Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198012910
Report Date: 06/27/2018
Date Signed 06/27/2018 05:55:57 PM

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:
06/27/2018
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
02:30 PM
MET WITH:Veronica Jimenez, Licensee TIME COMPLETED:
06:10 PM
NARRATIVE
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Licensing Program Analyst (LPA) Carlos Gonzalez conducted a Annual/Random inspection to the above facility. LPA met with Veronica Jimenez, Licensee, who guided Analyst on a tour of the facility. Also present were Licensee's Assistant's Kristen Maldonado, Lindsey McGaffey, and Alexis Gallardo. LPA determined through Licensing Information System (LIS) that Assistant, Alexis Gallardo is not currently associated to the facility. Per Licensee, Ms. Gallardo has been employed since the second week of April, 2018. This is an immediate risk to the health and safety of children in care. A civil penalty of $500.00 will be assessed. LPA observed twelve (12) children in care at the time of inspection, four (4) of whom were infants. Per Licensee there are twenty-two (22) children enrolled, an updated facility roster was provided at the time of inspection.

This is a single story home consisting of three bedrooms, two bathrooms, living room, kitchen, laundry area, and detached garage, used for day care activities. LPA observed an infant asleep in a baby swing inside the detached garage. Licensee was advised that the detached garage cannot be used for napping/or eating purposes. Children have access to the living room, front bedroom, bathroom, kitchen, and laundry area. The master bedroom and bathroom, and additional bedroom are off-limits to children in care. The home was inspected for safety, comfort, cleanliness, ventilation, and telephone service (land).

Currently residing in the home are Licensee, her minor daughter, and adult sister, Laura Zepeda. Licensee was informed that all individuals must obtain a criminal record clearance or exemption prior to working, residing or volunteering in a licensed home. Detergents, cleaning compounds, medications, and other items which could pose a danger, were determined to be inaccessible to children in care during this inspection.

LPA observed a fully charged 2:A-10-B:C fire extinguisher, which was purchased on 01/18/2018. Per State Fire Marshall standards, fire extinguishers shall be serviced annually. The combination smoke and carbon monoxide detector was working properly.
Report continues on next page 1 of 4
SUPERVISOR'S NAME: Katherine HarewoodTELEPHONE: (323) 981-3380
LICENSING EVALUATOR NAME: Carlos GonzalezTELEPHONE: (323) 981-3381
LICENSING EVALUATOR SIGNATURE:

DATE: 06/27/2018
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/27/2018
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 7
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: 06/27/2018
NARRATIVE
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There were NO ZERO TOLERANCE deficiencies cited during this visit. Zero Tolerance include: Absence of Supervision, the licensee understands that arrangements must be made for a substitute adult to care and supervise children when they are absent from the home; Accessible Bodies of Water; No bodies of water on the premises. Accessible Firearms, Ammunition or Both; No firearms or weapons in the home; Refused Entry to a Facility or Any Part of a Facility in Violation of Section 1596.852, 1596.853 or 1597.09. Regulations 101238 (g)(2); The Presence of an Excluded Individual. No excluded individuals; Children are not left in parked vehicles.

Infant Care: Licensee does have infants in care at this time. LPA advised Licensee to sleep infants where they can be directly supervised at all times and advised against sleeping infants in a separate room. LPA provided the applicant with a copy of the Child Care Provider’s Guide to Safe Sleep, by American Academy of Pediatrics. Online copy can be downloaded at: https://www.cdph.ca.gov/programs/SIDS/Documents/SIDSchildcaresafesleep.pdf

Incidental Medical Services (IMS): The licensee states that there are no children enrolled that require IMS at this time. 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.

Beginning January 1, 2018, Health and Safety Code 1596.8662 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. Effective January 1, 2018: Existing licensees must meet requirements by March 30, 2018. Preventive (OCAP) online training modules are free of cost and available at http://www.mandatedreporterca.com/. LPA determined that Licensee has not completed the Mandated Reporter training.
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SUPERVISOR'S NAME: Katherine HarewoodTELEPHONE: (323) 981-3380
LICENSING EVALUATOR NAME: Carlos GonzalezTELEPHONE: (323) 981-3381
LICENSING EVALUATOR SIGNATURE:

DATE: 06/27/2018
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/27/2018
LIC809 (FAS) - (06/04)
Page: 3 of 7
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: 06/27/2018
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
06/27/2018
Section Cited
HSC
102370(d)(1)
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Criminal Record Clearance. All individuals subject to a criminal record review as specified in Section 1596.871 prior to working, residing or volunteering in a licensed home, shall obtain a California clearance or a criminal record exemption as required by the Department.
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Licensee dismissed Assistant Alexis Gallardo from the day care facility during the time of inspection. Licensee will follow-up with Assistant to determine if a California clearance has been approved so that Assistant can resume working at the facility.
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evidenced by: Assistant, Alexis Gallardo is not currently associated to the Facility, although Licensee provided a copy of a DOJ applicant fingerprint response form. Per Licensee, Ms. Gallardo has been working in the Facility since mid April of 2018. This is an immediate risk to the health and safety of children in care.
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Type A
06/27/2018
Section Cited
CCR
102423(a)(2)
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Personal Rights. Each child shall be accorded safe, healthful and comfortable accommodations, furnishing and equipment.
Licensee did not meet this requirement as evidenced by: child #1 was found asleep in a baby swing inside the detached garage. This is an immediate risk to the health and safety
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Licensee immediately removed child #1 from the baby swing that was located in the garage during the inspection.
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of children in care.
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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: Katherine HarewoodTELEPHONE: (323) 981-3380
LICENSING EVALUATOR NAME: Carlos GonzalezTELEPHONE: (323) 981-3381
LICENSING EVALUATOR SIGNATURE:

DATE: 06/27/2018
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/27/2018
LIC809 (FAS) - (06/04)
Page: 5 of 7
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: 06/27/2018
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
07/27/2018
Section Cited
CCR
102416(c)
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Personnel Requirements. The Licensee and other personnel as specified shall complete training on preventive health practices including pediatric cardiopulmonary resuscitation and pediatric first aid, pursuant to Health and Safety Code Section 1596.866.
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Licensee obtained an updatetd First Aid/CPR card for Assistant Kristen Maldonado prior to LPAs departure at time of inspection.
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evidenced by: Assistant Kristen Maldonado is not in possession of a current First Aid/CPR card. This poses an immediate risk to the health and safety of children in care.
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Type B
07/27/2018
Section Cited
CCR
102417(g)(9)(A)(1)
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Operation of a Family Child Care Home. All homes shall conduct fire and disaster drills at least once every six months, and document the date and time of each drill. Licensee did not meet this requirement as evidenced by: no fire/or disaster drill log was presented at the time of inspection. This poses an immediate
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Licensee indicated that a fire/or disaster drill will be conducted and documented on the fire drill log provided by LPA during inspection. Licensee will submit a copy of the fire drill log by the POC due date.
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risk to the health and safety of children in care.
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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: Katherine HarewoodTELEPHONE: (323) 981-3380
LICENSING EVALUATOR NAME: Carlos GonzalezTELEPHONE: (323) 981-3381
LICENSING EVALUATOR SIGNATURE:

DATE: 06/27/2018
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/27/2018
LIC809 (FAS) - (06/04)
Page: 6 of 7
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: 06/27/2018
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
07/27/2018
Section Cited
HSC
1596.8662(b)(1)
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On or before March 30, 2018, a person who, on January 1, 2018, is a licensed child care provider, administrator, or employee of a licensed child day care facility shall complete the mandated reporter training provided pursuant to paragraphs (2) and (3) of subdivision (a), and shall complete renewal
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Licensee stated that she will complete the required mandated reporter training and submit proof to LPA by the POC due date.
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mandated reporter training every two years following the date on which he or she completed the mandated reporter training. Licensee did not meet this requirement as evidenced by: no proof of completion or certificate provided at time of inspection.
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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: Katherine HarewoodTELEPHONE: (323) 981-3380
LICENSING EVALUATOR NAME: Carlos GonzalezTELEPHONE: (323) 981-3381
LICENSING EVALUATOR SIGNATURE:

DATE: 06/27/2018
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/27/2018
LIC809 (FAS) - (06/04)
Page: 7 of 7
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: 06/27/2018
NARRATIVE
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Based on observations and records review, the following deficiencies listed on the attached LIC 809 (deficiency page) are being cited in accordance with California Code of Regulations Title 22. Deficiencies that are being cited need to be cleared to protect the children’s health & safety.

The Notice of Site Visit (LIC 9213)must remain posted for 30 days during the hours of operation after each site visit made by a licensing representative. Failure to maintain posting as required will result in a civil penalty of $100.00.

Exit interview was conducted with Licensee, Veronica Jimenez, including, but not limited to Provider Rights, Appeal Procedures and Agencies Consultative Role.
Report ends page 4 of 4
SUPERVISOR'S NAME: Katherine HarewoodTELEPHONE: (323) 981-3380
LICENSING EVALUATOR NAME: Carlos GonzalezTELEPHONE: (323) 981-3381
LICENSING EVALUATOR SIGNATURE:

DATE: 06/27/2018
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/27/2018
LIC809 (FAS) - (06/04)
Page: 4 of 7
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: 06/27/2018
NARRATIVE
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Per Licensee, there are no weapons, firearms, or pets on the premises. Additionally, LPA did not observe any bodies of water on the premises.

The licensee was observed to be operating within the licensed capacity limitations during this inspection. The licensee has completed training on preventive health practices including Pediatric First Aid and CPR. Licensee's Pediatric First Aid/CPR card expires on 03/18/2019 and Assistant, Lindsey McGaffey's First Aid/CPR card expires on 03/18/2019, Licensee's was not able to provide a current First Aid/CPR card for Assistant Kristen Maldonado's during inspection. There are first aid supplies are available.


UPDATE: H&S 1597.622: 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.
Children’s records were reviewed, including but not limited to, a copy of the emergency information card that contains all of the information required by regulation. LPA issued a Confidential Names List (LIC 811) to the licensee which documents the staff and/or children’s files that were reviewed during this inspection.

The following items were also discussed with licensee during this inspection:



· All homes shall conduct fire and disaster drills at least once every six months, and document the date and time of each drill. Per Licensee, a fire/disaster drill is conducted monthly, however not documented.

· POSTING REQUIREMENTS: Emergency Disaster Plan, Parent’s Rights Poster and the Facility License were observed to be posted.
· Infant Walkers, Johnny Jumpers, Saucer Chairs, or any other item that falls into these categories are not permitted in a family child care facility. SMOKING IS PROHIBITED IN A LICENSED FAMILY CHILD CARE HOME.
Report continues on next page 2 of 4
SUPERVISOR'S NAME: Katherine HarewoodTELEPHONE: (323) 981-3380
LICENSING EVALUATOR NAME: Carlos GonzalezTELEPHONE: (323) 981-3381
LICENSING EVALUATOR SIGNATURE:

DATE: 06/27/2018
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/27/2018
LIC809 (FAS) - (06/04)
Page: 2 of 7