Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198015102
Report Date: 04/28/2017
Date Signed 04/28/2017 04:17:15 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:NAVARRETE FAMILY CHILD CAREFACILITY NUMBER:
198015102
ADMINISTRATOR:NAVARRETE, ANA MARIAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(562) 908-4950
CITY:WHITTIERSTATE: CAZIP CODE:
90601
CAPACITY:14CENSUS: 11DATE:
04/28/2017
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
11:50 AM
MET WITH:Licensee Ana NavarretteTIME COMPLETED:
04:30 PM
NARRATIVE
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(1) An unannounced, Annual/Random inspection was conducted on this date by Licensing Program Analyst (LPA) B. Emiko Bell. Upon arrival, LPA was greeted and let into the residence by Licensee Ana Navarrette. Upon arrival, licensee and her adult son (acting as her assistant), Frank Navarrette, were with eleven (11) daycare children ages: one month, 17 months, 2 years, 2 years, 3 years, 2 years, 4 years, 19 months, 2 years, 3 years, 18 months. (There were four infants and 7 pre-school age children) Her minor daughter arrived at 1:45 P.M. One child was picked up at 2:00 and two more at 3:40 P.M.

All areas identified on the Facility Sketch, inside and outside, were inspected in the following order: outdoors: the backyard; indoors: family room, bedroom #1, bedroom #2, bathroom, bedroom #3, the living room, an extra room (technically a dining room), and the kitchen. The family room is used as the daycare room. This is a single-story residence with two bathrooms. Outdoors, there is a concrete storage shed, half of which is used for storage and half of which is a bathroom which the children can use when they are outside.

Though Licensee stated that all three bedrooms are off-limits, though the doors were shut, they were not locked and thus, LPA looked into each bedroom. There was one dog in bedroom #2 and one dog in bedroom #3. The door to bedroom #1 (the master bedroom) was locked and thus it and the master bathroom were not inspected. Licensee immediately locked the bedrooms after the doors were open. In addition, the garage and the storage shed are designated off-limit areas; both were locked, but licensee unlocked them to allow LPA to inspect them.

Licensee has two dogs, a Lhapso Apso and a Yorkie. Licensee stated that they are kept in bedroom #2 and bedroom #3 during daycare hours. Licensee stated there are no firearms or weapons on the premises. The family members residing at the facility are three adults and one minor. The residence was inspected for safety, comfort, cleanliness, telephone service (Licensee has a cell phone and there is a home landline),
SUPERVISOR'S NAME: Cassandra CooperTELEPHONE: (323) 981-3365
LICENSING EVALUATOR NAME: Betty BellTELEPHONE: (323) 981-3364
LICENSING EVALUATOR SIGNATURE:

DATE: 04/28/2017
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/28/2017
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 5


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: NAVARRETE FAMILY CHILD CARE
FACILITY NUMBER: 198015102
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/28/2017
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
05/26/2017
Section Cited
§1597.622(a1)
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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 between August 1 and December 1 of each year.
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Licensee agreed to obtain verification of measles antibodies and pertussis immunization by the COB on the POC due date of 05/26/17.
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-Licensee could not provide verification of MMR or TDAP or influenza immunizations.
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Type B
05/26/2017
Section Cited
§1597.622(a1)
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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 between August 1 and December 1 of each year.
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Licensee agreed to obtain verification of measles antibodies and pertussis immunization by the COB on the POC due date of 05/26/17.
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-Licensee's assistant, her adult son, Frank Navarrette, could not provide verification of MMR or TDAP or influenza immunizations.
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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: Cassandra CooperTELEPHONE: (323) 981-3365
LICENSING EVALUATOR NAME: Betty BellTELEPHONE: (323) 981-3364
LICENSING EVALUATOR SIGNATURE:

DATE: 04/28/2017
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/28/2017
LIC809 (FAS) - (06/04)
Page: 2 of 5


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: NAVARRETE FAMILY CHILD CARE
FACILITY NUMBER: 198015102
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/28/2017
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
05/08/2017
Section Cited
102417(d)
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OPERATION OF A FAMILY CHILD CARE HOME The home shall provide safe toys, play equipment and materials.

-Licensee has two cribs which she was not sure when they were purchased.
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Licensee agreed to remove the cribs and purchase two playpens in their place.
Type B
05/08/2017
Section Cited
102417(g)
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OPERATION OF A FAMILY CHILD CARE HOME
The home shall be free from defects or conditions which might endanger a child.

-There was a wheelbarrow, a ladder, and various other construcition materials which were accessible to the children in the backyard.
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Licensee agreed to block the materials with a fence, thus rendering them inaccessible to the daycare children.
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were accessible to the children in the backyard.
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Type B
05/08/2017
Section Cited
102419 (j)
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ADMISSION PROCEDURES AND PARENTAL AND AUTHORIZED REPRESENTATIVE'S RIGHTS
Copies of the signed receipt shall be available to the Department as provided in Section 102391(d).
-The file of Child #12 does not contain a signed Notification of Parents Rights.
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Licensee agreed to have the parents of Child #12 sign the LIC 995A Notification of Parents Rights.
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: Cassandra CooperTELEPHONE: (323) 981-3365
LICENSING EVALUATOR NAME: Betty BellTELEPHONE: (323) 981-3364
LICENSING EVALUATOR SIGNATURE:

DATE: 04/28/2017
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/28/2017
LIC809 (FAS) - (06/04)
Page: 4 of 5


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: NAVARRETE FAMILY CHILD CARE
FACILITY NUMBER: 198015102
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/28/2017
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
05/26/2017
Section Cited
§1597.622(a1)
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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 between August 1 and December 1 of each year.
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Licensee agreed to obtain verification of measles antibodies and pertussis immunization by the COB on the POC due date of 05/26/17.
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-Licensee could not provide verification of MMR or TDAP or influenza immunizations for her Mon.-Thurs. assistant, Gabriela Aldana.
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Type B
05/08/2017
Section Cited
102417(g9A1)
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OPERATION OF A FAMILY CHILD CARE HOME
All homes shall conduct fire and disaster drills at least once every six months, and document the date and time of each drill.

-Though Licensee had a fire drill log, the date of the fire drill was not listed.
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Licensee agreed to run and document the date and time of a fire drill by the COB on the POC due date of 05/08/17.
Type B
04/28/2017
Section Cited
102417(g)(8)
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OPERATION OF A FAMILY CHILD CARE HOME
All homes shall have a current roster of the children.
-Though licensee had a roster, it had not been updated since 07/06/16. *An immediate civil penalty of $150 has been assessed since this is a repeat violation within a 12 month period.*
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*Corrected during visit.*
Licensee immediately updated the LIC 9040 Child Care Facility Roster.
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: Cassandra CooperTELEPHONE: (323) 981-3365
LICENSING EVALUATOR NAME: Betty BellTELEPHONE: (323) 981-3364
LICENSING EVALUATOR SIGNATURE:

DATE: 04/28/2017
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/28/2017
LIC809 (FAS) - (06/04)
Page: 3 of 5


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: NAVARRETE FAMILY CHILD CARE
FACILITY NUMBER: 198015102
VISIT DATE: 04/28/2017
NARRATIVE
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heating and ventilation (there is central heating and air-conditioning throughout the house and a ceiling fan in each of the bedrooms and the family room/playroom), inaccessibility to poisons, detergents, cleaning compounds, medicine, and hazardous items that can pose a danger to children. The knives in the kitchen are kept on a shelf in one of the cabinets which is approximately 6' high. The medications are in a cabinet which have a lock. There are age-appropriate toys on the premises. There is napping equipment on the premises (there are four playpens, two cribs and six mattresses). There are four smoke detectors on the premises, one in the family room, one in the living room, one in the extra room where the children nap, and one in the kitchen; all were tested and are operable. There is an electrical carbon monoxide detector in the kitchen; it was tested and is operable. The fire extinguisher, size 2-A:10-B:C, is mounted on a wall in the kitchen; it was serviced 11/15/16. Licensee's Pediatric First Aid/CPR exp. 02/18. Licensee keeps a First Aid Kit in the bathroom used by the daycare children; it was reviewed for quantity and medications. Though Licensee ran a fire drill, the date was not listed. Licensee's days and hours of operation are Monday through Friday, 6:00 A.M.-6:00 P.M. Licensee has a roster, but is was not current. There are currently fourteen (14) children enrolled. Two children's files were reviewed for required forms, as listed on LIC 311D. Licensee does not transport daycare children. Licensee's Parent Board is hung in the family/daycare room, her license is posted in the extra room where the children nap and her Emergency Disaster Plan is posted right by the door. Licensee could not provide verification of MMR and DTAP and influenza vaccination for herself, her son, or her assistant.

Upon receipt, the Licensee shall post the Notice of Site Visit. The Notice of Site Visit shall be posted for 30 consecutive days. Failure to maintain posting as required will result in a $100 civil penalty.

The following deficiencies were cited in accordance to Title 22 of the California Code of Regulations and Health & Safety Codes. Please see 809D.

Exit interview conducted with, and a copy of this report has been signed by and provided to Licensee Ana Navarrette. Appeal rights were provided and explained to Licensee Ana Navarrette.
SUPERVISOR'S NAME: Cassandra CooperTELEPHONE: (323) 981-3365
LICENSING EVALUATOR NAME: Betty BellTELEPHONE: (323) 981-3364
LICENSING EVALUATOR SIGNATURE:

DATE: 04/28/2017
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/28/2017
LIC809 (FAS) - (06/04)
Page: 5 of 5