Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198012910
Report Date: 09/12/2016
Date Signed 09/12/2016 10:51:56 AM

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 CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME:JIMENEZ FAMILY CHILD CAREFACILITY NUMBER:
198012910
ADMINISTRATOR:JIMENEZ, VERONICAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(626) 358-2752
CITY:DUARTESTATE: CAZIP CODE:
91010
CAPACITY:14CENSUS: 12DATE:
09/12/2016
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
08:10 AM
MET WITH:Veronica JimenezTIME COMPLETED:
11:05 AM
NARRATIVE
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Teresa Licon Licensing Program Analyst (LPA) conducted An Random/Annual visit. Met with Veronica Jimenez licensee who guided analyst on a tour of the facility. Also present was Lindsey Mcgaffey Assistant.

Designated Areas identified on the facility sketch for day care were inspected. This is a single family home with 3 bedrooms and 1 bathroom.
The following areas were inspected: living room, Kitchen, dining area, 1 bedroom used for napping and 1 bathroom and back fenced patio yard. The licensee is using the converted garage for play activities only. Reminder: At no time shall the licensee use the garage for eating nor sleeping
Areas that are accessible to children are as follows: Living Room, Dining Area, 1 bedroom used as a Play room, and nap room, bathroom located in the hall way next to play room, LPA has advice licensee that 100% supervision is required when the children are in the outdoor play area. Kitchen cabinets also have latches in drawers for extra security. The bathroom cabinet which has some hygiene and cleaning products will need to have a security latch.
Areas that are inaccessible to children are as follows: 2 bedrooms, which are maintained, locked during day care hours.
The home was inspected as follows:
Physical plant - Detergents, cleaning compounds, medicines, and hazardous items that can pose a danger to children. Cleaning products are kept in the underneath the kitchen sink which have latches on the door. Reminder: Storage areas for poisons shall be inaccessible to children and locked.
Home shall be kept clean and orderly, with heating and ventilation for safety and comfort. Fireplaces and open face heaters shall be screened to prevent access by children. Electrical outlets in the living room and dinning area were not covered. Fire Extinguisher 2A 10 BC was up to date and purchased on 1/2016. Smoke detector/carbon monoxide combo was tested and is in working condition. he home provided safe toys, play equipment and materials.
SUPERVISOR'S NAME: Christina GabelmanTELEPHONE: (323) -98-3395
LICENSING EVALUATOR NAME: Teresa LiconTELEPHONE: 323-980-4924
LICENSING EVALUATOR SIGNATURE:

DATE: 09/12/2016
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/12/2016
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 CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME: JIMENEZ FAMILY CHILD CARE
FACILITY NUMBER: 198012910
VISIT DATE: 09/12/2016
NARRATIVE
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At this time per licensee there are no firearms in the facility.
No bodies of water were observed on the premises. Facility uses the fenced back yard for outdoor play space

Evaluation and Supervision
Outdoor play areas shall either be fenced or supervised by the license or caregiver. Licensee understands that supervision shall be maintained at all times while children are outside.
The capacity specified on the license shall be the maximum number of children for whom care can be provided. There were 11 children and 1 infant with licensee and assistant.

Facility Records Review: LPA reviewed the roster, observed Parents rights, disaster form and license. Homes shall conduct fire and disaster drill at least once every six months.
The licensee shall maintain, in each child’s record a copy of the emergency information card. Children's files were observed to be complete.

Facility Administration: First Aid and CPR expires 10/2016 for licensee. LPA reminded Licensee that her CPR must be renewed. All individuals subject to a criminal record review shall obtain a criminal record clearance or exemption prior to working, residing or volunteering in a licensed home. LPA reviewed criminal record clearances for those working and or living in the home.

· Commencing September 1, 2016, a person shall not be employed or volunteer at a family day care home if he or she has not been immunized against influenza, pertussis, and measles. Each employee and volunteer shall receive an influenza vaccination between August 1 and December 1 of each year. The family day care home shall maintain documentation of the required immunization's or exemptions from immunization, as set forth in this section, in the person’s personnel record that is maintained by the family day care home. At this time copies of immunization's for licensee and assistant were not available for review.

· Medication: LPA explained Incidental Medical services. At this time Applicant states that she will submit a Plan of Operation if she gets a child with IMS. (Incidental Medical Services)
SUPERVISOR'S NAME: Christina GabelmanTELEPHONE: (323) -98-3395
LICENSING EVALUATOR NAME: Teresa LiconTELEPHONE: 323-980-4924
LICENSING EVALUATOR SIGNATURE:

DATE: 09/12/2016
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/12/2016
LIC809 (FAS) - (06/04)
Page: 2 of 5


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 CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME: JIMENEZ FAMILY CHILD CARE
FACILITY NUMBER: 198012910
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/12/2016
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
10/12/2016
Section Cited
1597.622(c)
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The family day care home shall maintain documentation of the required immunizations or exemptions from immunization, as set forth in this section, in the person’s personnel record that is maintained by the family day care home.
Immunizations were not available for review
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Licensee will obtain immunizations for herself and assistants.
Copies shall be submitted to LPA
Type B
09/19/2016
Section Cited
102417(g)
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Operation of a Family Child Care Home: The home shall be free from defects or conditions which might endanger a child.
LPA observed the following:electrical outlet cover missing in living room. The latch to the shower door was broken.
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Licensee will fix the latch and place outlet covers

A picture shall be submitted to LPA
Type B
09/19/2016
Section Cited
102417(g)(1)
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Operation of a Family Child Care Home. Fire Places and open space heaters shall be screened to prevent access by children.
LPA observed that the screen for the fireplace was not latched.
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Licensee stated that she will replace the latch

A written stated indicating that this has been completed shall be submitted to LPA
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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: Christina GabelmanTELEPHONE: (323) -98-3395
LICENSING EVALUATOR NAME: Teresa LiconTELEPHONE: 323-980-4924
LICENSING EVALUATOR SIGNATURE:

DATE: 09/12/2016
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/12/2016
LIC809 (FAS) - (06/04)
Page: 5 of 5


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 CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME: JIMENEZ FAMILY CHILD CARE
FACILITY NUMBER: 198012910
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/12/2016
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
09/12/2016
Section Cited
102423(a)(2)
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Personal Rights. Each child shall be accorded safe, healthful and comfortable accommodations, furnishing and equipment. Upon Arrival LPA observed an infant in a car seat.
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Immediately Licensee removed the infant from the car seat.
A written plan of correction will be submitted to LPA to ensure this will never occur again.

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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: Christina GabelmanTELEPHONE: (323) -98-3395
LICENSING EVALUATOR NAME: Teresa LiconTELEPHONE: 323-980-4924
LICENSING EVALUATOR SIGNATURE:

DATE: 09/12/2016
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/12/2016
LIC809 (FAS) - (06/04)
Page: 4 of 5


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 CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME: JIMENEZ FAMILY CHILD CARE
FACILITY NUMBER: 198012910
VISIT DATE: 09/12/2016
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  • The mission of the Child Care Licensing Program is to ensure the health and safety of children in care. As a licensed child care provider, it is not only important that you maintain compliance with Community Care Licensing Laws and regulation, but you are also required to comply with other laws and regulations as well. Please read the quarterly newsletter that highlights the Americans with Disabilities Act.

Reminders: No smoking, No infant walkers, No Johnny jumpers, No exer-saucers and any other item that falls into that category are not permitted in the facility.

WEB SITE ADDRESS is (www.ccld.ca.gov). to access forms, quarterly updates

Facility is not in compliance therefore Deficiencies are cited under Title 22 Regulations on attached 809D.

The licensee shall furnish each parent a copy of the Type A citation, parent will need to sign the acknowledgment statement indicating that he/she has received the documents and the date they were received.


Exit interview was conducted with Veronica Jimenez Licensee. This report, appeals rights, were explained, read and provided to licensee. Notice of Site Visit provided and must be posted for (30) days..
SUPERVISOR'S NAME: Christina GabelmanTELEPHONE: (323) -98-3395
LICENSING EVALUATOR NAME: Teresa LiconTELEPHONE: 323-980-4924
LICENSING EVALUATOR SIGNATURE:

DATE: 09/12/2016
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/12/2016
LIC809 (FAS) - (06/04)
Page: 3 of 5