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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198400524
Report Date: 10/10/2022
Date Signed: 10/10/2022 01:19:18 PM

Document Has Been Signed on 10/10/2022 01:19 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:DELERY FAMILY CHILD CAREFACILITY NUMBER:
198400524
ADMINISTRATOR:PAZETTER, DELERYFACILITY TYPE:
810
ADDRESS:TELEPHONE:
9095450671
CITY:LOS ANGELESSTATE: CAZIP CODE:
90061
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 0DATE:
10/10/2022
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
09:54 AM
MET WITH:Pazetter Delery, ApplicantTIME COMPLETED:
01:25 PM
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On Monday, October 10, at 9:56 a.m., Licensing Program Analyst (LPA) Mayra Rivera conducted an announced pre licensing inspection and met with applicant Pazzetter Delery who guided LPA Rivera on a tour of the facility. The applicant is requesting a Large family childcare license.

Family members residing in the home has been discussed with applicant and are cleared. Operating hours will be Monday to Sunday from 6:00 a.m. to 10:00 p.m. and care for children ages 0 to 13. Fire clearance granted on June 29, 2022 for capacity of 14 children and with the condition of not using the two small buildings located in the backyard (two white sheds and the room with the fireplace).

This facility is a one-story home that consists of three bedrooms, two full bathrooms, kitchen, living room with backroom, dining area, garage, front yard and backyard (gated). All areas identified on the facility sketch were inspected. Areas that are accessible to children and identified on the facility sketch include; living room, backroom, dining room, two bedrooms and bathroom located in the hallway and backyard.

Areas off limits to children include- indoor-kitchen, master bedroom and bathroom. LPA observed off limits kitchen with an installed gate barrier, bedroom with a key lock. Outdoor- front yard, two white sheds and the room with the fireplace and garage. k.

At 10:10 a.m LPA Rivera inspected the facility for safety, comfort, cleanliness, ventilation and working phone (cell phone ) . For ventilation, LPA Rivera observed AC/heater central and the vents on the top ceiling walls. LPA observed the thermostat located in the hallway and temperature set at 72 degrees. LPA observed the furniture, children materials, to be in good condition and age appropriate.
SUPERVISORS NAME: Karen Chambers
LICENSING EVALUATOR NAME: Mayra Rivera
LICENSING EVALUATOR SIGNATURE: DATE: 10/10/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/10/2022
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: DELERY FAMILY CHILD CARE
FACILITY NUMBER: 198400524
VISIT DATE: 10/10/2022
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At approximately 10:15 a.m., LPA Rivera entered the restroom located in the hallway and observed the toilet, hand washing sink, and hand soap. LPA observed the bottom sink cabinet closed with a child proof lock and did not observe hazard materials and observed the restroom to be in good condition.

At approximately 10:23 a.m. LPA Rivera observed cleaning compounds items stored inside the bottom kitchen sink cabinet with a child proof lock making it inaccessible for children to open the cabinet doors. Knives and sharp objects are stored inside the kitchen drawer with child proof lock, making it inaccessible for children to open. Per applicant, water disposable cups will be provided and use the filtered water from the refrigerator. Applicant stated she will be providing the meals and is interested in enrolling with the California Adult Child Care Food Program.

LPA Rivera asked applicant if there are any pets, poisons, firearms, weapons or bodies of water. Applicant stated she does not have pets, no body of waters, firearms, weapons or poisons. LPA did not observe any pets, firearms, weapons, poisons nor bodies of water. Applicant was advised that if any poisons (ex; drano, rat poison or items with skull hazard symbol), firearms and weapons are purchased, it is required to be locked with a key or combination lock and firearm and ammunition must be stored separately.



At 10:35 a.m. LPA Rivera observed the required 2A10BC fire extinguisher located in the kitchen with the valve on the green area indicating fully charged and serviced on 4/20/22. LPA observed carbon monoxide detector and smoke alarm located in the living room/back room and both detectors were tested. LPA Rivera heard the sound. The smoke and carbon detectors are operable. LPA observed the first Aid complete with band aids, gauzes, adhesive bandages and antiseptic wipes and located in the kitchen.

At approximately 10:46 a.m., LPA Rivera inspected the outdoor area used by children for safety, comfort and cleanliness. LPA observed the equipment to be age appropriate and in safe condition, free of sharp, no loose or pointed parts. LPA observed a side emergency exit gate closed and with a self-latch. LPA observed a outdoor stainless steel patio heater with wheels. LPA did not observed a propane gas tank inside the heater. LPA observed 2 white sheds closed and locked with a keypad lock and garage door closed with a key lock . LPA also observed, a room with a fireplace and observed the room closed and locked with a keypad lock. Applicant has been advised from fire inspector, that the room cannot be utilized by the daycare children.

SUPERVISORS NAME: Karen Chambers
LICENSING EVALUATOR NAME: Mayra Rivera
LICENSING EVALUATOR SIGNATURE:

DATE: 10/10/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/10/2022
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: DELERY FAMILY CHILD CARE
FACILITY NUMBER: 198400524
VISIT DATE: 10/10/2022
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LPA observed applicant Pazzetter Delery Pediatric First Aid/ CPR certification dated 11/14/2021, Health and Safety certification dated 11/21/2021, and applicant has proof of immunization against Pertussis, MMR and Influenza. Applicant completed the mandated reporter (AB 1207) training on 2/9/2022. Applicant was advised that the mandated reporter training must be completed every 2 years, and is available at www.mandatedreporterca.com

LPA did not observe the required postings LIC 610A Emergency Disaster Plan, Pub 394 Notification of Parents Rights, LIC 999 Facility sketch, and child car seat law poster.



Criminal Record Statement

Applicant Pazzetter Delery 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, 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.

Safe Sleep

LPA discussed the safe sleep regulations with applicant Pazzetter Delery 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 Pazzetter Delery 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.

This facility plans to provide Incidental Medical Services – IMS. For IMS information , see PIN 22-02-CCP. 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

SUPERVISORS NAME: Karen Chambers
LICENSING EVALUATOR NAME: Mayra Rivera
LICENSING EVALUATOR SIGNATURE:

DATE: 10/10/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/10/2022
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: DELERY FAMILY CHILD CARE
FACILITY NUMBER: 198400524
VISIT DATE: 10/10/2022
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LPA explained and provided applicant Pazzetter Delery 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. Pub 394 Notification of Parents Rights, child car seat law poster, LIC 9227 Individual Infant Sleeping Plan, LIC 9221 Parent Consent for Administration of Medications and Medication Chart.

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 platform.

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.

Corrections, post the required postings LIC 610A Emergency Disaster Plan, Pub 394 Notification of Parents Rights, LIC 999 Facility sketch, and child car seat law poster. Corrections due date 11/10/22. An exit interview was conducted and report was reviewed with the applicant Pazzetter Delery

SUPERVISORS NAME: Karen Chambers
LICENSING EVALUATOR NAME: Mayra Rivera
LICENSING EVALUATOR SIGNATURE:

DATE: 10/10/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/10/2022
LIC809 (FAS) - (06/04)
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