198400515-1-19-2023-54-CC-AESA-CN8SBF-20230119124351

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 198400515
Report Date: 01/19/2023
Date Signed: 01/19/2023 12:44:15 PM

Document Has Been Signed on 01/19/2023 12:44 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
MONTEREY PARK S WEST, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME:	PRIETO FAMILY CHILD CARE		FACILITY NUMBER:	198400515
ADMINISTRATOR:	PRIETO, MIRSA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(323) 219-2506
CITY:	LOS ANGELES	STATE: CA	ZIP CODE:	90037
CAPACITY: 14	TOTAL ENROLLED CHILDREN: 14	CENSUS: 3	DATE:	01/19/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	09:45 AM
MET WITH:	Licensee Mirsa Prieto		TIME COMPLETED:	12:55 PM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	On 1/19/23 at 9:45 AM Licensing Program Analysts (LPAs) Austin Estrada and Jeanette Estrada conducted an unannounced required 1-year inspection at the above facility. LPA A. Estrada called Licensee Mirsa Prieto at 9:50 AM advising her that LPAs were at the facility to conduct an inspection. Licensee called her staff member (S2) who was present at the facility with the children to advise her LPAs were at the facility. LPAs met with the S2 at 9:58 AM and informed her of the purpose for the visit. LPA provided the inspection Entrance Checklist (LIC 126). S2 guided LPAs on a tour of the facility. There was 3 children (one infant) and 1 staff present during the inspection. Licensee arrived at the facility at 10:20 AM. All adults present during the inspection have obtained a criminal record clearance or exemption. Individuals residing in the home have been discussed and noted. Licensee provides care to children ages newborn to 13 years old and operation days/ hours are Monday through Friday 6 AM to 6 PM. This is a one story duplex with 2 bedrooms, 1 bathroom, living room, dining room area, kitchen, diaper changing area (located at the back of the kitchen), detached garage, and fenced backyard and fenced backyard. Off limits areas include the kitchen and both bedrooms. Children use the bathroom in the kitchen area. There is a on limits walkway for children to use to get to the bathroom. The kitchen is made inaccessible by a gate. All areas identified on the facility sketch that are accessible for children to use were inspected for safety, comfort, and cleanliness. The following was observed and reviewed during this inspection: LPA reviewed required posted documentation for Facility License, Publication (PUB) 394- Notification of Parent Rights and Licensing Form (LIC) 9148- Earthquake Preparedness form. All documents were observed to be posted in on the porch area leading to the entrance of the home. Facility records were reviewed for LIC 9040- Facility Roster, LIC 610A- Emergency Disaster Plan and Verification of Disaster and Fire Drills. Licensee did not have documentation of disaster and fire drill at the time of inspection. LPAs advised Licensee that disaster and fire drills should be conducted and documented at least once every six months.

SUPERVISORS NAME: Valarie Cook
LICENSING EVALUATOR NAME: Austin Estrada
LICENSING EVALUATOR SIGNATURE:	DATE: 01/19/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/19/2023

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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Document Has Been Signed on 01/19/2023 12:44 PM - It Cannot Be Edited

Created By: Austin Estrada On 01/19/2023 at 11:58 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: PRIETO FAMILY CHILD CARE	FACILITY NUMBER: 198400515
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 01/19/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

102425(b)

Infant Safe Sleep

(b) Cribs or play yards shall be free from all loose articles and objects. 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 by not removing loose articles from the crib while it was in use by a child #2 which poses a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 01/19/2023
	Plan of Correction
1 2 3 4	Licensee immediately removed the loose articles from the crib during the inspection.

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:

Austin Estrada

LICENSING EVALUATOR SIGNATURE:

DATE: 01/19/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/19/2023

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 S WEST, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME: PRIETO FAMILY CHILD CARE	FACILITY NUMBER: 198400515
	VISIT DATE: 01/19/2023

NARRATIVE

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There is an operable carbon monoxide detector and a smoke detector in the home. A fully charged Fire extinguisher (2A10BC) was observed and last serviced on 2/19/22. The home maintains telephone service(mobile). LPA observed cleaning compounds, sharp objects such as knives located in off limits kitchen area inaccessible to children in care. Per Licensee, no children require medication. Per Licensee there is no personal medication stored at the facility. LPAs observed poisons (bug spray) located in the front yard. LPA advised Licensee that all poisons must be locked away, not only inaccessible. Licensee removed poisons from the location into a locked storage area. Isolation area for sick children waiting to be picked up is in the back yard (supervised), away from the other children. Per Licensee there are no firearms or weapons stored in the home. Food is provided by Licensee. LPA advised Licensee if children bring food from home it must be labeled with the child’s name and properly stored or refrigerated. The home is observed to be clean and orderly. There are toys and other age-appropriate materials available for children. LPA observed a fireplace in the living room made inaccessible to children in care. The outdoor play area (back yard and front yard) was observed to be fenced and contain toys and other age- appropriate materials available for children. Per Licensee, children are supervised while playing outside. There is a storage shed in the backyard that was observed to be locked. LPAs did not observe any pools, spas, or other bodies of water. During the inspection, children present were observed to be treated with dignity and respect, observed to be receiving safe, healthful, and comfortable accommodations, furnishings, and equipment, and free from corporal and/or unusual punishment. Children’s records were reviewed for (LIC) 282- Affidavit Regarding Liability Insurance, Immunization Records, LIC 700- Identification and Emergency Information, LIC 627- Consent for Medical Treatment, LIC 995A Notification of Parents’ Rights, LIC 9227- Infant sleep form (0-12 months, and documentation of 15-minute Infant Sleep Check (0-24 months) Child #3 did not have any required documents at the time of inspection. Child #2 did not have a infant sleep log at the time of inspection. Staff records were reviewed for approved Pediatric First Aid and CPR certification, LIC-501: Personnel Record, LIC 508-Criminal Record Statement, LIC 9052- Employee Rights, Proof of immunizations against measles, pertussis and influenza or influenza declination, TB clearance or risk assessment, and LIC 9108- Statement of Child and Mandated Reporter Training Certificate. Licensee’s CPR/First Aid expires in 3/23 and Mandated Reporter Training Certificate was completed on 10/6/21. All records were observed to be complete. Infant Care: Currently licensee cares for 1 infant. LPAs observed one crib in the living room. LPAs observed child #2 in the crib with loose articles. LPAs advised Licensee that no loose articles should be in the crib while in use. LPAs reviewed Safe sleep regulations with Licensee, including LIC 9227 (Infant Sleep Plan) for infants under 12 months and 15-minute sleep check documentation for infants 0-24 months. LPA discussed the Child Care Licensing Safe Sleep webpage at

SUPERVISORS NAME: Valarie Cook
LICENSING EVALUATOR NAME: Austin Estrada
LICENSING EVALUATOR SIGNATURE:	DATE: 01/19/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/19/2023

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 S WEST, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME: PRIETO FAMILY CHILD CARE	FACILITY NUMBER: 198400515
	VISIT DATE: 01/19/2023

NARRATIVE

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https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPA provided a copy of PIN 20-24-CCP: Recently Approved Safe Sleep Regulations in Effect. Overnight Care: Per Licensee, there is no overnight care is not provided at the moment. Incidental Medical Services (IMS): 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 Center and the ADA, available at: http://www.ada.gov/childqanda.htm 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. 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/process. LPA advised Licensee that all adults age 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. Based on the LPA’s observations, interviews and records review, the following deficiency listed on the attached LIC 809D (deficiency page) is 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. Deficiencies include one type B violation for having loose articles in the crib while it was in use by a child in care.. An exit interview was conducted and report was reviewed with Licensee, Mirsa Prieto. A notice of site visit was given and must remain posted for 30 days. Failure to maintain posting as required will result in a $100.00 civil penalty. Appeal rights were discussed and provided to the Licensee.

SUPERVISORS NAME: Valarie Cook
LICENSING EVALUATOR NAME: Austin Estrada
LICENSING EVALUATOR SIGNATURE:	DATE: 01/19/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/19/2023

LIC809 (FAS) - (06/04)

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