Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197418856
Report Date: 12/11/2015
Date Signed 12/11/2015 02:34:10 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:CASTELLON FAMILY CHILD CAREFACILITY NUMBER:
197418856
ADMINISTRATOR:CASTELLON, CAROLINAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(323) 294-5943
CITY:LOS ANGELESSTATE: CAZIP CODE:
90062
CAPACITY:14CENSUS: 6DATE:
12/11/2015
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
01:30 PM
MET WITH:Carolina Castellon, LicenseeTIME COMPLETED:
03:00 PM
NARRATIVE
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LPA Sharalyn Jenkins-Sweeten conducted an unannounced random visit (1). LPA met with licensee, Carolina Castellon, who guided analyst on a tour of the facility. The home was inspected as follows: Kitchen, living room, four bedrooms, 2 bathrooms, dining room, front yard and backyard. The home was inspected for safety, comfort, cleanliness, telephone service, heating and ventilation, inaccessibility to poisons, detergents, cleaning compounds, medicines, and hazardous items that can pose a danger to children. The First Aid kit was observed on a kitchen shelf. The licensee denies the presence of any weapons in the home. The LPA did not observe any weapons or firearms of any kind in the facility during the inspection. There is no pool, spa or other body of water on the premises. There are age appropriate toys and equipment on the premises. The required fire extinguisher (SIZE 2A10BC) and smoke detector are in operable condition. The indoor and outdoor play areas were inspected for safety. Licensee states she has seventeen children currently enrolled. LPA reviewed six children's files during the visit. LPA observed licensee's current Pediatric CPR and Pediatric First Aid certificates, which expire 3/2017.
Areas off limits include: 3 rear bedrooms and master bathroom

Rooms/Areas were made inaccessible by: Child proof door knob covers render rooms inaccessible

LPA reminded the licensee that all adults living in or having access to day care children in the home are required to have criminal record clearances with the Department of Justice, FBI and Child Abuse Index prior to residing/ working in the home or having any contact with children. If the aforementioned is not adhered to, a Civil Penalty of $100 /day per uncleared adult will be assessed. Licensee has been reminded to provide parents with a Fact Sheet AB 633 Child Care Parent upon enrollment. The licensee is also reminded that walkers, activity center/walker without wheels, jumpers, bouncers and similar items are not allowed in child care facilities. Licensee was reminded of capacity limitations and that smoking is prohibited on the premises when children are present.
SUPERVISOR'S NAME: Bill MayedaTELEPHONE: (310) 337-4341
LICENSING EVALUATOR NAME: Sharalyn Jenkins-SweetenTELEPHONE: (310)568-2448
LICENSING EVALUATOR SIGNATURE:

DATE: 12/11/2015
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/11/2015
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: CASTELLON FAMILY CHILD CARE
FACILITY NUMBER: 197418856
VISIT DATE: 12/11/2015
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LPA discussed inspection authority, licensee appeal procedures/rights and the agency's consultative role. The LPA also discussed required forms for children’s files, facility files, posting requirements, earthquake safety and the necessity of drills conducted and documented (date/time) at least once every 6 months.

Incidental Medical Service (IMS) is the ability for a licensee to provide care for children with unusual medical conditions that need services beyond first aid, which can be done by a non-skilled medical professional given that certain criteria are met, documents are available for review and they have submitted an update to the facility’s plan of operation(P of O) describing the policies and procedures in place to ensure safe practices. Refer to Title 22 Regulations Section 102417. Licensee stated IMS services are not being provided at the facility.
***IF CITED FOR TYPE A VIOLATION***
Upon receipt of the Type A Violation(s), licensee shall post the report for 30 days in addition to the Notice of Site Visit, provide copies of the licensing report to parents/guardians of children in care at the facility and obtain a signed Acknowledgement of Licensing Reports (LIC 9224) from parent/guardian & place it in each child's file by the close of business the following day or the next day child returns to the facility. The same report must be provided to parents/guardians of children newly enrolled at the facility during the next 12 months & licensee will obtain a signed Acknowledgement of Licensing Reports (LIC 9224) from parent/guardian & place it in each child's file.

The Department of Social Services - Community Care Licensing Division website: http://www.ccld.ca.gov.

No deficiencies were observed or cited during the visit.

A copy of this report along with a Notice of Site Visit were issued and explained to the licensee.
SUPERVISOR'S NAME: Bill MayedaTELEPHONE: (310) 337-4341
LICENSING EVALUATOR NAME: Sharalyn Jenkins-SweetenTELEPHONE: (310)568-2448
LICENSING EVALUATOR SIGNATURE:

DATE: 12/11/2015
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/11/2015
LIC809 (FAS) - (06/04)
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