9:18 AM, LPAs observed Den to have cubbies for children's belongings. At 9:20 AM,LPAs observed Day Care Space to have wooden dramatic play equipment, bouncy toys, and other age appropriate toys, free of loose and sharp parts available for children at time of inspection. LPAs observed age appropriate tables and chairs available at
Report Continues - Page 1 of 4
SUPERVISORS NAME: Denise Gibbs
LICENSING EVALUATOR NAME: Katrina Chicote
LICENSING EVALUATOR SIGNATURE: DATE: 07/31/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/31/2024
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
MONTEREY PARK SW RO, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME: JIMENEZ FAMILY CHILD CARE
FACILITY NUMBER: 198400471
VISIT DATE: 07/31/2024
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time of inspection. Per Licensee, she provides food to children in care and use Day Care Space for eating, LPAs observed one child eating on table and chair and infant eating in high chair. LPAs observed infant removed from high chair once done eating. LPAs observed two Graco pack-n-plays stored in corner of Day Care Space, ensuring that infant equipment does not block entrances/exits at time of inspection. LPAs observed electrical cover outlets all through the home. At 9:23 AM, LPAs observed Bathroom to have general area sanitation and adequate supplies at time of inspection. Detergents, cleaning compounds, medications, and other items which can pose a danger to children are inaccessible. LPAs observed cleaning solutions stored on high shelf in Bathroom and in Kitchen cabinets that are off limits at time of inspection. Licensee states that there are no poisons in the home used to kill vermin/bugs at time of inspection. Licensee was advised that inaccessibility of hazards must be constantly reassessed depending on the age, size, and abilities of children in care. Personal Rights of children were observed by LPAs at time of inspection.

Per Licensee, the children will have access to backyard for outdoor play. LPAs observed backyard is accessible through side of the home. At 9:30 AM, LPAs observed backyard has grass and adequate perimeter fencing through-out the yard. LPA observed sandbox, plastic play equipment for infants/toddlers, wooden play structure with ladder, slide, and swings and other age appropriate toys free of loose and sharp parts available for the children in the backyard at time of inspection. LPAs observed garden area to the left of play area that have a variety of vegetables planted in tall garden boxes. At 9:34 AM, LPAs observed hazardous items accessible to children such as rakes, shovels, and garden equipment that have sharp edges and pointed parts. LPAs observed shrubs and plants maintained at time of inspection. LPAs observed a small dog roaming freely in backyard at time of inspection, per Licensee this dog is kept separate from children when children are in backyard. LPAs observed a small dog carrier available in backyard at time of inspection.

At 9:50 AM, LPAs observed the valve on the required 2A10-BC fire extinguisher indicates fully charged with proof of purchase receipt dated 05/06/2023. LPAs tested smoke detector which were observed to be operable at time of inspection. Per Licensee, she was told that smoke detectors were also carbon monoxide detectors but writing only indicates Smoke Detector at time of inspection. LPAs observed First Aid Kit stored in Day Care Space and Licensee states she has additional First Aid Kit in backyard. Licensee has current Pediatric First Aid and CPR valid until 08/2025 and proof of completion for AB1207 Mandated Reporter training on 01/02/2024. Proof of immunization against influenza, pertussis, and measles was readily available during today’s inspection.
Report Continues - Page 2 of 4
SUPERVISORS NAME: Denise Gibbs
LICENSING EVALUATOR NAME: Katrina Chicote
LICENSING EVALUATOR SIGNATURE:

DATE: 07/31/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/31/2024
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
MONTEREY PARK SW RO, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME: JIMENEZ FAMILY CHILD CARE
FACILITY NUMBER: 198400471
VISIT DATE: 07/31/2024
NARRATIVE
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At 10:10 AM, LPAs conducted record review for 2 of 2 children present at time of inspection and observed to be complete.

Per Licensee, there are no weapons, firearms in the home and there are no bodies of water around the premises. LPAs observation did not see any bodies of water around the premises or firearms/weapons at time of inspection.



The following were discussed:
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.

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.


To improve the quality and value of the new inspection process, a survey may 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 CARE tools, please send email inquiries 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.

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.

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.
Report Continues - Page 3 of 4

SUPERVISORS NAME: Denise Gibbs
LICENSING EVALUATOR NAME: Katrina Chicote
LICENSING EVALUATOR SIGNATURE:

DATE: 07/31/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/31/2024
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
MONTEREY PARK SW RO, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME: JIMENEZ FAMILY CHILD CARE
FACILITY NUMBER: 198400471
VISIT DATE: 07/31/2024
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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)/ (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: https://www.ada.gov/resources/child-care-centers/.

MyChildCarePlan.org – Centers and Family Child Care Homes Licensee was informed of the MyChildCarePlan.org website; 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.

During the exit interview, the Licensee Tania Jimenez, confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS.

Based on this information, the following deficiencies on the attached LIC 809D are being cited in accordance with California Code of Regulations Title 22. Deficiencies that are being cited need to be cleared to protect the children’s health & safety.

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

Exit interview was conducted and report was reviewed with the Licensee, Tania Jimenez.


Report Ends - Page 4 of 4
SUPERVISORS NAME: Denise Gibbs
LICENSING EVALUATOR NAME: Katrina Chicote
LICENSING EVALUATOR SIGNATURE:

DATE: 07/31/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/31/2024
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 07/31/2024 11:53 AM - It Cannot Be Edited


Created By: Katrina Chicote On 07/31/2024 at 11:23 AM
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: JIMENEZ FAMILY CHILD CARE
FACILITY NUMBER: 198400471

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/31/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
HSC
1597.543
Licensure Requirements
Every family day care home for children shall have one or more carbon monoxide detectors in the facility that meet the standards established in Chapter 8 (commencing with Section 13260) of Part 2 Division 12. The department shall account for the presence of these detectors during inspections.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on LPAs observation and interview, Licensee did not meet above requirement. LPAs observed only smoke detector present, Licensee believed this to be a dual detector but observation of writing on smoke detector only indicates as smoke detector. This poses a potential health, safety, and personal rights risk to children in care.
POC Due Date: 08/01/2024
Plan of Correction
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Licensee states she will obtain a carbon monoxide detector and provide photo to LPA by POC date via email.
Type B
Section Cited
CCR
102417(d)
Operation of A Family Child Care Home
(d) The home shall provide safe toys, play equipment and materials.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, Licensee did not meet above requirement. LPAs observed garden area in outdoor play area that had equipment that had sharp edges and pointed parts accessible at time of inspection. This poses a potential health, safety, and personal rights risk to children in care.
POC Due Date: 08/30/2024
Plan of Correction
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Licensee states she will place it inside the garage to make it inaccessible and provide photos to LPA by POC date via email.
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:Denise Gibbs
LICENSING EVALUATOR NAME:Katrina Chicote
LICENSING EVALUATOR SIGNATURE:
DATE: 07/31/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/31/2024


LIC809 (FAS) - (06/04)
Page: 5 of 6
Document Has Been Signed on 07/31/2024 11:53 AM - It Cannot Be Edited


Created By: Katrina Chicote On 07/31/2024 at 11:23 AM
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: JIMENEZ FAMILY CHILD CARE
FACILITY NUMBER: 198400471

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/31/2024

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
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Based on LPA observation and interview, Licensee did not meet above requirement. LPAs observed fire extinguisher to have proof of purchase receipt for 05/06/2023, which is not within the year at time of inspection. This poses a potential health, safety, and personal rights risk to children in care.
POC Due Date: 08/30/2024
Plan of Correction
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Licensee states she will obtain a new fire extinguisher and provide receipt to LPA by POC date via email.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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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:Denise Gibbs
LICENSING EVALUATOR NAME:Katrina Chicote
LICENSING EVALUATOR SIGNATURE:
DATE: 07/31/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/31/2024


LIC809 (FAS) - (06/04)
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