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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376629623
Report Date: 01/05/2024
Date Signed: 01/05/2024 04:16:43 PM

Document Has Been Signed on 01/05/2024 04:16 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, 7575 METROPOLITAN DR., STE 110
SAN DIEGO, CA 92108
FACILITY NAME:PENAGOS TORRES, LEIDY FAMILY CHILD CAREFACILITY NUMBER:
376629623
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 3CENSUS: 3DATE:
01/05/2024
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
02:45 PM
MET WITH:Leidy Penagos TorresTIME COMPLETED:
05:00 PM
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On 01/05/2024 at 2:45 PM, Licensing Program Analyst (LPA) Dana Stevens conducted a case management inspection for the purpose of an increase in capacity. LPA met with the Licensee, Leidy Penagos Torres and was granted entry into the facility. Licensee accompanied LPA on a tour of the inside and outside of the facility. Three (3) children all under 2 years of age were present in the facility during this inspection. This facility is a single story, 3 bedroom, 1 bathroom house. The following areas used for childcare are: living room, dining area, hall bathroom . kitchen, and one bedroom. Off-limit areas are, two bedrooms. These areas have been made inaccessible with door knob covers.

The fire extinguisher, smoke detector, and carbon monoxide detector met requirements. The licensee has toys, play equipment and materials available for children’s use. The home has a backyard available for outdoor activities. Licensee stated total supervision is provided. Licensee stated there are no weapons in the home. Licensee stated there are no bodies of water on the premises. A review of staff records on this date indicates that all facility staff or other individuals who require caregiver background checks have received criminal record and child abuse clearances or exemptions. Licensee’s First Aid and CPR certifications expire on 03/2025. Licensee has required immunization. Licensee completed Mandated Reporter Training AB 1207 on 03/27/2023. The fire clearance for 14 children was granted/received on 12/13/2023. 
SUPERVISORS NAME: Cynthia Gray
LICENSING EVALUATOR NAME: Dana Stevens
LICENSING EVALUATOR SIGNATURE: DATE: 01/05/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/05/2024
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, 7575 METROPOLITAN DR., STE 110
SAN DIEGO, CA 92108
FACILITY NAME: PENAGOS TORRES, LEIDY FAMILY CHILD CARE
FACILITY NUMBER: 376629623
VISIT DATE: 01/05/2024
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LPA discussed the maximum number of children for whom care shall be provided when there is an assistant provider in the home, including children under age 10 who live in the licensee's home and the assistant provider's children under age 10, shall be either: Twelve (12) children with no more than four of whom may be infants or Fourteen (14) children, with at least two of the children with 1 child enrolled in kindergarten and 1 child at least six years of age and no more than three infants.

Incidental Medical services (IMS) policy was discussed.
Licensee stated that Incident Medical Services are not being provided at this time. 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.

No deficiencies cited. No corrections are needed. A large license will be granted effective 01/05/2023.
SUPERVISORS NAME: Cynthia Gray
LICENSING EVALUATOR NAME: Dana Stevens
LICENSING EVALUATOR SIGNATURE:

DATE: 01/05/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/05/2024
LIC809 (FAS) - (06/04)
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