<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 192007738
Report Date: 09/22/2023
Date Signed: 09/22/2023 11:49:16 AM

Document Has Been Signed on 09/22/2023 11:49 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
EL SEGUNDO CC NORTH, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME:SAN GERMAN FAMILY CHILD CAREFACILITY NUMBER:
192007738
ADMINISTRATOR:SAN GERMAN, MARIA GERARDOFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(818) 767-0313
CITY:NORTH HOLLYWOODSTATE: CAZIP CODE:
91605
CAPACITY: 14TOTAL ENROLLED CHILDREN: 11CENSUS: 4DATE:
09/22/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:05 AM
MET WITH:Maria San German & Gerardo San German, LicenseesTIME COMPLETED:
11:45 AM
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
On 09/22/23, at 9:05 AM, Silva Garibyan, Licensing Program Analyst (LPA), conducted an unannounced Required- 1 Year Inspection and was met by Maria San German & Gerardo San German, Licensees. Days and hours of operation are Monday-Friday from 6:00 AM to 6:30 PM. LPA toured the home inside and outside and a census was taken. There were four children present at the time of the visit. Family members residing in the home include licensees, and their two adult children. All adults who reside or work in the home have a criminal record clearance or exemption. There are no excluded individuals present at this home. The areas identified on the facility sketch were inspected. All areas identified on the facility sketch were inspected. Licensees' home is a single story 3 bedroom, 3 bathroom home with living room, dining area, kitchen, den (used as a bedroom) and a guest room at the rear of the home. Main care is provided in the guest room at the rear of the home. Children have access to the living room, dining area, kitchen, and den/bedroom as well. Off limit areas include the home's 3 bedrooms. The home also has a laundry room and storage room that is accessible from the back yard. There is no pool, spa or other bodies of water on the premises. Children eat and nap in the guest room and den. LPA observed napping equipment, playpens,, cribs, small tables and chairs. Licensees report they have no firearms or weapons in the home. The LPA toured all areas used by children during this inspection.

Page 1 of 4

SUPERVISORS NAME: Betty Bell
LICENSING EVALUATOR NAME: Silva Garibyan
LICENSING EVALUATOR SIGNATURE: DATE: 09/22/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/22/2023
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 4
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO CC NORTH, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME: SAN GERMAN FAMILY CHILD CARE
FACILITY NUMBER: 192007738
VISIT DATE: 09/22/2023
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
 LPA also observed Licensees' current Pediatric CPR (Adult/Infant /Child) and Pediatric First Aid certifications (expire 03/2024). The bathroom in the guest room/play room and the kitchen was observed free of chemicals or toxic items that can pose danger to children in care. Children play outside in the back yard only. The yard is fenced and gated. Vehicles are parked at the rear of the yard, near the gate that leads to the alley. There is a second gate/fence used to separate the parking area from the play area. Children's outdoor play equipment and toys are age appropriate and in good repair. LPA observed the yard to be fully fenced. The Fire Extinguishers (2A-10-BC) are mounted on the wall in the kitchen and in the hall way. There is a working smoke/carbon monoxide detectors located in the hall way. The First Aid kit was observed, and complete. LPA observed age appropriate safe toys inside and outside. There are no stairs in this home. The home has working telephone service and LPA confirmed the phone number is (818) 767- 0313. Licensee states there are no firearms or ammunition on the premises, LPA did not observe any. All poisons are kept in a locked garage. Detergents, cleaning compounds, medication and other hazardous items are made inaccessible.

Licensee has the following documents posted in the FCCH; Facility License (LIC 203), Notification of Parents' Rights Poster (PUB 394) , Emergency Disaster Plan (LIC610a), Lead Poisoning Facts/Potential Sources Of Lead/Effects Of Lead Exposure, If You SEE Something, SAY Something poster.




Page 2 of 4
SUPERVISORS NAME: Betty Bell
LICENSING EVALUATOR NAME: Silva Garibyan
LICENSING EVALUATOR SIGNATURE:

DATE: 09/22/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/22/2023
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
EL SEGUNDO CC NORTH, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME: SAN GERMAN FAMILY CHILD CARE
FACILITY NUMBER: 192007738
VISIT DATE: 09/22/2023
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
A review of the children's records was conducted and are found to have the following: LIC 282 Affidavit Liability Insurance, LIC 627/Consent for Medical Treatment, LIC 700/ID and Emergency Information, LIC 995A/Parent's Rights, LIC995E/Caregiver Background Check, LIC 9150/Parent Notification, LIC 9212/Parent's Responsibilities, PM 286/Immunization Card.
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.

Licensees were 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.

Licensees were informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain child care by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.
Page 3 of 4
SUPERVISORS NAME: Betty Bell
LICENSING EVALUATOR NAME: Silva Garibyan
LICENSING EVALUATOR SIGNATURE:

DATE: 09/22/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/22/2023
LIC809 (FAS) - (06/04)
Page: 3 of 4
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO CC NORTH, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME: SAN GERMAN FAMILY CHILD CARE
FACILITY NUMBER: 192007738
VISIT DATE: 09/22/2023
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
LPA discussed the safe sleep regulations with licensees and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPA also informed licensee [or facility representative] 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/.

During the exit interview, the Licensees, Maria San German & Gerardo San German confirmed that there are no Registered Sex Offenders living in the facility and RSO profile in FAS was completed on 09/22/2023.

A notice of site visit was given and must remain posted for 30 days.

Exit interview conducted and report was reviewed with the licensees Maria San German & Gerardo San German
Page 4 of 4
SUPERVISORS NAME: Betty Bell
LICENSING EVALUATOR NAME: Silva Garibyan
LICENSING EVALUATOR SIGNATURE:

DATE: 09/22/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/22/2023
LIC809 (FAS) - (06/04)
Page: 4 of 4