Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198016603
Report Date: 09/08/2017
Date Signed 09/08/2017 09:59:00 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:CARPINTEYRO FAMILY CHILD CAREFACILITY NUMBER:
198016603
ADMINISTRATOR:CARPINTEYRO, ELIZABETHFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(562) 864-9674
CITY:NORWALKSTATE: CAZIP CODE:
90650
CAPACITY:14CENSUS: 1DATE:
09/08/2017
TYPE OF VISIT:Required - 3 YearUNANNOUNCEDTIME BEGAN:
08:05 AM
MET WITH:Elizabeth CarpinteyroTIME COMPLETED:
10:11 AM
NARRATIVE
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Licensing Program Analyst (LPA) Raul Navarro conducted an unannounced 3 year required inspection in Spanish. LPA met with Licensee Elizabeth Carpinteyro who guided this LPA on a tour of the facility. There were 1 child present during today’s inspection. Licensee states that there are currently 4 children enrolled. The children's roster is current. Disaster drill log was not available during today’s inspection.

Areas accessible to children were inspected as follows: Kitchen, living room, playroom, 1 bedroom, bathroom , and backyard area. Areas off limits include: Daughter's bedroom, Licensee's bedroom, detached garage, and front yard. .

Areas accessible to children were inspected to ensure that they are clean and orderly with ventilation and heating for the safety of the children. There is a working telephone maintained in the home. Family members residing in the home are 2 adults (criminal record clearances on file). There are no pets. Detergents, cleaning compounds, medications, and other items which can pose a danger to children are inaccessible. The licensee states that there are no poisons in the home. The licensee does understand that poison must be locked with a key or combination lock.

Per licensee, there are no weapons, firearms or bodies of water on the premises. There are safe toys, play equipment and materials observed for children. Emergency Disaster Plan was posted at the time of inspection. Children’s records were reviewed to ensure that each child has an Identification and Emergency form. The valve on the required 2A 10BC fire extinguisher indicates fully charged but was purchased over a year ago. Smoke and carbon monoxide detectors are in operable condition. The licensee states she has current Pediatric First Aid and CPR but did not provide LPA with proof during today's inspection.
Report continues- Page 1 of 3
SUPERVISOR'S NAME: Katherine HarewoodTELEPHONE: (323) 981-2956
LICENSING EVALUATOR NAME: Raul NavarroTELEPHONE: 323-981-3388
LICENSING EVALUATOR SIGNATURE:

DATE: 09/08/2017
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/08/2017
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 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: CARPINTEYRO FAMILY CHILD CARE
FACILITY NUMBER: 198016603
VISIT DATE: 09/08/2017
NARRATIVE
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The following was discussed: 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.

Rooms that are off-limits need to be made inaccessible during operating hours. No smoking, No infant walkers, No Johnny jumpers, No saucer chairs, No trampolines and any other item that falls into that category are not permitted in the facility. Effective January 1, 2010, licensees of family child care homes are required to ensure that at least one staff member with current training in pediatric first aid and pediatric CPR is on site at all times when children are present.

LPA reviewed and issued the LIC 311D - Forms/Records to Keep in Your Family Child Care Home.
Children’s Forms/Records, Facility Forms/Records and Information To Be Posted, Disaster drills, posting requirements, children records requirements, mandated child abuse and injury/ death reporting, criminal record transfer requirements, criminal record and child abuse clearances were also discussed during this inspection.

The Licensee was advised that inaccessibility of hazards must be constantly reassessed depending on the children in care. 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 was provided.

Mandatory Forms for the children’s files and staff files, requirements for fire drills, earthquake drills and documentation were discussed. Role and responsibilities of being a Mandated Reporter were reviewed. The Licensee was advised how to access forms and Regulations online at www.ccld.ca.gov. Licensee was made aware that it is his/her responsibility to know the regulations as well as anyone who assists in providing care.

Incidental Medical Services (IMS): The Licensee states that she will not administer any medication. If the Licensee chooses to administer prescription medication in the future, she must refer to California Title 22 Regulations Section 102417 for additional information on regulatory requirements.
Report continues- Page 2 of 3
SUPERVISOR'S NAME: Katherine HarewoodTELEPHONE: (323) 981-2956
LICENSING EVALUATOR NAME: Raul NavarroTELEPHONE: 323-981-3388
LICENSING EVALUATOR SIGNATURE:

DATE: 09/08/2017
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/08/2017
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: CARPINTEYRO FAMILY CHILD CARE
FACILITY NUMBER: 198016603
VISIT DATE: 09/08/2017
NARRATIVE
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The licensee’s email address was obtained during this inspection. The licensee was advised that email is public information.

LPA issued the Confidential Names List (LIC 811) to the licensee during this visit. The Confidential Names List documents the children’s files that were reviewed during this inspection.

The deficiencies listed below and on the following pages were observed by the LPA and are being cited in accordance with California Code of Regulations Title 22. Please see attached LIC 809d. Deficiencies that are being cited need to be cleared to protect the children’s health & safety.
- Fire extinguisher has not been serviced in over a year.
- Licensee does not have proof of immunization against influenza, pertussis, and measles.
- Fire/disaster drill log was not available during today's inspection.
- CPR/First aid certificate was not available during today's inspection.

Exit interview was conducted with Licensee. The Licensee was provided a copy of their appeal rights (LIC 9058) and their signature on this form acknowledges receipt of these forms.

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

Report ends- Page 3 of 3
SUPERVISOR'S NAME: Katherine HarewoodTELEPHONE: (323) 981-2956
LICENSING EVALUATOR NAME: Raul NavarroTELEPHONE: 323-981-3388
LICENSING EVALUATOR SIGNATURE:

DATE: 09/08/2017
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/08/2017
LIC809 (FAS) - (06/04)
Page: 3 of 5
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME: CARPINTEYRO FAMILY CHILD CARE
FACILITY NUMBER: 198016603
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/08/2017
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
10/08/2017
Section Cited
HSC
1597.622
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Employees or volunteers at family day care home; immunization requirements; records; exemptions

(a) (1) Commencing September 1, 2016, a person shall not be employed or volunteer at a family day care home if he or she has not
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Licensee will submit proof of immunization againist influenza, pertussis, and meales to LPA by POC date.
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been immunized against influenza, pertussis, and measles.

Licensee did not have proof of immunization againist influenza, pertussis, and measles during today's 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) 981-2956
LICENSING EVALUATOR NAME: Raul NavarroTELEPHONE: 323-981-3388
LICENSING EVALUATOR SIGNATURE:

DATE: 09/08/2017
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/08/2017
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
, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME: CARPINTEYRO FAMILY CHILD CARE
FACILITY NUMBER: 198016603
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/08/2017
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
09/15/2017
Section Cited
ILS
102417(g)(1)
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Operation of a Family Child Care Home.
Fire extinguishers and smoke detectors shall meet State Fire Marshal standards.

Fire extinguisher has not been serviced in over a year.
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Licensee will purchased a new fire extinguisher and send proof of purchased to LPA by POC date.
Type B
09/15/2017
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 provide LPA with a fire/disaster drill log during today's inspection.
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Licensee will conduct and document a fire drill and submit proof to LPA by POC date.
Type B
09/15/2017
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 will submit copy of Pediatric CPR/First aid certificate to LPA by POC date.
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Licensee did not provide LPA with proof of current Pediatric CPR and First aid certification during today's visit.
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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) 981-2956
LICENSING EVALUATOR NAME: Raul NavarroTELEPHONE: 323-981-3388
LICENSING EVALUATOR SIGNATURE:

DATE: 09/08/2017
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/08/2017
LIC809 (FAS) - (06/04)
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