197412737-7-19-2024-58-CC-AMOY-D7BP4R-20240719105933

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 197412737
Report Date: 07/17/2024
Date Signed: 07/19/2024 10:59:51 AM

Document Has Been Signed on 07/19/2024 10:59 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:	MEDINA FAMILY CHILD CARE		FACILITY NUMBER:	197412737
ADMINISTRATOR/ DIRECTOR:	MEDINA, AURELIA L.		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(818) 746-6492
CITY:	PANORAMA CITY	STATE: CA	ZIP CODE:	91402
CAPACITY: 14	TOTAL ENROLLED CHILDREN: 16	CENSUS: 11	DATE:	07/17/2024
TYPE OF VISIT:	Required - 3 Year	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	03:00 PM
MET WITH:	Aurelia Medina, Licensee		TIME VISIT/ INSPECTION COMPLETED:	06:00 PM

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Licensing Program Analyst (LPA) Alicia Mooberry conducted a Required Annual Inspection on this date. LPA met with Aurelia Medina, who provided tour of facility. LPA explained the purpose of inspection and provided the inspection Entrance Checklist, LIC 126. LPA inspected rooms/areas on the facility sketch in which child-care services are provided and to which children have access. Per licensee the current hours of care provided are Monday – Friday 7:00am - 6:00pm. There were 11 children present, including 1 infant. Also present were Edgardo Medina, licensee's spouse and Bertha Ruelas, Assistant. All adults present have been cleared and associated to the facility. Individuals residing in the home were discussed and noted.

This is a single story home consisting of three bedrooms, one bathroom, living Room, dining area, kitchen, attached garage and backyard.

Per licensee, the areas used by children include: Den at rear of home (main daycare area), living room, dining room, bathroom (by living room), and backyard.

Off limit areas: Three bedrooms, kitchen, garage. The kitchen is made inaccessible by safety gate at the doorway. The garage and bedrooms were closed and locked.

Areas that are used by children were inspected for safety, comfort, cleanliness, telephone service, ventilation, and heating. Rooms that are off-limits need to be made inaccessible during operating hours. The licensee does understand that licensing staff may have access to off-limit areas during inspection visit if necessary.

Children are dropped off the the front door, Licensee was advised to post the required posted documentation in a location visible to parent/guardians of children in care. LPA observed the facility license, and other Licensing Forms forms posted in the daycare room. LPA reviewed completed facility records including LIC 9040- Facility Roster, LIC 610- Facility Disaster Plan. LPA discussed the importance of fire/disaster planning

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SUPERVISORS NAME: Valarie Cook
LICENSING EVALUATOR NAME: Alicia Mooberry
LICENSING EVALUATOR SIGNATURE:	DATE: 07/17/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/17/2024

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: MEDINA FAMILY CHILD CARE	FACILITY NUMBER: 197412737
	VISIT DATE: 07/17/2024

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Smoke and carbon monoxide detectors were tested and are operable. Fire extinguisher indicated fully charged. Licensee was reminded that fire extinguisher needs to be serviced yearly. The home maintains telephone service via cell phone. The home is observed to be clean and orderly with safe toys, play equipment and materials. LPA observed that cleaning compounds are in kitchen inaccessible to children in care. The bathroom that children use is located in the hallways by the dining room and observed to be clean and free of hazards.

Licensee states that there are no poisons stored in the home and understands that all poisons must be lock, not only inaccessible to children. LPA discussed with licensee firearms or weapons if stored in the home.

Isolation area for sick children waiting to be picked up is in living room, supervised and away from the other children.

There are currently 3 infants in care. The facility is compliant with Safe Sleep Regulations. 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-and-resources/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.

Currently, children are using the back yard for outdoor play. The outdoor play area was observed to be fenced. LPA observed that the outdoor yard with ample shade, toys and other materials for children. LPA did not observe any objects that could be hazardous to children in care. LPA discussed safety during water play and advised to scan the yard for any hazards prior to children going outside. LPA discussed caution with heat related illnesses/ LPA observed a small dog in the home. Per licensee, the dog is kept inaccessible to children in care during daycare hours.

Children’s records were reviewed for (LIC) 282- Affidavit Regarding Liability Insurance, Immunization's Records, LIC 700- Identification and Emergency Information, LIC 627- Consent for Medical Treatment, LIC 995A Notification of Parents’ Rights, and documentation of 15-minute Infant Sleep Check (0-24 months)

Licensee and staff records were reviewed all staff did not have the required EMSA approved Pediatric First Aid and CPR certification which poses a potential risk to the health at safety of children in care. -------------------Page 2 – Report Continues

SUPERVISORS NAME: Valarie Cook
LICENSING EVALUATOR NAME: Alicia Mooberry
LICENSING EVALUATOR SIGNATURE:	DATE: 07/17/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/17/2024

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: MEDINA FAMILY CHILD CARE	FACILITY NUMBER: 197412737
	VISIT DATE: 07/17/2024

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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/

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 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.

Based on the LPA's observations and records review the facility will receive 1 type B deficiency today in accordance with California Title 22 Regulations.

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, the licensee, confirmed that there are no Registered Sex Offenders (RSO) living in the facility and LPA completed the RSO search in Megan’s Law Website.

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

Exit interview conducted and report was reviewed with the licensee Aurelia Medina. Appeal Rights were discussed and provided..

SUPERVISORS NAME: Valarie Cook
LICENSING EVALUATOR NAME: Alicia Mooberry
LICENSING EVALUATOR SIGNATURE:	DATE: 07/17/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/17/2024

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 07/19/2024 10:59 AM - It Cannot Be Edited

Created By: Alicia Mooberry On 07/17/2024 at 04:44 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
, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245

FACILITY NAME: MEDINA FAMILY CHILD CARE	FACILITY NUMBER: 197412737
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 07/17/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

102416(c)

Personnel Requirements

(c) The licensee and other personnel as specified shall complete training on preventive health practices, including pediatric cardiopulmonary resuscitation and pediatric first aid, pursuant to Health and Safety Code Section 1596.866. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on record review, the licensee did not comply with the section cited above in that the Licensee and staff did not have EMSA approved perdiatric CPR and 1st Aid, which poses a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 07/31/2024
	Plan of Correction
1 2 3 4	Per licensee, the required EMSA approved Pediatric CPR/1st aid training will be complete for licensee and 2 staff and a copy ofcertificate will be sent to LPA by email by POC due

Section Cited


	Deficient Practice Statement
1 2 3 4
	POC Due Date:
	Plan of Correction
1 2 3 4

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:

Valarie Cook

LICENSING EVALUATOR NAME:

Alicia Mooberry

LICENSING EVALUATOR SIGNATURE:

DATE: 07/17/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/17/2024

LIC809 (FAS) - (06/04)

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