<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197494932
Report Date: 09/28/2021
Date Signed: 09/30/2021 03:51:23 PM

Document Has Been Signed on 09/30/2021 03:51 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:GARZA FAMILY CHILD CAREFACILITY NUMBER:
197494932
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 0CENSUS: DATE:
09/28/2021
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
11:20 AM
MET WITH:Petra GarzaTIME COMPLETED:
02:00 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
On 9/28/2021 at approximately 11:20 a.m. Licensing Program Analyst (LPA) Judy Laureano conducted an announced inspection with applicant Petra Garza for the purpose of a pre-licensing inspection of 5039 S. Verdun Avenue, Los Angeles, CA 90043. The purpose of this inspection is to ensure the standards for a Family Child Care Home are being met in accordance to California Tittle 22 Regulations and California Health and Safety Codes.

The applicant is applying for a small family childcare license with a max capacity of 8. Property owner/landlord consent (LIC 9151) is currently not on file. The licensee rents/leases property with her two minor children and mother. Lease agreement/control of property was received.

Per the application, currently, the ages the applicant wishes to provide services for children birth to 12 years old with the hours of operation being 24 hours a day, Monday through Saturday, indicating applicant will be providing overnight care. Applicant was informed that any changes to ages, hours and days of operation shall be submitted to the department for approval prior to initiation of changes.

The home is a two story family home which consists of 4 bedrooms, 3 bathroom, living room, dining room, family room with a fire place and a large den/family room that has been designated for the day care. The front yard is OFF LIMITS to the children and families will access the facility through the driveway, which is cemented and leads to a detached garage and back yard.

Parents will access the daycare through the side metal gate. LPA advised applicant to add an additional lock or latch to ensure children are not able to open the gate. As you enter
SUPERVISORS NAME: Maureen Neal
LICENSING EVALUATOR NAME: Judy Laureano
LICENSING EVALUATOR SIGNATURE: DATE: 09/28/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/28/2021
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 7
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: GARZA FAMILY CHILD CARE
FACILITY NUMBER: 197494932
VISIT DATE: 09/28/2021
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
26
27
28
29
30
31
32
Page 2

the yard, LPA observed a parent board that has the required posted documents. Applicant stated that the cubbies by the parent board will be used to hold sign in sheets and other information for parents. As a COVID-19 precaution, applicant is not allowing parents to enter the facility. LPA observed plastic outdoor cars for children to use and applicant confirmed that these is the area for children to ride the cars safely.

Walking up two steps, LPA observed a grassy area with a variety of age appropriate outdoor toys. A plastic children’s house, a plastic outdoor caterpillar tunnel and a wooden play structure were observed in the space. The yard is enclosed with a brick wall and is covered with grass. LPA observed a variety of plants enclosed in their own area covered with wooden chips, keeping the grass area separate from the plants.

The den area/day care room can be accessed through the sliding door. As you enter the room, LPA observed a Fire Extinguisher and First Aid Kit mounted on the wall. The area had a variety of age appropriate materials. LPA observed a child size table and chairs, a variety of arts and craft materials, children’s books and two easels. A changing table was observed to by the kitchen area, allowing applicant to wash hand with ease. LPA observed a crib that will be used for infants and a high chair. LPA advised applicant to ensure that Safe Sleep regulations are being followed. The area has a large couch that is covering the second sliding door that will not be used. LPA observed a mounted television set and entertainment unit with additional day care supplies. Next to the television set, the wall is lined up different children’s cubbies.

LPA observed a small closet that is used to store the washer and dryer unit as well as additional First Aid Kits and Earthquake kits. Applicant confirmed that the door will remain close at all times.

Next the wall of children’s cubbies, LPA observed a childproof mesh gate at the bottom of the stairs. The 2nd floor is OFF LIMITS to the children in care. LPA observed 2 bedrooms and bathroom with a small hallway. Both rooms were observed to have a carbon monoxide
SUPERVISORS NAME: Maureen Neal
LICENSING EVALUATOR NAME: Judy Laureano
LICENSING EVALUATOR SIGNATURE:

DATE: 09/28/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/28/2021
LIC809 (FAS) - (06/04)
Page: 2 of 7
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: GARZA FAMILY CHILD CARE
FACILITY NUMBER: 197494932
VISIT DATE: 09/28/2021
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
26
27
28
29
30
31
32
Page 3

and smoke detector. LPA advised applicant that all doors need to be closed and inaccessible to the children in care.

Across the den/day room, LPA observed the kitchen that is designated as OFF LIMITS to the children in care. A childproof mesh safety gate was observed making the kitchen in accessible. All kitchen cabinets were observed to have a magnet safety latch. The stove, refrigerator, dishwasher, sink and counter space area were observed and inspected. All kitchen cabinets were observed. Knifes and sharp object were observed to be made inaccessible to the children in care. Applicant confirmed that facility will be participating in the local Food Program.

Next to the kitchen, the dinning room was observed and designated as OFF LIMITS. Exiting the dinning room, a small living room area with a fire place was observed. The fire place was observed to have a metal covering. LPA observed a children’s safety gate between the daycare room and the small living room. Children will only access the bathroom that is located in the space.

Children will use bathroom 1, located in the small living room. LPA observed a toilet, shower and sink to be free of hazardous materials. A small cabinet above the toilet was inspected and observed to have a magnet safety latch. Both the medicine cabinet and under the sink cabinet were observed and inspected. All electrical outlets were covered. LPA advised applicant to add a hand washing sign to ensure children wash their hand properly.

LPA observed a door in the small living room space that leads to the two additional bedrooms and 1 bathroom that have been designated as OFF LIMITS. LPA advised applicant to ensure that the door remains closed at all times. A second door at the end of the hall way give access to the living room, that is designated as OFF LIMITS, and the main entrance of the home. Applicant confirmed that parents will not access the facility through the main door.
SUPERVISORS NAME: Maureen Neal
LICENSING EVALUATOR NAME: Judy Laureano
LICENSING EVALUATOR SIGNATURE:

DATE: 09/28/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/28/2021
LIC809 (FAS) - (06/04)
Page: 5 of 7
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: GARZA FAMILY CHILD CARE
FACILITY NUMBER: 197494932
VISIT DATE: 09/28/2021
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
26
27
28
29
30
31
32
Page 4

The following areas have been designated as OFF LIMITS TO THE CHILDREN IN CARE:
1st floor: main entrance, living room, dining room, small living room with fire place, bedroom 1, bedroom 2, bathroom 2 and kitchen.
2nd floor: staircase, bedroom 3, bedroom 4 and bathroom 3.

No corrections were observed during today’s inspections. Exit interview was conducted and report was reviewed with applicant, Petra Garza. The licensing determination of this application will be reviewed with Licensing Program Manager for final resolution.

The following was discussed with the applicant:
Applicant was made aware of The Child Care Advocate Program (CCAP) that is administered from within the Community Care Licensing Division. CCAP participates in many community activities and special projects in order to disseminate information on the State’s licensing role, provide information to the public and parents on child care licensing, and provide many other helpful resources to the licensees and the public. CCAP’s direct contact information is as followed: Phone number: (916) 654-1541
Email Address: childcareadvocatesprogram@dss.ca.gov

Immunizations: Commencing September 1, 2016, SB 792, prohibits a person from being employed or volunteering at a childcare facility or family day care if he or she has not been immunized against influenza, pertussis and measles. LPA discussed the influenza waiver during the inspection.

Mandated Reporter Training: Beginning on January 1, 2018, AB 1207, requires all licensed providers, applicants, directors and employees to complete training as specified on their mandated reporter duties and to renew their training every two years. Volunteers are encouraged but not required to take the training. Website: www.mandatedreporterca.com. Licensee was reminded of their responsibility to report suspected child abuse.

Mandatory Forms for the children’s files and provider’s files were discussed. Applicant was referred to LIC 311D: Records To Be must be kept current, as well as the roster and Drill
SUPERVISORS NAME: Maureen Neal
LICENSING EVALUATOR NAME: Judy Laureano
LICENSING EVALUATOR SIGNATURE:

DATE: 09/28/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/28/2021
LIC809 (FAS) - (06/04)
Page: 4 of 7
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: GARZA FAMILY CHILD CARE
FACILITY NUMBER: 197494932
VISIT DATE: 09/28/2021
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
26
27
28
29
30
31
32
Log additional forms can be obtained from Maintained At The Facility - Family Child Care Home.
FORMS TO BE POSTED
• LIC203 Facility License
• LIC 610A Emergency Disaster Plan
• LIC 9148 Earthquake Preparedness Checklist
• PUB394 Notification of Parents Rights Poster

Children’s records requirements:
• LIC 700 Identification and Emergency Information
• LIC 627 Consent for Emergency Medical Treatment
• LIC 282 Affidavit Regarding Liability Insurance
• LIC 9150 Parent Notification Additional Children in Care
• Immunization record
• PUB 72- Family Child Care Consumer Guide
• LIC 995A Notification of Parent’s Rights
• CDPH 286 (Immunization Blue Card)

FACILITY RECORDS:
• LIC 624B Unusual Incident/Injury Report
• LIC 9040 Child Care Facility Roster
• LIC 9052 Employee Rights,
• LIC 9108 Statement Acknowledging Requirement to Report Child Abuse
• LIC 9149 Landlord Consent Form, if you plan to care for more than 6 children for a Small
• LIC 9151 Property Owner/Landlord Notification Form
• Proof of current pediatric CPR and First Aid Certificates
• Copy of your deed or lease/rental agreement
• Documentation of Fire and Disaster drills
• Proof of immunization's against pertussis (TDAP), measles (MMR), and influenza
• Mandated Reporter certificate – www.mandated reporterca.com – renewed every two years.
SUPERVISORS NAME: Maureen Neal
LICENSING EVALUATOR NAME: Judy Laureano
LICENSING EVALUATOR SIGNATURE:

DATE: 09/28/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/28/2021
LIC809 (FAS) - (06/04)
Page: 7 of 7
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: GARZA FAMILY CHILD CARE
FACILITY NUMBER: 197494932
VISIT DATE: 09/28/2021
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
26
27
28
29
30
31
32
Licensee was made reminded that it is the licensee’s, as well as anyone who assists in providing care responsibility to know the regulations. Licensee was also encouraged to read the Child Care quarterly updates every season as they come out to stay informed of any changes or updates to statutes and regulations.
Applicant was advised that regulation prohibits the smoking of tobacco in a private residence licensed as a family child care home during the hours of operation.

Applicant was made aware that state law prohibits baby walkers, bouncy seats, exer-saucers and any other items that fall into that category. Applicant was also reminded that only children who are eating may be in highchairs and that car seats are utilized only for transportation.

Applicant was informed about SAFE SLEEP PRACTICES and was reminded that all infants must be placed on their backs when sleeping to prevent S.I.D.S. (Sudden Infant Death Syndrome). LPA provided applicant with SAFE to SLEEP handouts. Applicant was also informed that the provider is required to wash hands after every diaper change and to never shake a baby to prevent the Shaken Baby Syndrome.
Safe Sleep Links:
AAP: https://www.healthychildren.org/English/ages-stages/baby/sleep/Pages/A-Parents-Guide-to-Safe-Sleep.aspx
NIH: https://safetosleep.nichd.nih.gov/safesleepbasics/environment/room/text_alternative
Safe to Sleep Campaign: https://safetosleep.nichd.nih.gov/materials

Incidental Medical Services (IMS) policy was discussed. 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: http://www.ada.gov/childqanda.htm

Applicant will not be providing IMS incidental medical services at this time.
SUPERVISORS NAME: Maureen Neal
LICENSING EVALUATOR NAME: Judy Laureano
LICENSING EVALUATOR SIGNATURE:

DATE: 09/28/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/28/2021
LIC809 (FAS) - (06/04)
Page: 3 of 7
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: GARZA FAMILY CHILD CARE
FACILITY NUMBER: 197494932
VISIT DATE: 09/28/2021
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
26
27
28
29
30
31
32
•Individuals who are 18 years of age or older living in the home must obtain a criminal record clearance. Individuals within one month of their 18th birthday must be fingerprinted immediately. If the aforementioned is not adhered to, a Civil Penalty of up to $500, per non-cleared adult will be assessed immediately. Please advise your analyst of any person who will be visiting regularly or for longer than one week.
•In the absence of the licensee a qualified adult must be present supervising the children; a qualified adult is an individual who has a valid and current adult/infant CPR & Pediatric First Aid certification and a valid criminal record clearance associated to the facility license.
•A current roster of children enrolled must be available and maintained for a period of three years, even after children no longer are attending the facility.
•Annual fees must be paid promptly and by the due date or a late fee shall be assessed, and/or the License shall be terminated. (If paying by check please make sure to write facility number on check to ensure that payment is applied to your facility number)
• The fire extinguisher type 2A-10BC must be serviced annually or as often as necessary. Smoke and carbon monoxide detectors should be checked, and batteries should be replaced.
•Changes should be reported the to the Department as soon as they occur such as construction and remodeling.
•Telephone number changes and/or if you move from home
•Reporting requirements: Applicant must report any unusual incident or injuries to the Child Care Regional office by telephone within 24 hours and in writing within 7 days. Applicant was provided with LIC 624 as a reference
•Fire and safety drills must be performed every six months and documented for review by the Department. (Child care Fire Drill log provided to applicant)
•All adults living and working in the home shall be made of aware of the Departments right to inspection authority, which includes but not limited to the right to enter the home when children are being cared for, interview children and adults and review documentation.
•Emergency Disaster Plan, Parent’s Rights Poster and the Facility License are required to be posted.
•LPA advised the applicant how to access forms, regulations and quarterly updates on the Child Care Licensing website at: www.ccld.ca.gov



SUPERVISORS NAME: Maureen Neal
LICENSING EVALUATOR NAME: Judy Laureano
LICENSING EVALUATOR SIGNATURE:

DATE: 09/28/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/28/2021
LIC809 (FAS) - (06/04)
Page: 6 of 7