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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197495129
Report Date: 12/15/2023
Date Signed: 12/15/2023 02:26:27 PM

Document Has Been Signed on 12/15/2023 02:26 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:DAGO FAMILY CHILD CAREFACILITY NUMBER:
197495129
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 2CENSUS: 1DATE:
12/15/2023
TYPE OF VISIT:Case Management - Licensee InitiatedANNOUNCEDTIME BEGAN:
11:30 AM
MET WITH:Zina Dago, LicenseeTIME COMPLETED:
02:30 PM
NARRATIVE
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On 12/15/2023, at 11:30 AM, Licensing Program Analyst (LPA) Elicia Calvillo and Licensing Program Manager (LPM) Rita Ramos met with Licensee Zina Dago. The purpose of the announced visit is due to Licensee requesting and submitting an application for a capacity increase at the facility located at 4235 McClung Drive, Los Angeles, CA 90008. The home is a duplex in which Licensee resides on the first floor and there is a different tenant and address located above on a 2nd floor. LPA and LPM conducted the visit to ensure the health, safety, and personal rights as required by Title 22 and Health and Safety Regulations governing California Child Care Homes will be met. Applicant is requesting a capacity of 14 children, ages 6 months to 6 years old. The Family Child Care Home will operate Monday through Friday 6:30 a.m. – 6:30 p.m. Currently living in the home are licensee, spouse, and three children. The Entrance Checklist was provided to the applicant upon entrance.

Due to the licensee renting/leasing the home, proof of landlord notification is required. The LPA and LPM observed the Property Owner/Landlord Notification form (LIC 9151) that the applicant confirms was provided to the property owner/landlord. The applicant obtained a signed Property Owner/Landlord Consent form (LIC 9149).



At 11:35am, licensee guided LPA and LPM on a tour of the residence and the outdoor area. All areas identified on the facility sketch were inspected, including but not limited to, off limit areas. This is a one-story home. The home consists of 3 bedrooms, 2 bathrooms, living room, dining room, kitchen and nook. Areas that are accessible to children are the living room, 1 bedroom, and 1 bathroom. The areas that have been labeled Off Limits in the facility sketch are the master bedroom, second bathroom, kitchen, and garage. LPA and LPM observed the Off Limit areas to be made inaccessible by child proof door knobs and safety gates.
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SUPERVISORS NAME: Rita Ramos
LICENSING EVALUATOR NAME: Elicia Calvillo
LICENSING EVALUATOR SIGNATURE: DATE: 12/15/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/15/2023
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: DAGO FAMILY CHILD CARE
FACILITY NUMBER: 197495129
VISIT DATE: 12/15/2023
NARRATIVE
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LPA and LPM observed the outdoor area is a shared space with the tenant that resides on the top floor and a separate address. There is a ramp that children walk on when exiting the facility and entering the outdoor area. LPA and LPM observed that in an effort to cover the bottom opened space of the ramp, the Licensee used chicken wire. The chicken wire has sharp edges and points that are protruding which are a hazard. LPA and LPM observed that the backyard has mostly toys. Per Licensee, Licensee will be present at all times when children are in the backyard and will ensure that children are not left alone. LPA and LPM also observed a shaded play area with artificial grass and the detached garage is off limits to children.

While inspecting the indoor areas, LPA and LPM observed a working carbon monoxide detector in the room that is labeled as the children's play area and LPA and LPM were able to hear a successful test. Fire extinguisher 2-A-10-B:C was observed to be located in the Laundry Room. LPA and LPM observed that the fire extinguisher did not have a Fire Marshal tag or receipt to determine the last service date. Electrical outlets were observed to be inaccessible to children in care with the use of plug covers. LPA and LPM observed safe toys, play equipment, and materials. LPA and LPM advised, baby walkers, bouncers, Johnny jumpers, trampolines, and saucer chairs are not permitted.

LPA and LPM inspected one of the bedrooms and observed 2 cribs. LPA and LPM observed that one crib was surrounded by bumper pads and the other crib had a large stuffed animal inside. LPA and LPM discussed infant safe sleep regulations with the Licensee. LPA and LPM advised Licensee that mattresses shall be firm and covered with a fitted sheet that is appropriate to the mattress size, fits tightly on the mattress, and overlaps the underside of the mattress so it cannot be dislodged. Mattresses shall be made specifically for the size crib or play yard in which they are placed. LPA and LPM advised, cribs or play yards shall be free from all loose articles, objects, bumper pads shall not be used, and there shall be no objects hanging above or attached to the side of the cribs.

During the tour of the restroom that children use, LPA and LPM observed a razor in the shower with personal care products, Ajax disinfecting cleaners under the unlocked/unlatched sink cabinet, and the latches on the cabinets were not latching appropriately.

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SUPERVISORS NAME: Rita Ramos
LICENSING EVALUATOR NAME: Elicia Calvillo
LICENSING EVALUATOR SIGNATURE:

DATE: 12/15/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/15/2023
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: DAGO FAMILY CHILD CARE
FACILITY NUMBER: 197495129
VISIT DATE: 12/15/2023
NARRATIVE
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Licensee was reminded that all adults 18 and over living or working in the home, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, 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 for a maximum of 5 days or, if the penalty is for a repeat violation, for a maximum of 30 days per person will be assessed if this regulation is violated.

LPA and LPM 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 and LPM informed licensee of the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at http://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. 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/resources/child-care-centers/ .

Licensee was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain child care by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California. Page 3 of 4
SUPERVISORS NAME: Rita Ramos
LICENSING EVALUATOR NAME: Elicia Calvillo
LICENSING EVALUATOR SIGNATURE:

DATE: 12/15/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/15/2023
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: DAGO FAMILY CHILD CARE
FACILITY NUMBER: 197495129
VISIT DATE: 12/15/2023
NARRATIVE
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During the exit interview, the Licensee, Zina Dago, confirmed that there are no Registered Sex Offenders living in the facility and LPA and LPM completed the RSO profile in FAS.

Prior to increasing the capacity from a small license to a large license, a final review of the application will conducted. LPA and LPM advised Licensee to update their facility sketch to show a closet, windows, and built in drawers located by the hallway and note the 2nd bathroom as off limits.

Although Licensee had their own child in care and removed the hazardous items from the restroom and the bumper pads from the crib during the inspection, LPA and LPM reminded Licensee that they are already licensed. Therefore, the following deficiencies are being cited on the attached deficiencies page.

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

Exit interview conducted and report was reviewed with the Licensee, Zina Dago.

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SUPERVISORS NAME: Rita Ramos
LICENSING EVALUATOR NAME: Elicia Calvillo
LICENSING EVALUATOR SIGNATURE:

DATE: 12/15/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/15/2023
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 12/15/2023 02:26 PM - It Cannot Be Edited


Created By: Elicia Calvillo On 12/15/2023 at 01:41 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: DAGO FAMILY CHILD CARE
FACILITY NUMBER: 197495129

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/15/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
12/15/2023
Section Cited
CCR
192425(b)(2)

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102425 Infant Safe Sleep
(b) Cribs or play yards shall be free from all loose articles and objects. (2) Bumper pads shall not be used.

This requirement was not met as evidenced by LPA and LPM observing a bumper pad
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Licensee removed bumper pads during the inspection.
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surrounding one of the cribs. Since no infants were in care, this poses a potential health, safety, and personal rights risk to children in care.
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Type B
12/29/2023
Section Cited
CCR102417(g)(4)

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102417 Operation of a Family Child Care Home
(g) The home shall be free from defects or conditions which might endanger a child(4) Poisons, detergents, cleaning compounds, medicines, firearms and other items which could pose a danger if readily available
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Licensee removed razor and Ajax during the inspection, however, will replace or remove the chicken wire and submit pictures by POC due date of 12/29/23.
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to children shall be stored where they are inaccessible to. This requirement was not met based on Licensee having razor and Ajax in the restroom and chicken wire protruding that are accessible to children in care.
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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:Rita Ramos
LICENSING EVALUATOR NAME:Elicia Calvillo
LICENSING EVALUATOR SIGNATURE:
DATE: 12/15/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/15/2023


LIC809 (FAS) - (06/04)
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