Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198015845
Report Date: 09/22/2017
Date Signed 09/22/2017 02:05:50 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:MACIAS FAMILY CHILD CAREFACILITY NUMBER:
198015845
ADMINISTRATOR:MACIAS, MARICELAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(562) 429-2920
CITY:HAWAIIAN GARDENSSTATE: CAZIP CODE:
90716
CAPACITY:14CENSUS: 6DATE:
09/22/2017
TYPE OF VISIT:Required - 3 YearUNANNOUNCEDTIME BEGAN:
12:50 PM
MET WITH:Maricela MaciasTIME COMPLETED:
02:20 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
Licensing Program Analyst (LPA) Felicia Wyatt conducted an unannounced required 3 year inspection. Upon arrival, LPA met with licensee, Maricela Macias and licensee’s daughter Adriana Macias who guided analyst on a tour of the facility. Also present was 4 preschool age children and 3 infants. Licensee states that there are currently 8 children enrolled, children's roster was reviewed and is current. Disaster drill log was available, last drill was conducted on September 18, 2017.

This is a single story home which consists of 4 bedrooms, 2.5 bathrooms, living room, kitchen, dining room and fenced backyard.

Per licensee the following areas are used for day-care:
Living room, 2 bedrooms, 1 bathroom and dining area in the kitchen. For outdoor play Ms. Macias states children use the fenced back yard.

Per licensee the following areas are off limit to children and parents:
2 bedrooms, 1.5 bathrooms, living room, formal dining room and garage.

All areas used by children were 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. The licensee states that there are no poisons in the home. The licensee understands that any poisons must be locked with a key or combination lock.

Individuals residing in the home are licensee and 1 adult. Per licensee; operating hours are from 6am-6pm, Monday- Friday.
SUPERVISOR'S NAME: Claudia GuangorenaTELEPHONE: (323) -98-3417
LICENSING EVALUATOR NAME: Felicia WyattTELEPHONE: (323) 981-3382
LICENSING EVALUATOR SIGNATURE:

DATE: 09/22/2017
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/22/2017
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 3
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME: MACIAS FAMILY CHILD CARE
FACILITY NUMBER: 198015845
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/22/2017
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
11/06/2017
Section Cited
HSC
1597.622(a)(1)
1
2
3
4
5
6
7
Employees or volunteers at family day care home; immunization requirements; records; exemptions
Effective 9/1/16, a person shall not be employed or volunteer at a family day care home if he/she has not been immunized against influenza, pertussis, and measles.
1
2
3
4
5
6
7
Licensee will submit proof of immunization for herself as well as for her daughter, Adriana Macias by plan of correction due date.
8
9
10
11
12
13
14
Immunization records unavailable for licensee and her daughter, who also help with the day care.
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) -98-3417
LICENSING EVALUATOR NAME: Felicia WyattTELEPHONE: (323) 981-3382
LICENSING EVALUATOR SIGNATURE:

DATE: 09/22/2017
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/22/2017
LIC809 (FAS) - (06/04)
Page: 1 of 1
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: MACIAS FAMILY CHILD CARE
FACILITY NUMBER: 198015845
VISIT DATE: 09/22/2017
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
Recent regulatory changes were discussed (including SB277—Vaccinations, SB792—Immunizations: Exemption, AB 2386—Carbon Monoxide detectors).

LPA reviewed and issued the LIC 311 - Forms/Records to Keep in Your Family Child Care Home.
LPA advised the licensee how to access forms, regulations and quarterly updates on line at: www.ccld.ca.gov

LPA issued the Confidential Names List (LIC 811) to the licensee during this visit. The Confidential Names List documents the children’s files that were reviewed during this visit.

After a complete inspection of the facility, the following deficiencies were observed according to California Code of Regulations Title 22. Deficiencies that are being cited need to be cleared to protect the children’s health & safety.

I. Licensee does not have current proof of immunization for Pertussis, Measles and Influenza. Records are also unavailable for licensee’s daughter, Adriana Macias who also assist with the day care.

The Notice of Site Visit (LIC 9213)must remain posted for 30 days during the hours of operation after each site visit by a licensing representative. Failure to maintain posting as required will result in a civil penalty of $100.00.

Exit interview was conducted with Licensee, Mrs. Macias and assistant, Adriana Macias. Appeal rights explained & provided.
SUPERVISOR'S NAME: Claudia GuangorenaTELEPHONE: (323) -98-3417
LICENSING EVALUATOR NAME: Felicia WyattTELEPHONE: (323) 981-3382
LICENSING EVALUATOR SIGNATURE:

DATE: 09/22/2017
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/22/2017
LIC809 (FAS) - (06/04)
Page: 3 of 3
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: MACIAS FAMILY CHILD CARE
FACILITY NUMBER: 198015845
VISIT DATE: 09/22/2017
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
Per Licensee there are no weapons, or firearms on the premises. Posting requirements were observed to be posted at the time of inspection. Children’s records were reviewed. LPA observed the required 2A10BC fire extinguisher inside the kitchen. Receipt attached to Fire extinguisher shows that it was purchased on 05/07/17.

Carbon Monoxide detector located in the kitchen was tested and is in operable condition. Smoke detector located in the hallway was tested and is operable condition. All adults present have obtained a criminal record clearance. Licensee has current proof of Pediatric first aid and CPR which expires on 04/25/2019. Licensee’s daughter/assistant also has current proof of Pediatric first aid and CPR valid through 04/25/2019.

The following was discussed:

INFANT CARE: LPA discussed the licensee’s plan for supervising sleeping infants.



Licensee states the following: Any infants in care will stay in the area where the licensee or assistant are.
LPA advised the licensee to sleep infants where the infant can be directly supervised and advised against sleeping infants in a separate room. The licensee states that she will not sleep infants in a separate room. LPA provided the following document about SIDS.

1) Helping you to reduce the risk of SIDS

Medication: 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

No smoking, No infant walkers, No Johnny jumpers, No saucer chairs, No trampolines and any other item that falls into this category are not permitted in a family child care facility.

SUPERVISOR'S NAME: Claudia GuangorenaTELEPHONE: (323) -98-3417
LICENSING EVALUATOR NAME: Felicia WyattTELEPHONE: (323) 981-3382
LICENSING EVALUATOR SIGNATURE:

DATE: 09/22/2017
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/22/2017
LIC809 (FAS) - (06/04)
Page: 2 of 3