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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197494582
Report Date: 06/16/2021
Date Signed: 06/16/2021 02:28:15 PM


COMPREHENSIVE INSPECTION

Document Has Been Signed on 06/16/2021 02:28 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:AMZALEG FAMILY CHILD CAREFACILITY NUMBER:
197494582
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 0CENSUS: 6DATE:
06/16/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:00 PM
MET WITH:Moran Amzaleg, Licensee
TIME COMPLETED:
02:30 PM
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On 6/16/2021, Licensing Program Analyst (LPA) Lisa Clayton, conducted an unannounced Annual Required Inspection and was met by Licensee, Moran Amzaleg. Also present was fingerprint cleared assistant Danae Osorio Lopez, fingerprint cleared husband Guy and 6 children in care. Days and hours of operation are Mon - Fri, 8:15a - 4pm, ages 18 months - 5 years.
LPA toured the home inside and outside and a census was taken. Current facility sketch reviewed and Licensee confirmed that the entry way, dining room, bathroom, play room (den)are used for providing care and are accessible to children. All other rooms on the first floor and the entire second floor are off-limits and made inaccessible by use of gates, locked doors and supervision. There is no swimming pool or other bodies of water on the premises. There are no firearms or ammunition on the premises. All poisons are kept in a locked storage area. Detergents, cleaning compounds, medication and other hazardous items are made inaccessible. The facility roster was reviewed, and a copy will be emailed to LPA (email address provided). A review of 3 children's files and 1 staff files was completed, children’s files and observed files were complete with emergency information as required. A review of records indicates that all employees and/or volunteers have immunization records on file for influenza, pertussis and measles
The fireplace located in the living is made in-accessible and will not be in use while children are in care. There is a fully charged 2A10BC fire extinguisher, working smoke detector, working carbon monoxide detector and adequate heating and ventilation for safety and comfort. Stairs are in-accessible and supervision is provided when children under age 5 years old are present. Safe toys and play equipment are observed. The home has working telephone service and LPA confirmed the phone number is (310)717-2558.
LPA discussed Safe Sleep Regulations with licensee. Infants can be visually observed through an open door if sleeping in a separate room. Licensee ensures that children in care are supervised at all times and is aware children shall not be left in parked vehicles. Car seats are used for transportation purposes only and are not used for sleeping children. The outdoor play area in the backyard is fenced and there are no hazards to children present. Capacity as specified on the license is being maintained. Licensee was advised to complete a LIC279 for a Change of Capacity.
SUPERVISORS NAME: Mary Ruiz
LICENSING EVALUATOR NAME: Lisa Clayton
LICENSING EVALUATOR SIGNATURE: DATE: 06/16/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/16/2021
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: AMZALEG FAMILY CHILD CARE
FACILITY NUMBER: 197494582
VISIT DATE: 06/16/2021
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Licensee’s Mandated Reporter Training was completed on 6/16/2021. Licensee’s pediatric CPR/First Aid expires on 7/30/2021. Licensee is scheduled to renew her CPR/First Aid and Lead Poisoning on 6/16/2021. A copy of the updated CPR is to be emailed to LPA upon receipt. .
All adults who reside or work in the home have a criminal record clearance.

Incidental Medical Services (IMS) are not currently being provided. Licensee is aware that an IMS plan is required to be submitted to the licensing office if they provide any of these services. Information regarding Americans with Disability Act (ADA) can be obtained by contacting US Department of Justice toll free ADA Information line at (800) 514-0301(voice), (800) 514-0383 (TDD) and website link https://www.ada.gov/childqanda.htm
LPA and Licensee discussed the Community Care Licensing website www.ccld.ca.gov which will provide access to Provider Information Notices (PINs), Quarterly Updates, COVID-19 Information and Resources, Mandated Reporter Training, Safe Sleep in Child Care, Lead Poisoning Facts, Forms and Regulations.

There are no deficiencies cited. This facility is found to be in substantial compliance with Title 22 regulations. This report shall remain on file for 3 years. A notice of site visit was given and must remain posted for 30 days. Exit interview conducted.
SUPERVISORS NAME: Mary Ruiz
LICENSING EVALUATOR NAME: Lisa Clayton
LICENSING EVALUATOR SIGNATURE:

DATE: 06/16/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/16/2021
LIC809 (FAS) - (06/04)
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