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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197494932
Report Date: 01/12/2023
Date Signed: 01/12/2023 02:06:54 PM

Document Has Been Signed on 01/12/2023 02:06 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
EL SEGUNDO CC NORTH, 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: 8CENSUS: 2DATE:
01/12/2023
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
11:11 AM
MET WITH:Petra GarzaTIME COMPLETED:
02:25 PM
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On 1/12/2023 Licensing Program Analyst (LPA) Laticia Thompson conducted a case management visit to Garza family child care home for the purpose of an increase in capacity. The licensee is applying for a large family child care home. Licensee will care for children ages newborn – 12 years. Facility operating hours Sunday- Saturday 12am-11:59pm Upon arrival, LPA met with the Petra Garza, Licensee. LPA observed 2 children under care during the visit. The fire clearance was granted for 14 children on 12/19/2022 by the Los Angeles City Fire Department.

The facility is a two story home that consists of 4 bedrooms, main care is being provided in the family room(daycare area) and backyard, The children will use the bathroom located in the office room area on the first floor. The off limits area is the living room, dining room, 2 bedrooms and full bathroom located on the first floor. The entire second floor is off limits. There is a safety gate separating the stair casing that access the second floor from the day care area. There is a detached garage(off limits) located next to the backyard. There is play equipment and grass providing cushioning in the backyard area.

LPA observed proper posting per posting requirements in day care areas. LPA observed emergency disaster drill log.
LPA reviewed 5 children files with all documentation within compliance of Title 22 regulations.
SUPERVISORS NAME: Rita Ramos
LICENSING EVALUATOR NAME: Laticia S Thompson
LICENSING EVALUATOR SIGNATURE: DATE: 01/12/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/12/2023
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
EL SEGUNDO CC NORTH, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME: GARZA FAMILY CHILD CARE
FACILITY NUMBER: 197494932
VISIT DATE: 01/12/2023
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Licensee states there were no weapons/firearms in the home, and none were observed by LPA. There are no bodies of water present at the facility.
Licensee stated she has two dogs. LPA observed a gated area on the right side of the house separating dogs from backyard play area. Licensee has three birds in cages.

Carbon monoxide and smoke detector were tested and found to be in operable condition located in day care area. LPA observed 3 fire extinguishers fully charge 2-A:10-BC. LPA observed a receipt for 2 fire extinguisher from Crystal Stairs dated 08/05/2022.

Home is clean and orderly with heating and ventilation. Home has central heat. Licensee has ceiling fans for cooling facility. Licensee has two fireplaces. Fireplace is located in living room and office area. Licensee will place a stable screens of fireplaces to prevent children from accessing area.

LPA observed cots and play yards for sleeping/napping. LPA observed learning materials and safe play equipment in daycare area. Licensee stated no one smokes in the home. Licensee will separate ill children in the office area located next to the day care area. Cleaning compounds and medication are stored in cabinets with safety latches and in areas inaccessible to children. All drawers and cabinets in kitchen have safety latches that prevents sharp utensils items from being accessible to children. Facility has a landline telephone service (323) 903-6841 and cellular phone service. Licensee provides food and beverages for children. Refrigerator, freezer, toilets and faucets are clean, safe and operable. Shower is free of hazards.

SUPERVISORS NAME: Rita Ramos
LICENSING EVALUATOR NAME: Laticia S Thompson
LICENSING EVALUATOR SIGNATURE:

DATE: 01/12/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/12/2023
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
EL SEGUNDO CC NORTH, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME: GARZA FAMILY CHILD CARE
FACILITY NUMBER: 197494932
VISIT DATE: 01/12/2023
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Applicant has a first aid kit with a thermometer.
At this time, the licensee does not provide Incidental Medical Services (IMS).
The following was discussed with the licensee:

Plan of correction:

Licensee was issued a Technical Violation to provide a criminal record clearance for Shelley Harris whom resides in the home. At this time the individual has a live scan but no clearance has been issued. The clearance is currently pending.
Licensee will place stable screens on fireplaces that will prevent children from accessing the area
Licensee will place a safety knob on closet located in office area.
Licensee will provide an updated Facility Sketch with sizes of rooms, door and window exits.
Licensee will provide a copy of a Completed Frist Aid and CPR certificate for licensee and assistant
Licensee will provide an updated Application answering questions #5 and hours of operation
Licensee will provide a updated copy of Disaster Plan with updated temporary location and correct number of licensing
Child Abuse Form (LIC 9108) for assistant
SUPERVISORS NAME: Rita Ramos
LICENSING EVALUATOR NAME: Laticia S Thompson
LICENSING EVALUATOR SIGNATURE:

DATE: 01/12/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/12/2023
LIC809 (FAS) - (06/04)
Page: 3 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 NORTH, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME: GARZA FAMILY CHILD CARE
FACILITY NUMBER: 197494932
VISIT DATE: 01/12/2023
NARRATIVE
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LPA provided applicant with posting requirements, emergency disaster plan information, earthquake preparedness checklist, Lead flyer requirements, Forms and Records to Keep in FCCH (LIC311D), Liability Insurance regulation, all documents required for children files, pool requirements, parents rights posting, safe sleep documents, ratio documents and additional help information.

Applicant was reminded that all adults 18 and over living in the home, persons who provide care and supervision to children, and staff who have contact with children, 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. LPA also informed [applicant, licensee, or facility representative] 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.

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.

SUPERVISORS NAME: Rita Ramos
LICENSING EVALUATOR NAME: Laticia S Thompson
LICENSING EVALUATOR SIGNATURE:

DATE: 01/12/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/12/2023
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 NORTH, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME: GARZA FAMILY CHILD CARE
FACILITY NUMBER: 197494932
VISIT DATE: 01/12/2023
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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

An exit interview was conducted with the plan of corrections that were discussed. A copy of this report was provided to the licensee. Final license determination will be made upon review by the Licensing Program Manager and corrections made.

SUPERVISORS NAME: Rita Ramos
LICENSING EVALUATOR NAME: Laticia S Thompson
LICENSING EVALUATOR SIGNATURE:

DATE: 01/12/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/12/2023
LIC809 (FAS) - (06/04)
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