Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197409910
Report Date: 01/18/2018
Date Signed 01/18/2018 12:47:39 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: 3DATE:
01/18/2018
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
10:50 AM
MET WITH:Maria CastanedaTIME COMPLETED:
12:55 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 3 children ( one infant) 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 storage 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 13 year old daughter and adult son). Main care is provided in the living room and the detached playroom. 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 storage 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. The Fire Extinguisher (2A-10-BC) is mounted on the wall in the kitchen. 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 12/2016 expire 12/18.
SUPERVISOR'S NAME: Mary RuizTELEPHONE: (310) 337-4826
LICENSING EVALUATOR NAME: Silva GaribyanTELEPHONE: (310) 337-3754
LICENSING EVALUATOR SIGNATURE:

DATE: 01/18/2018
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/18/2018
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, 6167 BRISTOL PARKWAY #400
CULVER CITY, CA 90230
FACILITY NAME: CASTANEDA FAMILY CHILD CARE
FACILITY NUMBER: 197409910
VISIT DATE: 01/18/2018
NARRATIVE
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Senate Bill 792: This bill, commencing September 1, 2016, prohibits a person from being employed or volunteering at a child care facility or family day care if he or she has not been immunized against influenza, pertussis and measles. Per the licensee, staff immunization are not up to date.

New Appeal Process: A licensee may file an appeal, in writing 15 business days from the date of receiving the penalty assessment

New Immunization Requirement: Law enacted by SB 277, beginning January 1, 2016, personal beliefs exemptions will no longer be an option for the vaccines that are currently required for entry into child care or school in California. Personal beliefs exemptions already on file will remain valid until the child reaches the next immunization checkpoint. Update on Incidental Medical Services:

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 licensee was informed of The Child Care Advocate Program (CCAP) that is administered from within the Community Care Licensing Division. CCAP participates in many community activities and special projects in order to disseminate information on the State’s licensing role, provide information to the public and parents on child care licensing, and provide many other helpful resources to the licensees and the public. CCAP’s direct contact information is as followed: Phone number: (916) 654-1541


Email Address: childcareadvocatesprogram@dss.ca.gov
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: 01/18/2018
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/18/2018
LIC809 (FAS) - (06/04)
Page: 3 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: 01/18/2018
NARRATIVE
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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. 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), Emergency Disaster Plan (LIC610a), Notification of Parents' Rights Poster (PUB 394), and Facility Roster ( LIC904, included the ages of the children or their enrollment/last date in care).

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.

The following was thoroughly discussed with the licensee:

Assembly Bill 633: Upon receipt by the licensee, licensees are to provide to parents/guardians the following: Copies of any licensing reports that document a Type A citation- this includes facility visits and substantiated complaint investigations; copy of licensing documents pertaining to a conference conducted by a local licensing agency management representative and the licensee of this family child care home in which issues of noncompliance are discussed or copies of a summary of an accusation indicating the Department's intent to revoke the facility's license. Copies of any of the above licensing documents the licensee has received in the prior 12 months shall be provided to parents/guardians of newly enrolled child at the facility.

Continued
SUPERVISOR'S NAME: Mary RuizTELEPHONE: (310) 337-4826
LICENSING EVALUATOR NAME: Silva GaribyanTELEPHONE: (310) 337-3754
LICENSING EVALUATOR SIGNATURE:

DATE: 01/18/2018
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/18/2018
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, 6167 BRISTOL PARKWAY #400
CULVER CITY, CA 90230

FACILITY NAME: CASTANEDA FAMILY CHILD CARE
FACILITY NUMBER: 197409910
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/18/2018
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
02/15/2018
Section Cited
HSC
1597.622
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Employees or volunteers at family day care home; immunization requirements; records; exemptions: 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. Licensee's immunizations are not up to date.
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The licensee shall ensure all employees or volunteers at the family day care home , have been immunized against influenza, pertussis, and measles. For those choosing to waive the influenza vaccine, proper documentation must be on file. The licensee must show proof of immunization no later than 02/15/2018.
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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: 01/18/2018
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/18/2018
LIC809 (FAS) - (06/04)
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