Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198016385
Report Date: 05/25/2016
Date Signed 05/25/2016 12:56:56 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:ROBLES FAMILY CHILD CAREFACILITY NUMBER:
198016385
ADMINISTRATOR:ROBLES, SHANIAHFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(323) 589-8271
CITY:LOS ANGELES,STATE: CAZIP CODE:
90001
CAPACITY:14CENSUS: 3DATE:
05/25/2016
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
12:00 PM
MET WITH:Licensee: Shaniah Robles TIME COMPLETED:
01:00 PM
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A RANDOM VISIT CONDUCTED IN SPANISH
Licensing Program Analyst, Ariel Cazares conducted an unannounced annual random site visit to ensure the health & safety standards as required by regulations governing family child care homes. Upon arrival, LPA met with Licensee, and toured the facility. There were 3 children present, along with licensee's spouse and mother (all fingerprint cleared). Individuals residing in the home are the licensee, spouse, and mother. Licensee’s operating hours are Monday through Saturday, various hours.

The home is a one story, 3-Bed, 2-Bath home. The following areas are used for day-care: Living Room, 2 bedroom, 1 restroom, side yard. Off limit areas include: 2 bedrooms, 1 bathroom, and backyard (where cars are parked and made inaccessible with a gate).

Licensee has the Parent’s Rights poster and other appropriate forms posted on wall in the living room. First Aid/CPR certificate are valid thru 02/2018. Licensee is documenting disaster drills and last conducted a drill on 04/2016. Licensee has a working telephone.

LPA inspected all areas of the home accessible to children. Detergents and cleaning supplies were observed in a high shelf in the hallway. All areas of the home are safe and in compliance with Title 22 regulations. Fire extinguisher has been serviced in the last year, card on extinguisher notes March 2016. There is an operational smoke detector and carbon monoxide in the home, and were observed in the living room, children's rooms and hallway. The home has electrical outlet covers throughout and maintains a First Aid Kit. There are adequate age appropriate toys, books, and games. There are no firearms present on the premises as stated by licensee. LPA inspected the yard and observed no deficiencies. There are no pools or spas, or other bodies of water. Currently there are no pets.

SUPERVISOR'S NAME: Bertha ManzanaresTELEPHONE: (323) 981-3365
LICENSING EVALUATOR NAME: Ariel AlmazanTELEPHONE: () -
LICENSING EVALUATOR SIGNATURE:

DATE: 05/25/2016
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/25/2016
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: ROBLES FAMILY CHILD CARE
FACILITY NUMBER: 198016385
VISIT DATE: 05/25/2016
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Children's Roster is readily available and updated . Children’s Files were reviewed.

The following were discussed: Individuals who are 18 years of age or older living in the home must be finger print cleared prior to being in the presence of the children in care. Individuals within one month of their 18th birthday must be fingerprinted immediately. No smoking, No infant walkers, No baby bouncers, No Johnny jumpers, No exersaucers and any other item that falls into that category. LPA discussed disaster drills, posting requirements, children records requirements, mandated child abuse and injury/death reporting.

LPA reviewed LIC 311D with licensee, reminding her of required forms. LPA reviewed SIDs, Never Shake A Baby, and safe sleeping practices. Infants should sleep mouth up, on their backs, free of clutter surrounding their sleeping space.

Incidental Medical Services are not provided at this time. Licensee was informed to contact the department 30 days prior to enrolling any child with IMS needs.

A qualified Assistant must be present and actively involved in caring for children whenever nine (9) or more children are present at the facility in a large family child care home.

No Deficiencies were cited on this visit.

LPA advised the Licensee to access forms and regulations on line at: www.ccld.ca.gov
Email Address: not provided at this time.

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, Shaniah Robles. Appeal rights discussed and explained.
SUPERVISOR'S NAME: Bertha ManzanaresTELEPHONE: (323) 981-3365
LICENSING EVALUATOR NAME: Ariel AlmazanTELEPHONE: () -
LICENSING EVALUATOR SIGNATURE:

DATE: 05/25/2016
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/25/2016
LIC809 (FAS) - (06/04)
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