Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198007740
Report Date: 05/10/2016
Date Signed 05/10/2016 04:01:02 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME:SANCHEZ FAMILY CHILD CAREFACILITY NUMBER:
198007740
ADMINISTRATOR:SANCHEZ, VENERANDAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(562) 929-1154
CITY:NORWALKSTATE: CAZIP CODE:
90650
CAPACITY:14CENSUS: 1DATE:
05/10/2016
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
03:10 PM
MET WITH:Veneranda SanchezTIME COMPLETED:
04:16 PM
NARRATIVE
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ANNUAL/RANDOM VISIT CONDUCTED IN ENGLISH

An Annual Random visit was conducted by LPA Timothy Fields. LPA was guided on a tour of the facility by Licensee Veneranda Sanchez. This is a single story home with three bedrooms and two bathrooms. Residing in the home are two adults and no children. Upon arrival LPA observed one child in the living room. Care is mainly provided in the living room area. The kitchen and dining room are accessible. The hallway contains three bedrooms and two bathrooms. All there bedrooms and guest bathroom are accessible. The remaining bathroom located in the master bedroom is off limits. There were no fireplaces, wall heaters, or detached sheds observed in the home.

The front yard is off limits while the backyard is used for outdoor activity space. Licensee has a small dog isolated in the backyard. LPA did not observe children locked in a locked car. All rooms that are off-limits need to be made inaccessible during operating hours. Storage areas for poisons, detergents, cleaning compounds, medicines, and other items which pose a danger to children were observed to be inaccessible to children in care. LPA observed the home to be kept clean and orderly, with heating and ventilation for safety and comfort. Capacity and ratio was observed to be in compliance. Licensee complied with inspection authority.

Per licensee there are no weapons or firearms in the home. Telephone service was in operable condition. There are no *swimming pool or spa on the premises. The backyard is adequately fenced. There are age appropriate toys and equipment on the premises. The smoke detectors and fire extinguisher (2A 10BC) are in operable condition.
SUPERVISOR'S NAME: Claudia GuangorenaTELEPHONE: (323) 981-3417
LICENSING EVALUATOR NAME: Timothy FieldsTELEPHONE: (323) 981-3985
LICENSING EVALUATOR SIGNATURE:

DATE: 05/10/2016
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/10/2016
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, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME: SANCHEZ FAMILY CHILD CARE
FACILITY NUMBER: 198007740
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/10/2016
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
05/16/2016
Section Cited
§1503.2
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Carbon monoxide detectors required; inspection

Every facility licensed or certified pursuant to this chapter shall have one or more carbon monoxide detectors in the facility that meet the standards established in Chapter 8
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Licensee states she will purchase a carbon monoxide detector by POC date and submit proof.
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(commencing with Section 13260) of Part 2 of Division 12. The department shall account for the presence of these detectors during inspections.

Licensee did no have a carbon monoxide detector.
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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: Claudia GuangorenaTELEPHONE: (323) 981-3417
LICENSING EVALUATOR NAME: Timothy FieldsTELEPHONE: (323) 981-3985
LICENSING EVALUATOR SIGNATURE:

DATE: 05/10/2016
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/10/2016
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, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME: SANCHEZ FAMILY CHILD CARE
FACILITY NUMBER: 198007740
VISIT DATE: 05/10/2016
NARRATIVE
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The following deficiencies are cited in accordance with Title 22 of California Code of Regulations and discussed with licensee:

Licensee did not have a carbon monoxide detector.

See 809 D attached.
The licensee shall require each recipient (Parent/guardian) of a licensing report documenting a
Type A citation resulting from a complaint investigation and any licensing document pertaining to a conference, and any summary of an accusation indicating the Department’s intent to revoke a license, to sign
LIC 9224 form, indicating that he or she has received the documents and the date they were received. The licensee shall keep verification of receipt in each child’s file.

Exit interview was conducted with licensee and appeal rights and procedures were explained. Licensee was instructed to post notice of site visit for 30 days.

Web site address to order forms: http://www.dss.cahwnet.gov/cdssweb/On-lineFor_293.htm#l
INTERNET ADDRESS: http://www.ccld.ca.gov – To access licensing forms, updates and Title 22.
SUPERVISOR'S NAME: Claudia GuangorenaTELEPHONE: (323) 981-3417
LICENSING EVALUATOR NAME: Timothy FieldsTELEPHONE: (323) 981-3985
LICENSING EVALUATOR SIGNATURE:

DATE: 05/10/2016
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/10/2016
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, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME: SANCHEZ FAMILY CHILD CARE
FACILITY NUMBER: 198007740
VISIT DATE: 05/10/2016
NARRATIVE
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The following was discussed: Individuals who are 18 years of age or older living or working in the home must be finger print cleared prior to licensure or living/working in the facility. Individuals within one month of their 18th birthday must be fingerprinted immediately. An immediate $100 per day Civil Penalty for a maximum of five days for the first violation and a maximum of 30 days for subsequent violations per individual will be issued. If an individual has a clearance with the Department, a criminal record clearance may be transferred. LIC 9182 Criminal Background Clearance Transfer Request may be used.

During operating hours no smoking, no infant walkers, Johnny jumpers, Exersaucers and any other item that falls into that category are allowed in the facility. Earthquake, fire disaster, and safety drill posting requirement were explained in detail on this date.

Licensee has been advised of the following:.
.Pools should be inaccessible by a pool cover or a 5-foot fence around the perimeter of the pool. If the fence is made out of chain link, the opening should not allow a golf ball to pass through. Fences made out of mesh will need to be approved by the department. Mesh fence will remain in place whenever licensed care is provided, and as long as the mesh fence makes the swimming pool inaccessible to children as determined by licensing staff.
· Pool cover label should read F1346-91 American Society for Testing Material and it should be able to withstand the weight of an adult without water above cover when standing.
·Dog(s) and or pets should be isolated from children in care.
·It is recommended that a First Aid kit be available on premises.
Outdoor supervision required at all times. If outdoor area not adequately fenced provider must be with children at all times when outdoors.

-CPR and First Aid expires: 9/12/17
-Child Care Roster, Disaster Plan, and Children's Records were discussed.
-Children records and required licensing forms were discussed as well as mandated child abuse reporting and criminal records clearance (finger prints and child abuse clearance) requirement.
SUPERVISOR'S NAME: Claudia GuangorenaTELEPHONE: (323) 981-3417
LICENSING EVALUATOR NAME: Timothy FieldsTELEPHONE: (323) 981-3985
LICENSING EVALUATOR SIGNATURE:

DATE: 05/10/2016
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/10/2016
LIC809 (FAS) - (06/04)
Page: 2 of 4