195700291-7-1-2024-58-CC-RLAA-D6RVFQ-20240701162418

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 195700291
Report Date: 07/01/2024
Date Signed: 07/01/2024 04:24:45 PM

Document Has Been Signed on 07/01/2024 04:24 PM - 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:	NEPOMUCENO FAMILY CHILD CARE		FACILITY NUMBER:	195700291
ADMINISTRATOR/ DIRECTOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY: 8	TOTAL ENROLLED CHILDREN: 0	CENSUS: 0	DATE:	07/01/2024
TYPE OF VISIT:	Prelicensing	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	02:00 PM
MET WITH:	Edith & Rosa Nepomuceno, Applicants		TIME VISIT/ INSPECTION COMPLETED:	04:45 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 Analysts (LPAs) Roberto Luque Avila and Elicia Calvillo conducted a pre-licensing inspection on 7/1/2024. LPAs arrived at the facility at 2:00 PM and met with Edith and Rosa Nepomuceno, Applicants, who guided analyst on a tour of the facility. During the inspection individuals residing in the home were discussed and noted. The applicant is requesting a small family child care home license. Per applicant, operation hours will be Monday-Friday, 06:00 AM to 06:00 PM. Applicant states that they will care for children 6 weeks- 12 years of age. Entrance Checklist was provided to the applicant. All areas identified on the facility sketch were inspected, including but not limited to, off limit areas. This is a one story home that consists of 3 bedrooms, 3 restrooms, dining room, living room, kitchen, laundry closet, front yard, backyard, and garage converted to family room located on the far left in the backyard. The family room is in front of a gate with access to an alleyway which will be locked during hours of operation. Per applicant, the children will use the restroom #3, located in the family room equipped with operable child sink and toilet. Children will eat in the dining area in the home. Areas that will be used by children were inspected for safety, comfort, cleanliness, ventilation and heating. There are toys available for children and are age appropriate. Pg. 1 of 5

SUPERVISORS NAME: Rita Ramos
LICENSING EVALUATOR NAME: Roberto Luque Avila
LICENSING EVALUATOR SIGNATURE:	DATE: 07/01/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/01/2024

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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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: NEPOMUCENO FAMILY CHILD CARE	FACILITY NUMBER: 195700291
	VISIT DATE: 07/01/2024

NARRATIVE

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The applicant states that they will provide food for children in care and will be prepped in the kitchen.

The applicant has completed the required Health and Safety Training, Nutrition Training. Applicant also completed Pediatric First Aid and CPR which expires on Dec 2025 for Edith Nepomuceno and June 2026 for Rosa Nepomuceno. There are first aid supplies available located in the dining area and family room.

Based on the Facility Sketch submitted, areas off limits to children and parents are: Master bedroom, bathroom #1 and #2. There are child safety locks for the lower cabinets in the kitchen. Applicant states that the latch will stay latched during the hours of operation. The applicant understands that licensing staff may have access to off-limit areas during inspection visit if necessary.

Detergents, cleaning compounds, medicines, sharp objects and hazardous items that can pose a danger to children are inaccessible in areas designated for children.

The applicant states that there are no poisons on the premises. Licensee was advised poisons are to be locked in cabinet with a pad lock.

The children will use the back yard for outdoor play, which was observed to be fenced and have a shaded area.

Per applicant, there are no pets in the home.

Applicant states there are no firearms or weapons in the home. No bodies of water on the premises.

The value on the 2A10BC fire extinguisher indicates fully charged, and was indicated was purchased June, 22, 2024.

Smoke and carbon monoxide detectors located in the living room, dining room, hallway and family room were tested and are operable.

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SUPERVISORS NAME: Rita Ramos
LICENSING EVALUATOR NAME: Roberto Luque Avila
LICENSING EVALUATOR SIGNATURE:	DATE: 07/01/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/01/2024

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
EL SEGUNDO CC NORTH, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245

FACILITY NAME: NEPOMUCENO FAMILY CHILD CARE	FACILITY NUMBER: 195700291
	VISIT DATE: 07/01/2024

NARRATIVE

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Applicants were reminded that all adults 18 and over living in the home, persons who provide care and supervision to children, and staff who have contact with children, 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.

On this date, 03/25/24, the California Attorney General - Megan’s Law website was searched for information on sex offenders required to register with local law enforcement under California's Megan's Law. No registered sex offenders were found at the facility addresses. Under state law, some registered sex offenders are not subject to public disclosure; therefore, they may not have been included in this search. However, the Department conducts a monthly cross reference of each address on record for all registered sex offenders against all CCLD facility addresses pursuant to information shared by California DOJ.

The applicant provided proof of control of property with a mortgage statement.

Licensee was 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.

LPAs discussed the safe sleep regulations 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. LPAs also informed applicant 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.

LPAs advised the applicant to sleep infants where they can be directly supervised at all times and must make a log documenting infants sleep in 15 minute intervals. Licensee was advised against sleeping infants in a separate room. Applicant states that infants will sleep in the bedroom #2 where they will be providing supervision. LPAs also provided the LIC 9227 to Applicant.
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SUPERVISORS NAME: Rita Ramos
LICENSING EVALUATOR NAME: Roberto Luque Avila
LICENSING EVALUATOR SIGNATURE:	DATE: 07/01/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/01/2024

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
EL SEGUNDO CC NORTH, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245

FACILITY NAME: NEPOMUCENO FAMILY CHILD CARE	FACILITY NUMBER: 195700291
	VISIT DATE: 07/01/2024

NARRATIVE

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Licensee stated for ill children the isolation area will be in the living room.

This facility plans to provide Incidental Medical Services – IMS. For IMS information , see PIN 22-02-CCP. 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

LPAs reviewed with applicants the LIC 311D, Forms/Records To Keep In Your Family Child Care Homes, children’s forms/records, facility forms/records, and information to be posted

LPAs advised the applicant how to access forms, regulations and quarterly updates on the Child Care Licensing website at: www.ccld.ca.gov.

Community Care Licensing Division (CCLD) regularly sends information to licensed facilities, providers, and stakeholders by way of Provider Information Notices (PIN), Program Quarterly Update Newsletters and other important information communication platforms.
To receive important licensed related information to licensed facilities, visit the CCLD Important Information website at https://www.cdss.ca.gov/inforesources/community-care-licensing/subscribe and select the Child Care option to receive email communication.

Applicant was reminded of all the terms and conditions noted on the LIC 279 – Application of a Family Child Care Home that applicant signed and agreed to.

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

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SUPERVISORS NAME: Rita Ramos
LICENSING EVALUATOR NAME: Roberto Luque Avila
LICENSING EVALUATOR SIGNATURE:	DATE: 07/01/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/01/2024

LIC809 (FAS) - (06/04)

Page: 5 of 5

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: NEPOMUCENO FAMILY CHILD CARE	FACILITY NUMBER: 195700291
	VISIT DATE: 07/01/2024

NARRATIVE

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The following corrections need to be corrected prior to obtaining a small family child care license.
Corrections are due by 7/12/2024.

· Place safety locks for off limit areas to include: Master Bedroom, Bathroom #1, and Panel Room in the Family Room.

· Submit new facility sketch LIC999 (Home) and LIC999A (Yard)

Exit interview conducted and report was reviewed with the Edith Nepomuceno.

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SUPERVISORS NAME: Rita Ramos
LICENSING EVALUATOR NAME: Roberto Luque Avila
LICENSING EVALUATOR SIGNATURE:	DATE: 07/01/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/01/2024

LIC809 (FAS) - (06/04)

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