Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198013959
Report Date: 11/04/2016
Date Signed 11/04/2016 12:51:50 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:MACIEL FAMILY CHILD CAREFACILITY NUMBER:
198013959
ADMINISTRATOR:MACIEL, CLAUDIAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(562) 843-2061
CITY:WHITTIERSTATE: CAZIP CODE:
90604
CAPACITY:14CENSUS: 5DATE:
11/04/2016
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
11:40 AM
MET WITH:Claudia Maciel, LicenseeTIME COMPLETED:
01:05 PM
NARRATIVE
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Visit Conducted in Spanish
An unannounced Annual Random Visit was conducted by Licensing Program Analyst (LPA) Armando J. Lucero. Analyst met with licensee Claudia Maciel who guided LPA on a tour of the facility. This is a single story, three bedroom, two bathroom home. Currently residing in the home are three adults (Licensee, husband George Cervantes, and adult son Kimball Monge) and one child. Also present at the time of the visit, is licensee's sister Gladys Garcia who also assists Licensee. Upon arrival, LPA observed that all areas that are off limits were inaccessible to children in care.

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

Areas off limits include: All three bedrooms, laundry room, attached garage, front yard, and both sides of the outside of the house where the Licensee's dog is kept.

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 the Licensee, LPA has determined that Licensee could not provide proof of vaccinations according to Health & Safety code 1597.622. This is a potential risk to 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: 11/04/2016
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/04/2016
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: MACIEL FAMILY CHILD CARE
FACILITY NUMBER: 198013959
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/04/2016
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
12/02/2016
Section Cited
§1597.622
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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
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Licensee stated that she and assistant will make an appointment with their doctors to obtain proof of vaccinations according to the Health & Safety Code. Licensee will mail copies of proof of vaccinations for herself and assistant to LPA by POC date.
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between August 1 and December 1 of each year.

After discussion with Licensee, LPA determined that Licensee could not provide proof of vaccination according to Health & Safety Code above for herself or for her assistant.
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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: Armando J LuceroTELEPHONE: (323) 981-3435
LICENSING EVALUATOR SIGNATURE:

DATE: 11/04/2016
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/04/2016
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: MACIEL FAMILY CHILD CARE
FACILITY NUMBER: 198013959
VISIT DATE: 11/04/2016
NARRATIVE
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—CPR and First Aid expire: 11/10/2017 for Licensee Claudia Maciel
—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.

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.
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: 11/04/2016
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/04/2016
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: MACIEL FAMILY CHILD CARE
FACILITY NUMBER: 198013959
VISIT DATE: 11/04/2016
NARRATIVE
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· 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.

These forms may also be downloaded from our website: www.ccld.ca.gov

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: 11/04/2016
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/04/2016
LIC809 (FAS) - (06/04)
Page: 3 of 4