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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197413071
Report Date: 06/16/2023
Date Signed: 06/16/2023 05:02:18 PM

Document Has Been Signed on 06/16/2023 05:02 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
CCLD Regional Office, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME:CHAVEZ FAMILY CHILD CAREFACILITY NUMBER:
197413071
ADMINISTRATOR:CHAVEZ, VERONICA I.FACILITY TYPE:
810
ADDRESS:TELEPHONE:
(310) 673-2557
CITY:INGLEWOODSTATE: CAZIP CODE:
90303
CAPACITY: 14TOTAL ENROLLED CHILDREN: 5CENSUS: 4DATE:
06/16/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
03:16 PM
MET WITH:Veronica Chavez - licenseeTIME COMPLETED:
05:17 PM
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On 6/16/2023 Licensing Program Analyst (LPA), Jillinda Chandler conducted an unannounced I year required visit for Chavez Family Child Care Home. Present in the home were licensee Veronica Chavez and licensee's adult son The home is a single family, single story home. The home consists of three bedrooms, living-room, kitchen, dining room and two bathrooms. Day care operations are conducted in the last room of the home near the kitchen, were children nap and have a designated restroom, other areas of the home are off limits. day care activities are conducted in a detached garage. Parents and quest enter the day care through the side gate leading to the back yard. The home was inspected inside and out for Health and Safety compliance per Title 22.
LPA observed the following:
Proper care and supervision were observed
The homes capacity was within the scope of the license
Appropriate size fire extinguisher carbon and smoke detector were present & operable.
Detergents,knives and toxins were stored in the off limit areas of the home.
SUPERVISORS NAME: Claudia Escobedo
LICENSING EVALUATOR NAME: Jillinda Chandler
LICENSING EVALUATOR SIGNATURE: DATE: 06/16/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/16/2023
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, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME: CHAVEZ FAMILY CHILD CARE
FACILITY NUMBER: 197413071
VISIT DATE: 06/16/2023
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The homes kitchen was inaccessible to children in care Licensee uses a mobile device for communication, LPA explained there must be an extra mobile device left in the home if the provider is away during day care operations. LPA observed the homes parent notification board; the license, facility sketch, Emergency Disaster Plan, Notification of Parent’s Rights Poster, Lead Poison Awareness, Safe Sleep and California were posted.
A first aid kit was observed containing the required supplies: scissors, tweezers, bandages, medical ointment and a thermometer. Licensee’s Pediatric CPR and First Aid Card expires 2/2024 No bodies of water were observed on the premises
Children records were available and in good order.
Licensees Mandated Reporter certificate expires 11/2025
A roster was current and readily available for review.
Parents and authorized adults sign children in and out using their original signatures.
Licensee was not providing Incidental Medical Services (IMS) during todays inspection.Incidental Medical Services were discussed with licensee.
All adults in the home cleared a Criminal Background Clearance.
Toys, equipment and materials were available and in good order Children napped on mats and play yards, napping equipment was found to be in good condition. Infant safe sleeping was discussed with licensee.
SUPERVISORS NAME: Claudia Escobedo
LICENSING EVALUATOR NAME: Jillinda Chandler
LICENSING EVALUATOR SIGNATURE:

DATE: 06/16/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/16/2023
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, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME: CHAVEZ FAMILY CHILD CARE
FACILITY NUMBER: 197413071
VISIT DATE: 06/16/2023
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 Licensee was not providing transportation at the time of the inspection. Licensee was reminded that children are only to use car seats during transportation.
Licensee was reminded that feeding chairs shall only be used during mealtime and children shall be removed immediately following feedings. Outdoor activities were conducted in the back yard of the home. LPA did not observe any hazardous conditions in this area.

To improve the quality and value of the new inspection process, a survey will 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 tools, please send them by email 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/process.

Licensee was reminded that all adults 18 and over living or working in the home, including employees and volunteers, 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 up to $500.00 maximum per day/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-and-resources/safe-sleep as an additional resource.

SUPERVISORS NAME: Claudia Escobedo
LICENSING EVALUATOR NAME: Jillinda Chandler
LICENSING EVALUATOR SIGNATURE:

DATE: 06/16/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/16/2023
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, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME: CHAVEZ FAMILY CHILD CARE
FACILITY NUMBER: 197413071
VISIT DATE: 06/16/2023
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Licensee provided the following email address; Corazonsalavaje47@yahoo.com

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.

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

Exit interview conducted and report was reviewed with the licensee Veronica Chavez.

SUPERVISORS NAME: Claudia Escobedo
LICENSING EVALUATOR NAME: Jillinda Chandler
LICENSING EVALUATOR SIGNATURE:

DATE: 06/16/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/16/2023
LIC809 (FAS) - (06/04)
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