Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197418856
Report Date: 12/15/2016
Date Signed 12/15/2016 01:32:34 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: 4DATE:
12/15/2016
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
12:00 PM
MET WITH:Carolina Castellon, LicenseeTIME COMPLETED:
01:45 PM
NARRATIVE
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An annual random visit was conducted by LPA, Sharalyn Jenkins-Sweeten (2). 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 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), carbon monoxide detector and smoke detector are in operable condition. The indoor and outdoor play areas were inspected for safety. Licensee stated she has 14 children currently enrolled. Licensee produced current Pediatric CPR and Pediatric First Aid certificates, which expired 3/2017.

Areas off limits include: 3 rear bedrooms and master bathroom
Rooms/Areas were made inaccessible by: Child safety 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. 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.
SUPERVISOR'S NAME: Jennie FerreiraTELEPHONE: (310) 337-7332
LICENSING EVALUATOR NAME: Sharalyn Jenkins-SweetenTELEPHONE: (310)568-2448
LICENSING EVALUATOR SIGNATURE:

DATE: 12/15/2016
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/15/2016
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: 12/15/2016
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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. The licensee stated IMS services are not being provided at the facility. It is the responsibility of the licensee, not the Department, to make admission, retention decisions for individual children to ensure the child’s needs can be met at the time of admission and throughout the child’s attendance at the facility. Child care licensees may want to consult with an attorney for advice and/or ADA for information and materials by calling 800-514-0301. Licensees who administer IMS shall create and submit a Plan of Operation as required by the department. Licensee stated IMS services are not being provided at the facility.

LPA also explained and provided literature on new regulatory requirements for child care providers and assistants regarding immunization for measles, pertussis and influenza and requirement to retain proof of vaccination 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.

The deficiency observed during this visit was cited as follows:
1) The licensee failed to document a fire and disaster drill during past 6 months

A copy of this report along with a Notice of Site Visit were issued and explained to the licensee. An exit interview was conducted.
SUPERVISOR'S NAME: Jennie FerreiraTELEPHONE: (310) 337-7332
LICENSING EVALUATOR NAME: Sharalyn Jenkins-SweetenTELEPHONE: (310)568-2448
LICENSING EVALUATOR SIGNATURE:

DATE: 12/15/2016
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/15/2016
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
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/15/2016
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
12/22/2016
Section Cited
102417 g 9 A 1
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Operation of a Family Child Care Home. The licensee failed to document a fire and disaster drill during past 6 months. Per Title 22 Regulatios, all homes shall conduct fire and disaster drills at least once every six months, and document the date and time of each drill.
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The licensee shall conduct a fire and disaster drill while children are in care, document the date and time of the drill, then submit a copy of the documented drill to the department no later than 12/22/16 to clear the deficiency.
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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: Jennie FerreiraTELEPHONE: (310) 337-7332
LICENSING EVALUATOR NAME: Sharalyn Jenkins-SweetenTELEPHONE: (310)568-2448
LICENSING EVALUATOR SIGNATURE:

DATE: 12/15/2016
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/15/2016
LIC809 (FAS) - (06/04)
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