Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198016467
Report Date: 07/19/2017
Date Signed: 07/19/2017 10:34:16 AM

COMPREHENSIVE INSPECTION
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:MEDRANO & AGUIRRE FAMILY CHILD CAREFACILITY NUMBER:
198016467
ADMINISTRATOR:MEDRANO, M & AGUIRRE, WFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(562) 699-2549
CITY:WHITTIERSTATE: CAZIP CODE:
90606
CAPACITY:14CENSUS: 15DATE:
07/19/2017
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
08:05 AM
MET WITH:Marlen Medrano, LicenseeTIME COMPLETED:
10:42 AM
NARRATIVE
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Visit Conducted in Spanish

An unannounced Annual Random Inspection was conducted by Licensing Program Analysts (LPA) Armando J. Lucero and Carlos Gonzalez. Analysts met with licensee Marlen Medrano who guided LPAs on a tour of the facility. This is a single story, three bedroom, two bathroom home. Currently residing in the home are three adults (Licensee, husband Wilfredo Aguirre and Licensee's mother-in-law Zoila Castillo) and three children. Present at the time of inspection is Licensee's minor son and Licensee's minor assistant.

At the initial start of the inspection, LPAs observed that the Licensee was alone without an assistant with 14 children. Licensee's assistant arrived at 8:11am to assist in the Family Child Care Home. Child #1 arrived shortly after and Licensee was then over capacity with 15 children. LPA also observed Clorox wipes and Lysol spray within reach of children. LPAs also observed Child #2 in a swing carrier.

Areas accessible to children were inspected as follows: Living room, dining area, kitchen, one bathroom, den that has been converted into a day care area, outside patio and back yard.

Areas off limits include: All three bedrooms, one bathroom, front yard, and dog run area on both sides of house.
Report Continues on Next Page
SUPERVISOR'S NAME: Cassandra CooperTELEPHONE: (323) 981-3365
LICENSING EVALUATOR NAME: Armando J LuceroTELEPHONE: (323) 981-3435
LICENSING EVALUATOR SIGNATURE:

DATE: 07/19/2017
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/19/2017
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: MEDRANO & AGUIRRE FAMILY CHILD CARE
FACILITY NUMBER: 198016467
VISIT DATE: 07/19/2017
NARRATIVE
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A current roster of children enrolled must be available and maintained for a period of three years, even after children no longer are attending the facility. Annual fees must be paid promptly and by the due date or a late fee shall be assessed and/or the License shall be terminated.

The fire extinguisher type 2A-10BC must be serviced annually or as often as necessary. Smoke detectors should be checked and batteries replaced as needed. Changes should be reported to the Department as soon as they occur such as construction, remodeling, telephone number changes and/or if you move from your home.

Any unusual incidents or injuries must be reported to the Department within 24 hours via telephone and within seven (7) days in writing. Fire and safety drills must be performed every six months and documented for review by the Department. Smoking is prohibited in a family child care home. Children and Staff records must be maintained and updated as needed and must be available for review by the Department.

Baby walkers, saucer chairs, bouncers or any similar items are prohibited. Sudden Infant Death Syndrome (SIDS) and Never-Shake-a-Baby were discussed. A hard copy of A Child Care Provider’s Guide to Safe Sleep (SP) was provided.

All adults living and working in the home shall be made of aware of the Departments right to inspection authority, which includes but not limited to the right to enter the home when children are being cared for, interview children and adults and review documentation.

These forms may also be downloaded from our website: www.ccld.ca.gov

See deficiencies page for deficiencies cited during today's visit in accordance to the California Code of Regulations Title 22, Division 12, Chapter 1
Report Continues on Next Page
SUPERVISOR'S NAME: Cassandra CooperTELEPHONE: (323) 981-3365
LICENSING EVALUATOR NAME: Armando J LuceroTELEPHONE: (323) 981-3435
LICENSING EVALUATOR SIGNATURE:

DATE: 07/19/2017
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/19/2017
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: MEDRANO & AGUIRRE FAMILY CHILD CARE
FACILITY NUMBER: 198016467
VISIT DATE: 07/19/2017
NARRATIVE
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Upon receipt of this report, the Licensee shall post the Notice of Site Visit and any Licensing report documenting a type “A” deficiency. The report and the Notice of Site Visit shall be posted for 30 consecutive days. Failure to maintain posting as required, will result in an immediate $100 civil penalty. A copy of this report shall be provided to the parent/guardian of children currently enrolled by the next business day or immediately upon return. A copy of this report shall also be provided to the parent/guardian of any newly enrolled children for the next 12 months (1 year). The Acknowledgement of Receipt (LIC 9224 form must be maintained in each child’s file immediately upon receipt from parent. Licensee was provided with a copy of the Acknowledgement of Receipt of Licensing Reports (LIC 9224) Form during this visit.

Exit interview, copy of report was given. Appeal rights were issued and discussed.
SUPERVISOR'S NAME: Cassandra CooperTELEPHONE: (323) 981-3365
LICENSING EVALUATOR NAME: Armando J LuceroTELEPHONE: (323) 981-3435
LICENSING EVALUATOR SIGNATURE:

DATE: 07/19/2017
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/19/2017
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: MEDRANO & AGUIRRE FAMILY CHILD CARE
FACILITY NUMBER: 198016467
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/19/2017
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
07/24/2017
Section Cited
102417(g)(8)
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Operation of a Family Child Care Home

All homes shall have a current roster of the children.

During records review, LPAs determined that Licensee did not have a current Facility Roster.
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Licensee stated that she will mail LPA a current copy of the facility roster by POC date.
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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: Cassandra CooperTELEPHONE: (323) 981-3365
LICENSING EVALUATOR NAME: Armando J LuceroTELEPHONE: (323) 981-3435
LICENSING EVALUATOR SIGNATURE:

DATE: 07/19/2017
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/19/2017
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: MEDRANO & AGUIRRE FAMILY CHILD CARE
FACILITY NUMBER: 198016467
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/19/2017
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
07/19/2017
Section Cited
102423(a)(2)
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Personal Rights

Each child shall be accorded safe, healthful and comfortable accommodations, furnishing and equipment.

During the inspection of the home, LPAs observed Child #2 in a swing/carrier.
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Corrected during visit. Licensee removed child #2 from the swing/carrier and placed child on a padded mat.
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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: Cassandra CooperTELEPHONE: (323) 981-3365
LICENSING EVALUATOR NAME: Armando J LuceroTELEPHONE: (323) 981-3435
LICENSING EVALUATOR SIGNATURE:

DATE: 07/19/2017
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/19/2017
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: MEDRANO & AGUIRRE FAMILY CHILD CARE
FACILITY NUMBER: 198016467
VISIT DATE: 07/19/2017
NARRATIVE
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Licensee states that there are no weapons or firearms on the premises. LPA did observe a covered and dried water fountain in the back yard. The fountain is inaccessible to children in care. The backyard is adequately fenced. There are age appropriate toys and equipment on the premises. The smoke detectors, fire extinguisher, and carbon monoxide detector are in operable condition. LPA Lucero obtained new facility sketch of indoor and outdoor with on-limits and off-limits areas shown.

—CPR and First Aid expire: 06/03/2019
—Child Care Roster was not current, Disaster Plan, and Children's Records were reviewed and discussed.

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

The following was discussed with the Licensee:

Individuals who are 18 years of age or older living in the home must obtain a criminal record clearance. Individuals within one month of their 18th birthday must be fingerprinted immediately. Failure to obtain a criminal record background check clearances prior to initial presence in the home will result in an immediate $100.00 dollar or more per day Civil Penalty.

In the absence of the Licensee, a qualified adult must be present supervising the children; a qualified adult is an individual who has a valid and current adult/infant CPR & Pediatric First Aid certification and a valid criminal record clearance associated to the facility license.
Report Continues on Next Page
SUPERVISOR'S NAME: Cassandra CooperTELEPHONE: (323) 981-3365
LICENSING EVALUATOR NAME: Armando J LuceroTELEPHONE: (323) 981-3435
LICENSING EVALUATOR SIGNATURE:

DATE: 07/19/2017
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/19/2017
LIC809 (FAS) - (06/04)
Page: 2 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: MEDRANO & AGUIRRE FAMILY CHILD CARE
FACILITY NUMBER: 198016467
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/19/2017
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
07/19/2017
Section Cited
102416.5(a)
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Staffing Ratio and Capacity

The capacity specified on the license shall be the maximum number of children for whom care can be provided.
During the inspection, child #1 arrived placing Licensee's Ratio/Capacity at 15 children present during care.
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Licensee stated that she will disenroll one child to ensure that she remains in licensed capacity. POC visit will be conducted.
Type A
07/19/2017
Section Cited
102416.5(f)
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Staffing Ratio and Capacity

If no assistant provider is present at a Large Family Child Care Home, then the licensee shall comply with the capacity requirements for a Small Family Child Care Home as specified in subsections (b) and (c).
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Licensee stated that she will change her assistant's hours to come in at 7:30am. POC visit will be conducted.
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During inspection of the home, LPAs observed that Licensee was alone with 14 children in care without an assistant.
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Type A
07/19/2017
Section Cited
102417(g)(4)
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Operation of a Family Child Care Home
Poisons, detergents, cleaning compounds, medicines, firearms and other items which could pose a danger to children shall be stored where they are inaccessible to children.
LPAs observed Lysol spray and Clorox wipes within reach of children in care. This is an immediate risk to children in care.
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Corrected during visit. Licensee removed the Clorox wipes and Lysol spray into an off-limits bedroom.
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: Cassandra CooperTELEPHONE: (323) 981-3365
LICENSING EVALUATOR NAME: Armando J LuceroTELEPHONE: (323) 981-3435
LICENSING EVALUATOR SIGNATURE:

DATE: 07/19/2017
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/19/2017
LIC809 (FAS) - (06/04)
Page: 5 of 7