Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197493475
Report Date: 06/07/2017
Date Signed 06/07/2017 11:30:01 AM

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:CALERO FAMILY CHILD CAREFACILITY NUMBER:
197493475
ADMINISTRATOR:CALERO, LESLIEFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(818) 462-3991
CITY:RESEDASTATE: CAZIP CODE:
91335
CAPACITY:14CENSUS: 0DATE:
06/07/2017
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
08:25 AM
MET WITH:Leslie CaleroTIME COMPLETED:
11:15 AM
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This is an announced pre-licensing visit conducted by LPA, Margarit Sislyan. LPA Sislyan met with licensee/ applicant, Leslie Calero, who guided analyst on a tour of the facility. All areas identified on the facility sketch were inspected. This is a single family, single story home. The home was inspected inside and out. Family members residing at facility are: 2 adults and no children. 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.

Per applicant, there are no weapons or firearms of any kind in the facility at this time. The LPA did not observe any weapons. There is no pool, spa or other bodies of water on the premises. There are age appropriate toys and equipment on the premises. The required smoke detectors and carbon monoxide detectors are in operable condition. Applicant needs to provide proof of Preventative Health and Safety certificates. Applicant submitted a disaster plan and needs to demonstrated control of property.

The following were discussed: No smoking, no infant walkers, Johnny jumpers, exersaucers or any other item that falls into that category. The LPA also discussed earthquake safety and necessity of drills, required forms for children’s files, facility files and posting requirements. Fingerprint clearance, transfer process and capacity / ratios. Regulation 102416.3 was explained and discussed with applicant.

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
SUPERVISOR'S NAME: Sharon GreeneTELEPHONE: (310) 337-4313
LICENSING EVALUATOR NAME: Margarit SislyanTELEPHONE: (310) 337-4346
LICENSING EVALUATOR SIGNATURE:

DATE: 06/07/2017
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/07/2017
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: CALERO FAMILY CHILD CARE
FACILITY NUMBER: 197493475
VISIT DATE: 06/07/2017
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Applicant(s) /Licensee was informed that she is a mandated child abuse reporter with the responsibility of reporting any suspected child abuse to the Child Abuse Hotline at (800) 540-4000.

The applicant was informed that all adults living in or having access to the home are required to have fingerprint clearances with Department of Justice, FBI and Child Abuse Index prior to having contact with children. If the aforementioned is not adhered to, a Civil Penalty of $500 per non-cleared adult will be assessed.

The following is needed prior to licensure:

1) Fire Extinguisher (2A10BC)
2) Current 15-hour Adult, Child & Infant CPR and Pediatric First Aid.
3) Lease agreement
4) The fruit trees shall be trimmed or have to be separated with fence at least 4 feet high.
5) First Aid Kit

ALL REQUIREMENTS DUE BY 07/07/17

For additional information and forms visit our website at: www.ccld.ca.gov

Exit interview conducted
SUPERVISOR'S NAME: Sharon GreeneTELEPHONE: (310) 337-4313
LICENSING EVALUATOR NAME: Margarit SislyanTELEPHONE: (310) 337-4346
LICENSING EVALUATOR SIGNATURE:

DATE: 06/07/2017
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/07/2017
LIC809 (FAS) - (06/04)
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