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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197495241
Report Date: 05/17/2023
Date Signed: 05/23/2023 02:23:17 PM

Document Has Been Signed on 05/23/2023 02:23 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:PINA FAMILY CHILD CAREFACILITY NUMBER:
197495241
ADMINISTRATOR:ANGELA PINAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(310) 910-8830
CITY:LOS ANGELESSTATE: CAZIP CODE:
90045
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 0DATE:
05/17/2023
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Angela PinaTIME COMPLETED:
11:30 AM
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On 05/17/2023 Licensing Program Analyst (LPA) Judy Laureano conducted an announced inspection with applicant Angela Pina the purpose of a pre licensing inspection of 7320 Piper Avenue, Los Angeles, CA 90045. 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. Present during today’s inspection was applicant only.

Applicant was previously licensed with facility number: 197494720. Unlicensed complaint was received at the El Segundo office for this address on 8/2/2022. Complaint 30-CC-20220802121635 was unsubstantiated.

Per the application, at this time, the ages the applicant wishes to provide services for are children 3 months old to 6 years old, Monday- Friday from 7:00 am to 6:00 p.m. Licensee 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. Applicant is rent/lease the home and copy of rental agreement was submitted to the ESCRO.

Currently living in the home is Applicant with two additional adults; daughter and son in law with 2 minor children. Applicant stated a minor grandchild will sometimes visit the home but does not live on the premises.

The home is a single-family home with 3 bedroom 3 bathroom with a living room, dining room, kitchen, sun room and detached garage. The home has enclosed back yard that is separated by cement and grass area. The front yard is off limits and the front main entrance of the home will not be used for day care purpose.

Parents will access the home through the side gate of the home. LPA observed gate to be self-latching with a security code. Parents will access the day care through the side gate. Entering the side gate you are lead to the back yard of the home. A side door to the sun room was observed and applicant confirmed children will enter the space through the side door.
SUPERVISORS NAME: Claudia Escobedo
LICENSING EVALUATOR NAME: Judy Laureano
LICENSING EVALUATOR SIGNATURE: DATE: 05/17/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/17/2023
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
CCLD Regional Office, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME: PINA FAMILY CHILD CARE
FACILITY NUMBER: 197495241
VISIT DATE: 05/17/2023
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Sun room was observed to have children size tables and chairs, a reading area with a variety of children’s books and children’s cubbies. LPA observed a parent board mounted by the entrance of the home with all necessary posting. The space was observed to have a sliding door that leads to the back yard. The sun room was observed to have three steps that leads to the rest of the home. Applicant confirmed children will eat and nap in the sun room. LPA observed applicant test the carbon and smoke detector in the space and all electrical outlets were observed to be covered.
Sun room has a door that lead to bedroom 1 which has been designated as day care room. Applicant confirmed that younger children will nap in the space. LPA observed the space with one bunk bed style beds and all electrical outlets were observed to be covered.

The bathroom that has been designated as day care space is located outside bedroom 1. LPA observed and inspected a sink, toilet and shower. All electrical outlets were covered. LPA advised applicant to add a hand washing sign in the space to assist children in handwashing. LPA advised applicant to add a door knob cover to the double doors outside bedroom 1 to ensure the rest of the home remains inaccessible to the children in care.

Outside bedroom 1, you are led to the living room space that has been designated as OFF LIMITS to the children in care. LPA observed a barricaded fireplace- metal and glass door making the fire place inaccessible.

Outside the living room LPA observed a hallway that leads to bedroom 3, bathroom 2 and bedroom 2 and bathroom . ALL areas have been designated as off limits. Applicant
was reminded any area designated as OFF LIMITS will need to have doors locked during the hours of operations. LPA advised applicant to add a doorknob cover to bedroom 2 door and hallway door.

The dining room and kitchen area were observed and inspected. The kitchen is located next to the dining room. The kitchen was observed to have a door that gives access to the sun room. Kitchen is designated as OFF LIMITS to the children, LPA observed the door that leads to the sun room to have a lock, making the area inaccessible. Knifes and sharp objects were observed in the top cabinet above the refrigerator. Cabinets were observed to have safety latches making the content inaccessible. LPA observed all detergent and cleaning supplies in a top cabinet with a safety latch, making the content inaccessible. Applicant confirmed that she will be providing meals and snacks. LPA discuss the importance of creating a log/system to ensure dietary restrictions and allergies are flagged. LPA encouraged applicant to contact their local Resources and Referral Agency, Connections for Children, to inquiry about the different food programs.
SUPERVISORS NAME: Claudia Escobedo
LICENSING EVALUATOR NAME: Judy Laureano
LICENSING EVALUATOR SIGNATURE:

DATE: 05/17/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/17/2023
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
CCLD Regional Office, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME: PINA FAMILY CHILD CARE
FACILITY NUMBER: 197495241
VISIT DATE: 05/17/2023
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The outdoor area was observed and inspected. You are able to access the back yard through the side door of the sun room and the sliding door. The backyard was observed to have a variety of age appropriate outdoor toys. The area is cemented with some areas covered with grass. LPA observed a wooden play structure, slide area was observed to have soft mat at the bottom of the slide and LPA advised applicant to add soft cushioning around the swing area as well. The area was observed to have shaded sand box area and LPA reminded applicant to ensure that sand box is racked/cleaned regularly and covered when not in used. Toward the back of the yard applicant confirmed the area next to the green house is OFF LIMITS. LPA advised applicant to add a safety latch or secure the gate better to ensure children do not access the side area.

The following area are designated as OFF LIMITS:
1. Attach Garage- doors will remain locked during the hours of operations.
2. Bedroom 2, Bedroom 3, bathroom 2 and bathroom 3
3. Living room with main entrance of the home
4. Dining room and kitchen area.
The following requirements shall be submitted by May 31, 2023. The licensing determination of this application will be reviewed with Licensing Program Manager for final resolution. The following corrections need to be completed prior to licensure:
1. Side of the green house/back of the yard- gate needs to be secured to ensure children do not have access.
2. Double doors to bedroom 1/nap room- add doorknob covered to ensure children do not access the rest of the home.
3. Bedroom 2 and hallway door- add a doorknob cover to ensure children do not have access to the area.
4. Outdoor swing area- add a soft cushion under the swings.

Exit interview was conducted with applicant Angela Pina and a copy of this report was provided.
SUPERVISORS NAME: Claudia Escobedo
LICENSING EVALUATOR NAME: Judy Laureano
LICENSING EVALUATOR SIGNATURE:

DATE: 05/17/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/17/2023
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
CCLD Regional Office, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME: PINA FAMILY CHILD CARE
FACILITY NUMBER: 197495241
VISIT DATE: 05/17/2023
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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 childcare 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.
LPA discussed the LIC 311D- Forms/Records to Keep In Your Family Child Care Home and provided applicant with a sample packet.

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 childcare home during the hours of operation.
SUPERVISORS NAME: Claudia Escobedo
LICENSING EVALUATOR NAME: Judy Laureano
LICENSING EVALUATOR SIGNATURE:

DATE: 05/17/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/17/2023
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
CCLD Regional Office, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME: PINA FAMILY CHILD CARE
FACILITY NUMBER: 197495241
VISIT DATE: 05/17/2023
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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 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.

LPA discussed the safe sleep regulations with applicant [or facility representative] 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 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 Evaluator Manual - Regulation Interpretations and Procedures for Family Child Care Homes Section 102417. 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 was reminded that all adults 18 and over responsible for administration or direct supervision of staff, persons who provides 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 Child Care Center. A civil penalty of $100.00 minimum/day up to $500.00 maximum per day/per person will be assessed.
• 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.
SUPERVISORS NAME: Claudia Escobedo
LICENSING EVALUATOR NAME: Judy Laureano
LICENSING EVALUATOR SIGNATURE:

DATE: 05/17/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/17/2023
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
CCLD Regional Office, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME: PINA FAMILY CHILD CARE
FACILITY NUMBER: 197495241
VISIT DATE: 05/17/2023
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• 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.
• 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.
• Community Care Licensing Division (CCLD) regularly sends information to licensed facilities, providers, and stakeholders by way of Provider Information Notices (PIN), Program Quarterly Update Newsletters and other important information communication platform. To receive important licensed-related information to licensed facilities, visit the CCLD Important Information website at https://www.cdss.ca.gov/inforesources/community-care-licensing/subscribe and select the Child Care option to receive email communication.
SUPERVISORS NAME: Claudia Escobedo
LICENSING EVALUATOR NAME: Judy Laureano
LICENSING EVALUATOR SIGNATURE:

DATE: 05/17/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/17/2023
LIC809 (FAS) - (06/04)
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