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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 191604592
Report Date: 12/20/2024
Date Signed: 12/21/2024 06:50:42 AM

Document Has Been Signed on 12/21/2024 06:50 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MONTEREY PARK SW RO, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME:SERNA FAMILY DAY CAREFACILITY NUMBER:
191604592
ADMINISTRATOR/
DIRECTOR:		SERNA, MADELINE ANNFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(562) 602-1188
CITY:LAKEWOODSTATE: CAZIP CODE:
90712
CAPACITY: 14TOTAL ENROLLED CHILDREN: 5CENSUS: 3DATE:
12/20/2024
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
11:00 AM
MET WITH:Licensee, Madeline Ann SernaTIME VISIT/
INSPECTION COMPLETED:
04:20 PM
NARRATIVE
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On 12/20/2024 at 11:00am, Licensing Program Analyst (LPA) Jonnisha Culbert conducted an unannounced inspection at the facility noted above and met with Licensee, Madeline Serna. The purpose of the inspection was to conduct an annual/random inspection. The operating hours of the facility are Monday through Friday from 6:00 AM to 6:00 PM. Entrance Checklist (LIC 126) was provided to the Licensee upon arrival. Individuals residing in the home were discussed and noted. At the time of the inspection, the Licensees, Licensee's Assistant/Staff (S1), 5 adults, and 3 children were present. Per licensee, the adults that were present were family members visiting for the holidays.

This is a single-family home that consists of three (3) bedrooms, two (2) bathrooms, living room, dining room, kitchen, detached garage, and fenced drive way, fenced backyard.

Areas that are accessible to children include: one (1) bathroom, day care room, and the fenced backyard. Per Licensee, the children utilize the fenced backyard and fenced driveway for outdoor activities.

Areas off-limits to children include: 3 bedrooms,1 bathroom, living room, dining room, kitchen, and detached garage. Per Licensee, they currently use two of the bedrooms for napping making two of the off-limits rooms and kitchen accessible to children in care. Licensee was reminded to inform the department of changes made to areas that are on or off limits to children.

The following documents were posted: Facility License, Notification of Parents' Rights (PUB 394), Earthquake Preparedness (LIC 9148), facility sketch, and Emergency Disaster Plan (LIC 610A). Licensee has a current Facility Roster (LIC 9040) available for review. LPA observed Disaster and Fire Drill log available for review. The last drill was conducted on 10/12/2024.
SUPERVISORS NAME: Karen Chambers
LICENSING EVALUATOR NAME: Jonnisha Culbert
LICENSING EVALUATOR SIGNATURE: DATE: 12/20/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/20/2024
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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Document Has Been Signed on 12/21/2024 06:50 AM - It Cannot Be Edited


Created By: Jonnisha Culbert On 12/20/2024 at 02:15 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

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

FACILITY NAME: SERNA FAMILY DAY CARE
FACILITY NUMBER: 191604592

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/20/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
HSC
1596.8662(b)(1)
Administration of Child Day Care Licensing
(1) On or before March 30, 2018, a person who, on January 1, 2018, is a licensed child day care provider, administrator, or employee of a licensed child day care facility shall complete the mandated reporter training provided pursuant to paragraphs (2) and (3) of subdivision (a), and shall complete renewal mandated reporter training every two years following the date on which he or she completed the initial mandated reporter training.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on interview and record review, the licensee did not comply with the section cited above in 2 out of 2 persons providing care did not have a renewed mandated reporter training which poses a potential safety risk to persons in care.
POC Due Date: 01/31/2025
Plan of Correction
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Per licensee, licensee and assistant will complete the training and email LPA J. Culbert mandated reporter certificates by plan of correction date.
Type B
Section Cited
HSC
1597.622(c)
Administration of Child Day Care Licensing
(c) The family day care home shall maintain documentation of the required immunizations or exemptions from immunization, as set forth in this section, in the person's personnel record that is maintained by the family day care home.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, the licensee did not comply with the section cited above in 2out of 2 persons providing care did not have documentation of the required immunizations or exemptiions from immunization which poses a potential health and safety risk to persons in care.
POC Due Date: 01/31/2025
Plan of Correction
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Per licensee, they will email LPA J. Culbert immunization documentation for themselves and assistant by plan of correction date.
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:Karen Chambers
LICENSING EVALUATOR NAME:Jonnisha Culbert
LICENSING EVALUATOR SIGNATURE:
DATE: 12/20/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/20/2024


LIC809 (FAS) - (06/04)
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Document Has Been Signed on 12/21/2024 06:50 AM - It Cannot Be Edited


Created By: Jonnisha Culbert On 12/20/2024 at 02:15 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

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

FACILITY NAME: SERNA FAMILY DAY CARE
FACILITY NUMBER: 191604592

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/20/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102418(g)
Immunizations
(g) The licensee shall document each child's immunizations as required by the California Code of Regulations, Title 17, Section 6070, and shall maintain such documentation for as long as the child is enrolled.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on interview and record review, the licensee did not comply with the section cited above in 2 out of 2 persons in care did not have documented immunizations. Per licensee, they did not have the immunizations for child 2 and 3. This poses a potential health and safety risk to persons in care.
POC Due Date: 01/31/2025
Plan of Correction
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Per licensee, they will email LPA J. Culbert Child 2 and 3's immunizations by plan of correction date.
Type B
Section Cited
CCR
102425(c)
Infant Safe Sleep
An Individual Infant Sleeping Plan [LIC 9227 (3/20)] shall be completed for each infant up to 12 months of age the provider has in care and included in the infant's file at the facility.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on interview and record review, the licensee did not comply with the section cited above in 3 out of 3 infants in care did not have a completed Individual Infant Sleeping Plan (LIC 9227) in infant's file which poses a potential safety risk to persons in care.
POC Due Date: 01/31/2025
Plan of Correction
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Per licensee, they will send completed forms for all 3 infants to LPA J. Ciulbert by plan of correction date.
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:Karen Chambers
LICENSING EVALUATOR NAME:Jonnisha Culbert
LICENSING EVALUATOR SIGNATURE:
DATE: 12/20/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/20/2024


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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
MONTEREY PARK SW RO, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME: SERNA FAMILY DAY CARE
FACILITY NUMBER: 191604592
VISIT DATE: 12/20/2024
NARRATIVE
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Areas used by children were inspected for safety, comfort, heating, cleanliness, and telephone service.
The home is equipped with central air and heating. Per licensee, the home has a fireplace in the main daycare area, but it is covered by cabinets. LPA observed that the fireplace was covered. Detergents, cleaning compounds, and medicines were made inaccessible to children. Poisons are kept in a cubby outside in the driveway. LPA observed that there was no look on the cubby. Per Licensee, children are always monitored outside, the cubby stays closed, and none of the children currently enrolled can reach the handles. LPA reminded license that poison are to remain in areas that are locked and inaccessible to children. Per Licensee, there are no bodies of water, firearms and/or weapons on the premises. LPA observed age-appropriate toys and napping equipment for children.

LPA observed the required fire extinguisher (3-A:10-B:C) that is fully charged and last serviced 02/21/2024. Licensee was reminded to have the fire extinguisher serviced yearly. A combined smoke and carbon monoxide detector were observed. Per licensee, they are connected to Brinks’ alarm system. Per licensee, parents provided the food for their children and licensee provided lunch and snacks as needed. Licensee was reminded that food that is brought from the children's home shall be labeled with the child’s name and properly stored or refrigerated.

LPA conducted a record review of three (3) children's records and 2 personnel records. Based on the children's record review, Child 1, 2, and 3 are missing an Individual Infant Sleep Plan (LIC 9227). This poses a potential safety risk to children in care. LPA provided a copy of the form to licensee for parents to complete. Child 2 and Child 3 files were missing a copy of the immunization records. This poses a potential health and safety risk to persons in care. LPA reminded licensee that immunization record are to be collected prior to enrolling children.

Based on the personnel records, S1 and licensee were missing current mandated reporter certificates and records of immunization against measles, pertussis, and tuberculosis. This poses a potential health and safety risk to persons in care. LPA reminded licensee that they are required to maintain a record of immunization and that mandated reporter training must be completed every 2 years and is available at www.mandatedreprterca.com.
Licensee has a current Pediatric First Aid and CPR certification (expire 05/11/2024).
SUPERVISORS NAME: Karen Chambers
LICENSING EVALUATOR NAME: Jonnisha Culbert
LICENSING EVALUATOR SIGNATURE:

DATE: 12/20/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/20/2024
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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
MONTEREY PARK SW RO, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME: SERNA FAMILY DAY CARE
FACILITY NUMBER: 191604592
VISIT DATE: 12/20/2024
NARRATIVE
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To improve the quality and value of the new inspection process, a survey may be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or CARE tools, please send email inquiries to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/inspection-process.

Licensee Madeline Serna was reminded that all adults 18 and over living or working in the home, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a licensed Family Child Care Home. A civil penalty of $100.00 minimum/day for a maximum of 5 days or, if the penalty is for a repeat violation, for a maximum of 30 days per person will be assessed if this regulation is violated.

LPA discussed the safe sleep regulations with licensee and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-andresources/safe sleep as an additional resource. LPA also informed licensee of the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at https://www.cpsc.gov/ and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment.Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02- CCP. 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: https://www.ada.gov/resources/child-care-centers/.MyChildCarePlan.org – Centers and Family Child Care Homes Licensee was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain childcare by connecting them to childcare providers and Resource and Referral Agencies (R&Rs) throughout California.

During the exit interview, Madeline Serna, confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS.

Type B citations were cited during today's visit. Appeal rights were provided to licensee. Please see attached LIC 809D.Exit interview conducted and report was reviewed with the licensee, Madeline Serna.

SUPERVISORS NAME: Karen Chambers
LICENSING EVALUATOR NAME: Jonnisha Culbert
LICENSING EVALUATOR SIGNATURE:

DATE: 12/20/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/20/2024
LIC809 (FAS) - (06/04)
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