Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198010952
Report Date: 10/28/2016
Date Signed 10/28/2016 01:59:57 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:GARCIA FAMILY CHILD CAREFACILITY NUMBER:
198010952
ADMINISTRATOR:GARCIA, NOEMYFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(562) 945-4737
CITY:WHITTIERSTATE: CAZIP CODE:
90606
CAPACITY:14CENSUS: 4DATE:
10/28/2016
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
01:02 PM
MET WITH:Noemy Garcia, LicenseeTIME COMPLETED:
02:50 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
Visit Conducted in Spanish
An unannounced Annual Random Visit was conducted by Licensing Program Analyst (LPA) Armando J. Lucero. Analyst met with licensee Noemy Garcia who guided LPA on a tour of the facility. This is a single story, two bedroom, one bathroom home. Currently residing in the home are three adults (Licensee, husband Julio Garcia, and adult niece Glenda Echeverria) and no children.

Areas accessible to children were inspected as follows: Living room, dining area, kitchen, one bathroom, back yard, and front yard.

Areas off limits include: Gated pool area, pool, side of home where washer and dryer are located, and two bedrooms.

During a tour of the home, LPA observed a swimming pool located in the back yard. Swimming pool is surrounded by a fence, home, and a detached unit. Detached unit and bedrooms are off limits to children. Fencing meets regulations. Gates were tested on this date, both are self latching that swing away from the pool. LPA observed windows in both bedrooms to have access to pool area. LPA observed Licensee's bedroom to have a large, heavy dresser to barricade window to prevent children from gaining access to pool. LPA observed the second bedroom's window to have an iron fence to prevent children from gaining access to pool area.

Report Continues on 809-C
SUPERVISOR'S NAME: Claudia GuangorenaTELEPHONE: (323) 981-3417
LICENSING EVALUATOR NAME: Armando J LuceroTELEPHONE: (323) 981-3435
LICENSING EVALUATOR SIGNATURE:

DATE: 10/28/2016
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/28/2016
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC809 (FAS) - (06/04)
Page: 1 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: GARCIA FAMILY CHILD CARE
FACILITY NUMBER: 198010952
VISIT DATE: 10/28/2016
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
LPA informed Licensee to log onto web site www.ccld.ca.gov to obtain forms and LIVE SCAN application. Records for all children and staff must be maintained for three (3) years after separation from the facility.

The Licensee was also advised of the requirement to report Unusual Incidents and/or injuries to the parent/guardian and to CCL within the time frame specified by the regulation. Licensee advised to visit www.shotsforschool.org for immunization information.

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.

· Dog(s) and/or pets should be isolated from children in care.
· It is recommended that First-Aid kits 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.

See page 809-D for deficiencies cited during today's visit in accordance to the California Code of Regulations Title 22, Division 12, Chapter 1

Upon receipt of this report, the Licensee shall post the Notice of Site Visit and any Licensing report documenting a type “A” deficiency. The report and the Notice of Site Visit shall be posted for 30 consecutive days. Failure to maintain posting as required, will result in an immediate $100 civil penalty.

Exit interview, copy of report was given. Appeal rights were issued and discussed.
SUPERVISOR'S NAME: Claudia GuangorenaTELEPHONE: (323) 981-3417
LICENSING EVALUATOR NAME: Armando J LuceroTELEPHONE: (323) 981-3435
LICENSING EVALUATOR SIGNATURE:

DATE: 10/28/2016
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/28/2016
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: GARCIA FAMILY CHILD CARE
FACILITY NUMBER: 198010952
VISIT DATE: 10/28/2016
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
There are no weapons, firearms, swimming pools or spas on the premises. The backyard is adequately fenced. There are age appropriate toys and equipment on the premises. The smoke detectors, fire extinguisher, and carbon monoxide detector are in operable condition.

After discussion with Licensee, LPA determined that Licensee does not have proof of vaccination according to Health & Safety Code 1597.622.

—CPR and First Aid expire: October 2017 for Licensee Noemy Garcia
—Child Care Roster, Disaster Plan, and Children's Records were reviewed and discussed.
—Children records and required licensing forms were discussed as well as mandated child abuse reporting and criminal record clearance requirement.

The following was discussed with the licensee:

Rooms that are off-limits need to be made inaccessible during operating hours. Smoking is prohibited. No infant walkers, no Johnny Jumpers, no excersaucers or any other item that falls into that category are allowed in facility. The Licensee was advised that inaccessibility of hazards must be constantly reassessed depending on the children in care. Sudden Infant Death Syndrome (SIDS) and Never-Shake-a-Baby were discussed.

Mandatory Forms for the children’s files and staff files, requirements for fire drills, earthquake drills and documentation for both were reviewed. Role and responsibilities of being a Mandated Reporter were reviewed. The Licensee was advised how to access forms and Regulations online at www.ccld.ca.gov. Licensee was made aware that it is his/her responsibility to know the regulations as well as anyone who assists in providing care. The Licensee was advised that inaccessibility of hazards must be constantly reassessed depending on the children in care.
Report Continues on 809-C
SUPERVISOR'S NAME: Claudia GuangorenaTELEPHONE: (323) 981-3417
LICENSING EVALUATOR NAME: Armando J LuceroTELEPHONE: (323) 981-3435
LICENSING EVALUATOR SIGNATURE:

DATE: 10/28/2016
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/28/2016
LIC809 (FAS) - (06/04)
Page: 2 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: GARCIA FAMILY CHILD CARE
FACILITY NUMBER: 198010952
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/28/2016
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
11/28/2016
Section Cited
§1597.622
1
2
3
4
5
6
7
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. Each employee and volunteer shall receive an influenza vaccination
1
2
3
4
5
6
7
Licensee stated that she will make an appointment with her doctor to obtain proof of vaccinations. Licensee stated that she will mail proof of vaccinations to LPA by POC date.
8
9
10
11
12
13
14
between August 1 and December 1 of each year.

After discussion with Licensee, LPA determined that Licensee cannot provide proof of vaccinations according to Health & Safety code above.
8
9
10
11
12
13
14
1
2
3
4
5
6
7
1
2
3
4
5
6
7
1
2
3
4
5
6
7
1
2
3
4
5
6
7
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: Armando J LuceroTELEPHONE: (323) 981-3435
LICENSING EVALUATOR SIGNATURE:

DATE: 10/28/2016
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/28/2016
LIC809 (FAS) - (06/04)
Page: 4 of 4