Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197415246
Report Date: 02/01/2019
Date Signed: 02/11/2019 09:17:44 AM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME:MATAL-BANOS FAMILY CHILD CAREFACILITY NUMBER:
197415246
ADMINISTRATOR:MATAL-BANOS, ANAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(818) 509-0587
CITY:NORTH HOLLYWOODSTATE: CAZIP CODE:
91606
CAPACITY:14CENSUS: 5DATE:
02/01/2019
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
07:35 AM
MET WITH:Ana Matal-BanosTIME COMPLETED:
09:55 AM
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Licensing Program Analyst (LPA) Silva Garibyan conducted a site visit for the purpose of an Annual Random visit . LPA met with the licensee and toured the home inside and outside at 7: 50 a.m on 02/01/2019. There were four children present at the time of the visit ( including licensee's grandson and two infants). All areas identified on the facility sketch were inspected. LIcensee's home is a two story home. Licensee's home consists of 4 bedrooms, 2 bathrooms, living room, family room, dining room, kitchen and garage. The second floor remains a guest home, occupied by the licensee's son and it consists of 1 bedroom, living room, kitchen and bathroom. The second floor is only accessible from the backyard. There is a pool in the back yard with a fence that measures 5 feet in height. The space between the cement floor and the pool gate is 2 inches. Spacing between the vertical beams are 4 inches apart and there are at least 45 inches between the horizontal beams. LPA tested the pool gate and observed it to be self-closing and self-latching. Main care is provided in the Living room. Children use the bathroom in the hallway and are escorted, as this area is primarily off-limits. Children eat and nap in the living room area and in the bedroom adjacent to the living room. . Off limit areas include the remainder of the home. The bedroom doors all have safety covers on the knobs; making the rooms inaccessible. Family members residing in the home include the licensee. spouse. licensee's adult daughter and son, and licensee's minor daughter ( 9 yrs. old). LPA observed tables, chairs and napping equipment. The main entry door is used to enter the facility. Licensee reports she has no firearms or weapons in the home. The LPA toured all areas used by children during this inspection. LPA also observed Licensees' current Pediatric CPR (Adult/Infant /Child) and Pediatric First Aid certifications (expire 10/2019). The bathroom in the family room and the kitchen was observed free of chemicals or toxic items that can pose danger to children in care. Children play in the front yard. LPA observed the yard to be clean, free of debris, and fully fenced. The Fire Extinguisher (2A-10-BC) is stored in the kitchen. Page 1 of 3
SUPERVISOR'S NAME: Mary RuizTELEPHONE: (424) 301-3061
LICENSING EVALUATOR NAME: Silva GaribyanTELEPHONE: (424) 301-3062
LICENSING EVALUATOR SIGNATURE:

DATE: 02/01/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/01/2019
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC809 (FAS) - (06/04)
Page: 1 of 3
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME: MATAL-BANOS FAMILY CHILD CARE
FACILITY NUMBER: 197415246
VISIT DATE: 02/01/2019
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There is a working smoke and Carbon Monoxide detectors located in the living room The First Aid kit was observed, and complete. LPA observed the fire drill log. The fire drills are done every month.

Licensee has the following documents posted in the FCCH; Facility License (LIC 203), Notification of Parents' Rights Poster (PUB 394) , Child Care Facility Roster (LIC9040), Emergency Disaster Plan (LIC610a).
A review of the children's records was conducted and are found to have the following: LIC 282 Affidavit Liability Insurance, LIC 627/Consent for Medical Treatment, LIC 700/ID and Emergency Information, LIC 995A/Parent's Rights, LIC995E/Caregiver Background Check, LIC 9150/Parent Notification, LIC 9212/Parent's Responsibilities, PM 286/Immunization Card.

The following was thoroughly discussed with the licensee:

Assembly Bill 633: Upon receipt by the licensee, licensees are to provide to parents/guardians the following: Copies of any licensing reports that document a Type A citation- this includes facility visits and substantiated complaint investigations; copy of licensing documents pertaining to a conference conducted by a local licensing agency management representative and the licensee of this family child care home in which issues of noncompliance are discussed or copies of a summary of an accusation indicating the Department's intent to revoke the facility's license. Copies of any of the above licensing documents the licensee has received in the prior 12 months shall be provided to parents/guardians of newly enrolled child at 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. Staff immunization records are up to date.

New Appeal Process: A licensee may file an appeal, in writing 15 business days from the date of receiving the penalty assessment
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SUPERVISOR'S NAME: Mary RuizTELEPHONE: (424) 301-3061
LICENSING EVALUATOR NAME: Silva GaribyanTELEPHONE: (424) 301-3062
LICENSING EVALUATOR SIGNATURE:

DATE: 02/01/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/01/2019
LIC809 (FAS) - (06/04)
Page: 2 of 3
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME: MATAL-BANOS FAMILY CHILD CARE
FACILITY NUMBER: 197415246
VISIT DATE: 02/01/2019
NARRATIVE
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New Immunization Requirement: Law enacted by SB 277, beginning January 1, 2016, personal beliefs exemptions will no longer be an option for the vaccines that are currently required for entry into child care or school in California. Personal beliefs exemptions already on file will remain valid until the child reaches the next immunization checkpoint.
Update on Incidental Medical Services: 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 Centers and the ADA, available at: http://www.ada.gov/childqanda.htm

Mandated Reporter: Beginning on January 1, 2018, AB 1207, requires all licensed providers, applicants, directors and employees to complete training as specified on their mandated reporter duties and to renew their training every two years. Volunteers are encouraged but not required to take the training. Website: www.mandatedreporterca.com. Completed on March 29, 2018



The licensee was informed of The Child Care Advocate Program (CCAP) that is administered from within the Community Care Licensing Division. CCAP participates in many community activities and speciDatabase Link Iconal projects in order to disseminate information on the State’s licensing role, provide information to the public and parents on child care licensing, and provide many other helpful resources to the licensees and the public. CCAP’s direct contact information is as followed: Phone number: (916) 654-1541
Email Address: childcareadvocatesprogram@dss.ca.gov
On February 1, 2019, the facility has been found operating within substantial compliance per the California Health & Safety Code(s) and Title 22 Regulation(s).
A Copy of this Report and Notice of Site Visit were provided to the Director.
An Exit interview was conducted. Page 3 of 3
SUPERVISOR'S NAME: Mary RuizTELEPHONE: (424) 301-3061
LICENSING EVALUATOR NAME: Silva GaribyanTELEPHONE: (424) 301-3062
LICENSING EVALUATOR SIGNATURE:

DATE: 02/01/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/01/2019
LIC809 (FAS) - (06/04)
Page: 3 of 3