Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197409910
Report Date: 03/09/2016
Date Signed 03/09/2016 03:55:25 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 6167 BRISTOL PARKWAY #400
CULVER CITY, CA 90230
FACILITY NAME:CASTANEDA FAMILY CHILD CAREFACILITY NUMBER:
197409910
ADMINISTRATOR:CASTANEDA, MARIAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(818) 255-2459
CITY:NORTH HOLLYWOODSTATE: CAZIP CODE:
91605
CAPACITY:14CENSUS: 6DATE:
03/09/2016
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
02:05 PM
MET WITH:Maria CastanedaTIME COMPLETED:
04:00 PM
NARRATIVE
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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. LPA observed 6 children ( 2 infants) in care. The licensee's home is a single story 3 bedroom, 3 bathroom home with living room, dining room, kitchen and detached day care room (garage). There is a divided office room at the rear of the garage and there is 1 bathroom in the garage for children's use. There is 1 bathroom inside the home and 1 bathroom in the detached laundry structure. The laundry room is locked and off limits to children. There is no pool, spa or other bodies of water on the premises. Family members residing in the home include 2 adults ( licensee and her spouse) and one child ( licensee's daughter). Main care is provided in the living room and the detached playroom. At this time, licensee does not have an assistant and only cares for a small amount of children. Children have free access to the home's dining area and kitchen and use the bedrooms as needed for napping. Children play in the enclosed backyard under the covered patio and the remainder of the open yard. There is a dog run on the right side of the home and licensee has 1 dog.
Off limit areas include the laundry room and the office room, accessible from the play room.
The home was found to be clean and orderly with proper ventilation for safety and comfort. The bathroom was inspected for inaccessibility of chemicals/toxins and other potential hazards to children in care. The kitchen cabinets and drawers were inspected for inaccessibility of toxins/chemicals, knives and other sharp objects which may be harmful to children in care. LPA observed cleaning chemicals in the under the sink cabinet and knives accessible in the kitchen. The Fire Extinguisher (2A-10-BC) is mounted on the wall in the kitchen.
SUPERVISOR'S NAME: Mary RuizTELEPHONE: (310) 337-4826
LICENSING EVALUATOR NAME: Silva GaribyanTELEPHONE: (310) 337-3754
LICENSING EVALUATOR SIGNATURE:

DATE: 03/09/2016
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/09/2016
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 4


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 6167 BRISTOL PARKWAY #400
CULVER CITY, CA 90230
FACILITY NAME: CASTANEDA FAMILY CHILD CARE
FACILITY NUMBER: 197409910
VISIT DATE: 03/09/2016
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There is a working smoke/carbon monoxide detector located in the play room. Licensee has current CPR or First Aid. Current CPR and First Aid taken 01/2016 expire 01/18. The First Aid kit was observed, and complete. There is a fireplace in the living room area which is properly screened. LPA observed the fire drill log. Licensee states the fire drills are done every 6 months . The licensee states there are no firearms or weapons of any kind in the facility at this time.
LPA observed toys and furniture that were age appropriate and in good repair.
LPA toured the backyard and found it to be fully fenced.

Licensee has the following documents posted in the FCCH; Facility License (LIC 203), Child Care Facility Roster (LIC9040), Emergency Disaster Plan (LIC610a). The Notification of Parents' Rights Poster (PUB 394) was not posted in the facility.

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. Licensee could not produce file for 1 child in care

Incidental Medical Services were discussed. Per licensee incidental medical services are not and will not be provided.

Licensee is advised to visit www.shotsforschool.org for Immunization information.
SB 277 - require all children attending day care or school based programs to be immunized and will eliminate personal/religious belief exemptions

Exit interview was conducted and a copy of the report was provided.
SUPERVISOR'S NAME: Mary RuizTELEPHONE: (310) 337-4826
LICENSING EVALUATOR NAME: Silva GaribyanTELEPHONE: (310) 337-3754
LICENSING EVALUATOR SIGNATURE:

DATE: 03/09/2016
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/09/2016
LIC809 (FAS) - (06/04)
Page: 2 of 4


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 6167 BRISTOL PARKWAY #400
CULVER CITY, CA 90230
FACILITY NAME: CASTANEDA FAMILY CHILD CARE
FACILITY NUMBER: 197409910
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/09/2016
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
03/16/2016
Section Cited
102419 (b)
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Parents Rights. The Licensee shall post the PUB 394, Family Child Care Home Notification of Parents’ Rights Poster in an accessible area in the family child care home at all times children are in care. LPA did not observe the Parent's Rights poster to be posted in a prominent area of the home
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Licensee will ensure the Parent's Rights poster is posted in a prominent area of the home immediately
Type B
03/16/2016
Section Cited
102421
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Child's Records

Licensee could not produce file for 1 child in care.
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Plan Of Correction (POC) visit will be conducted to review files and verify completeness.
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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: Mary RuizTELEPHONE: (310) 337-4826
LICENSING EVALUATOR NAME: Silva GaribyanTELEPHONE: (310) 337-3754
LICENSING EVALUATOR SIGNATURE:

DATE: 03/09/2016
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/09/2016
LIC809 (FAS) - (06/04)
Page: 4 of 4


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 6167 BRISTOL PARKWAY #400
CULVER CITY, CA 90230
FACILITY NAME: CASTANEDA FAMILY CHILD CARE
FACILITY NUMBER: 197409910
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/09/2016
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
03/09/2016
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. LPA observed cleaning chemicals and knives accessible in the kitchen
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Licensee must make all chemicals and knives inaccessible to the children in care. LPA observed licensee remove the chemicals and knives.
Corrected during the 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: Mary RuizTELEPHONE: (310) 337-4826
LICENSING EVALUATOR NAME: Silva GaribyanTELEPHONE: (310) 337-3754
LICENSING EVALUATOR SIGNATURE:

DATE: 03/09/2016
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/09/2016
LIC809 (FAS) - (06/04)
Page: 3 of 4