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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197494870
Report Date: 11/14/2024
Date Signed: 11/15/2024 09:22:31 AM

Document Has Been Signed on 11/15/2024 09:22 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 RO, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME:AYALA FAMILY CHILD CAREFACILITY NUMBER:
197494870
ADMINISTRATOR/
DIRECTOR:		JACQUELINE AYALAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(310) 897-7008
CITY:CULVER CITYSTATE: CAZIP CODE:
90232
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 10DATE:
11/14/2024
TYPE OF VISIT:Required - 3 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
11:15 AM
MET WITH:Jacqueline AyalaTIME VISIT/
INSPECTION COMPLETED:
02:45 PM
NARRATIVE
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On 11/14/2024, Licensing Program Analyst (LPA) Ranita Richmond and Brittany Lovest conducted an unannounced visit to the above-named Home to conduct the Required 3-year Inspection. LPA was greeted by licensee Jacqueline Ayala. LPA Richmond observed 10 children, being supervised and cared for appropriately by licensee and 1 finger print cleared assistant. Hours of operation are Monday through Friday, 8:00am – 5:00pm. Licensee provides meals, snacks, and water.

LPA Richmond toured the home inside and outside for a Health and Safety inspection. The home is neat and clean with heating and ventilation for safety and comfort.

LPA Richmond confirmed that the home consists of living room, dining room, formal living room, kitchen, 3 bedrooms, 3 bathrooms, detached garage with no house access, and fenced back yard.

The ON LIMIT AREAS are as follows: dining room (isolation area), living room (main daycare area/eating area) bathroom #A, and fenced back yard. Kitchen is used for walkthrough only to access fenced backyard.

The OFF-LIMIT AREAS are as follows: bedrooms #1, #2, #3, formal living room, bathroom #B and #C, and the detached garage.

Children enter the home through the front door. Upon entry you are in the living room. Left of the living room is Bedroom #1, inside bedroom is bathroom #B. To left of bedroom #1 is Bathroom #A. Left of bathroom is entry to dining area. Straight ahead is formal living room. Left of formalnliving room is hallway entrance leading to Bedroom #2, #3,and bath room #C. Right of the formal living room is the kitchen. Straight ahead in kitchen is a door leading to the outside gated backyard.

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SUPERVISORS NAME: Claudia Escobedo
LICENSING EVALUATOR NAME: Ranita Richmond
LICENSING EVALUATOR SIGNATURE: DATE: 11/14/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/14/2024
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 5
Document Has Been Signed on 11/15/2024 09:22 AM - It Cannot Be Edited


Created By: Ranita Richmond On 11/14/2024 at 01:35 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: AYALA FAMILY CHILD CARE
FACILITY NUMBER: 197494870

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/14/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102417(g)(4)
Operation of A Family Child Care Home
(g) The home shall be free from defects or conditions which might endanger a child. Safety precautions shall include but not limited to: (4) Poisons, detergents, cleaning compounds, medicines, firearms and other items which could pose a danger if readily available to children shall be stored where they are inaccessible to children.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, the licensee did not comply with the section cited above in 1 out of 2. Cleaning compounds and detergent were accessible on counters in bathroom, kitchen, and living room which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 11/27/2024
Plan of Correction
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Licensse will make cleaning compounds, detergents inaccessible to children in care.
Type B
Section Cited
CCR
102417(g)(4)(A)
Operation of A Family Child Care Home
(g) The home shall be free from defects or conditions which might endanger a child. Safety precautions shall include but not limited to: (4) Poisons, detergents, cleaning compounds, medicines, firearms and other items which could pose a danger if readily available to children shall be stored where they are inaccessible to children. (A) Storage areas for poisons, firearms and other dangerous weapons shall be locked.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, the licensee did not comply with the section cited above in 2 out of 2. Medications were stored in an unlocked cabinet which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 11/27/2024
Plan of Correction
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Licensee will lock all items which can pose danger to children in care
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:Claudia Escobedo
LICENSING EVALUATOR NAME:Ranita Richmond
LICENSING EVALUATOR SIGNATURE:
DATE: 11/14/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/14/2024


LIC809 (FAS) - (06/04)
Page: 2 of 5
Document Has Been Signed on 11/15/2024 09:22 AM - It Cannot Be Edited


Created By: Ranita Richmond On 11/14/2024 at 01:35 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: AYALA FAMILY CHILD CARE
FACILITY NUMBER: 197494870

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/14/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
HSC
1596.8662(b)(1)
Administration of Child Day Care Licensing
(1) On or before March 30, 2018, a person who, on January 1, 2018, is a licensed child day care provider, administrator, or employee of a licensed child day care facility shall complete the mandated reporter training provided pursuant to paragraphs (2) and (3) of subdivision (a), and shall complete renewal mandated reporter training every two years following the date on which he or she completed the initial mandated reporter training.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, the licensee did not comply with the section cited above in 1 out of 1. Staff 02 does not have current mandated reporter training which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 11/27/2024
Plan of Correction
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Licensee will ensure mandated reporter training is completed every 2 years as needed.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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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:Claudia Escobedo
LICENSING EVALUATOR NAME:Ranita Richmond
LICENSING EVALUATOR SIGNATURE:
DATE: 11/14/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/14/2024


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 RO, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME: AYALA FAMILY CHILD CARE
FACILITY NUMBER: 197494870
VISIT DATE: 11/14/2024
NARRATIVE
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Licensee is aware that the children must nap and have meals in the home.

LPA Richmond observed a fully charged 2A:10B:C Fire Extinguisher in the kitchen and working carbon monoxide detector in the dining room. The smoke detector and fire alarm is on a pull activation switch throughout the home. Fire alarm last tested in Jun 2024.

There are no firearms or ammunition on the premises. Detergents, cleaning compounds, medication and other hazardous items were not made inaccessible to children in care by locked doors, off limits area, and visual supervision. Citation issued. See LIC 809D.

There are no pools, ponds or other bodies of water on the premises.

LPA Richmond observed age-appropriate toys, books and furnishings. Furniture and equipment are in good condition, free of sharp, loose, or pointed parts.


LPA reviewed 3 children’s files and observed them to be in compliance as they contained current contact information for authorized representatives and/or relatives who can assume responsibility for the child, and authorization for medical treatment, and signed Parent’s Rights.

LPA Richmond observed the licensees updated mandated reporter training completed on 05/24/23 and compliance with immunizations requirements for childcare providers. Licensee has a current 1st aid/cpr completed on 04/29/24. Staff 02 mandated reporter training completed 5/12/22. Citation issued. See LIC 809D.



LPA Lovest discussed the safe sleep regulations with licensee and discussed the Child Care Licensing Safe Sleep web page 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.

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SUPERVISORS NAME: Claudia Escobedo
LICENSING EVALUATOR NAME: Ranita Richmond
LICENSING EVALUATOR SIGNATURE:

DATE: 11/14/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/14/2024
LIC809 (FAS) - (06/04)
Page: 4 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 RO, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME: AYALA FAMILY CHILD CARE
FACILITY NUMBER: 197494870
VISIT DATE: 11/14/2024
NARRATIVE
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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 Richmond reminded Licensee of 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.

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.

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&R) throughout California. Jacqueline confirmed that there are no Registered Sex Offenders living in the home and LPA completed the RSO profile in FAS.


Deficiencies were cited today, per Title 22 Regulations and Health and Safety Codes. See LIC 809D.

An exit interview was conducted a copy of this report and appeal rights was read and provided to licensee Jacqueline Ayala.

Notice of Site Visit was provided and required to be posted for 30 days.

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SUPERVISORS NAME: Claudia Escobedo
LICENSING EVALUATOR NAME: Ranita Richmond
LICENSING EVALUATOR SIGNATURE:

DATE: 11/14/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/14/2024
LIC809 (FAS) - (06/04)
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