Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197409882
Report Date: 09/28/2015 12:00:00 AM
Date Signed: 09/28/2015 02:55:41 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 6167 BRISTOL PARKWAY #400
CULVER CITY, CA 90230
FACILITY NAME:GUZMAN FAMILY CHILD CAREFACILITY NUMBER:
197409882
ADMINISTRATOR:GUZMAN, ISABELFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(818) 763-7849
CITY:NORTH HOLLYWOODSTATE: CAZIP CODE:
91601
CAPACITY:14CENSUS: 7DATE:
09/28/2015
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
01:38 PM
MET WITH:Isabel GuzmanTIME COMPLETED:
03:15 PM
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Licensing Program Analyst (LPA) Myriam Saullo Luga conducted an annual random visit. LPA met with licensee. lPA verified association to the facility of all adults present during the visit and all were associated. LPA inspected the facility indoor and outdoor. All required postings including facility license, emergency disaster plan, Parents rights notification poster were observed during the visit. There were 7 children and two adults( licensee and her husband) present at the facility during the visit. All adults are fingerprint cleared and associated to the facility. Some children were napping during the visit and others were engaged in indoor activities. The licensee indicated that the facility doesn’t provide incidental medical services. The facility is a one story home with two bedrooms, two bathrooms, kitchen, dining room, and a living room. Child care is mainly conducted in the living room, and one of the bedrooms . The following are the off limit areas; the master bedroom and the master bathroom. LPA observed a working smoke detector, fully charged 2A10BC fire extinguisher, carbon monoxide detector and a working telephone. There was good lighting and ventilation at the facility as well. All electrical outlets were covered with plastic covers. All detergents, cleaning supplies are stored in well latched cabinets under the sink. Sharp objects, including knives are stored in a latched upper drawer in the cabinet next to the stove. Medications are stored away from children’s reach. LPA inspected the bathroom utilized by children and it was clean and orderly. Per the licensee, there are no firearms on the premises.
SUPERVISOR'S NAME: Scott HerringTELEPHONE: (310) 337-4313
LICENSING EVALUATOR NAME: Myriam LugaTELEPHONE: (310) 337-4365
LICENSING EVALUATOR SIGNATURE:

DATE: 09/28/2015
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/28/2015
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, 6167 BRISTOL PARKWAY #400
CULVER CITY, CA 90230
FACILITY NAME: GUZMAN FAMILY CHILD CARE
FACILITY NUMBER: 197409882
VISIT DATE: 09/28/2015
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LPA observed a well -stocked first aid kit, age appropriate/ in good repair indoor toys and cribs/mats/cots for napping. Outdoor play of children is conducted in the backyard which is well fenced and equipped with age appropriate toys, such as bikes, in good repair, a play structure(swings/slide) and there is cushioning material under the structure. There is a room in the backyard that is used for indoor activities for children. This room was equipped with age appropriate furniture, toys, art craft supplies and books. Licensee was reminded that no napping or eating is permitted in this room.
Licensee has current pediatric CPR, first aid which expires in January 2016. There were no bodies of water or pets at the facility during the visit. LPA reviewed children’s records and they were in order. All record contained correct forms: LIC 627 (Emergency Consent), LIC 700 (ID & Emergency), LIC 702 (Health History), LIC 613A (Personal Rights), LIC 995A (Parent's Rights), LIC 995E (Important Information for Parents), LIC 282 (Affidavit Liability Insurance), immunization record.
LPA reminded Licensee that parents’ written consent needs to be obtained prior to; taking the children to a nearby park/or anywhere off premises, and before using children's photos for public advertisement of the facility. LPA reminded licensee of regulations regarding reporting unusual incidents and injuries within 24 hours and sending the written incident report to the department within 7 days. In addition, licensee was reminded that all adults, 18 year old and over living or working in the home or visiting on a frequent basis must be fingerprint cleared/associated to the facility prior to being on the premises. A minimum civil penalty of $100.00 per person per day will be assessed if this regulation is violated. Licensee was reminded to continue obtaining Immunization records from parents prior to a child being enrolled in/attending the facility, update children’s roster as needed and operate within license capacity/limitations.
SUPERVISOR'S NAME: Scott HerringTELEPHONE: (310) 337-4313
LICENSING EVALUATOR NAME: Myriam LugaTELEPHONE: (310) 337-4365
LICENSING EVALUATOR SIGNATURE:

DATE: 09/28/2015
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/28/2015
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, 6167 BRISTOL PARKWAY #400
CULVER CITY, CA 90230
FACILITY NAME: GUZMAN FAMILY CHILD CARE
FACILITY NUMBER: 197409882
VISIT DATE: 09/28/2015
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Title 22 Regulations, child care updates and additional information may be obtained at the department's website www.ccld.ca.gov

Licensee was reminded that all infants must be placed on their backs when sleeping to prevent S.I.D.S. (Sudden Infant Death Syndrome), and that the Provider is required to wash hands after every diaper change, No smoking is allowed on a day care/facility premises indoor or outdoor, to never shake a baby to prevent Shaken Baby Syndrome. Licensee was also reminded that only children eating may be in high chairs and that car seats are utilized only for transportation.
No deficiencies were observed at the time of the visit. An exit interview was conducted and a copy of this report was submitted to licensee.
SUPERVISOR'S NAME: Scott HerringTELEPHONE: (310) 337-4313
LICENSING EVALUATOR NAME: Myriam LugaTELEPHONE: (310) 337-4365
LICENSING EVALUATOR SIGNATURE:

DATE: 09/28/2015
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/28/2015
LIC809 (FAS) - (06/04)
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