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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197495241
Report Date: 08/22/2024
Date Signed: 08/23/2024 09:34:51 AM

Document Has Been Signed on 08/23/2024 09:34 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
CCLD Regional Office, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME:PINA FAMILY CHILD CAREFACILITY NUMBER:
197495241
ADMINISTRATOR/
DIRECTOR:		ANGELA PINAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(310) 910-8830
CITY:LOS ANGELESSTATE: CAZIP CODE:
90045
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 6DATE:
08/22/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:31 AM
MET WITH:Angela PinaTIME VISIT/
INSPECTION COMPLETED:
12:30 PM
NARRATIVE
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On 08/22/2024 Licensing Program Analyst (LPA) Judy Laureano conducted an unannounced case management inspection at the above-mentioned facility for the purpose of ensuring that standards are being met in accordance with California Tittle 22 Regulations and California Health and Safety Codes.

LPA Laureano met with Angela Pina, Licensee, and toured the home both indoors and outdoors.

LPA Laureano reviewed children’s file and staff files and observed files to be incomplete. Mandated Reporter Training certificate was not valid for both Licensee’s and Assistant K. Pina. LPA observed 4 out of 7 children’s files incomplete, missing the LIC 627 Consent for Emergency Medical Treatment.

2 Type B deficiencies were cited during today’s inspection in accordance to the California Code of Regulations Title 22, Division 12, Chapter 1 and California Health and Safety Code. Please see LIC 809D for reference.

Upon on receipt of this report, the Licensee shall post the Notice of Site Visit.
The Notice of Site Visit shall be posted for 30 consecutive days. Failure to maintain posting as required, will result in an immediate $100 civil penalty.

An exit interview was conducted, and report was reviewed with Licensee. A copy of this report and appeal rights were discussed and left with the Licensee, whose signature on this form confirm receipt of these documents.

SUPERVISORS NAME: Claudia Escobedo
LICENSING EVALUATOR NAME: Judy Laureano
LICENSING EVALUATOR SIGNATURE: DATE: 08/22/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/22/2024
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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Document Has Been Signed on 08/23/2024 09:34 AM - It Cannot Be Edited


Created By: Judy Laureano On 08/22/2024 at 10:53 AM
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: PINA FAMILY CHILD CARE
FACILITY NUMBER: 197495241

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/22/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
09/05/2024
Section Cited
CCR
102417(g)(7)

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102417(g)(7) Operations of a Family Child Care Home... (7) An emergency information card shall be maintained for each child and shall include ... of a parent or other responsible adult to be contacted in an emergency, the name and telephone number of the child's physician and the parent's authorization for the licensee or registrant to consent to emergency medical care.
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Licensee agrees to have families complete the LIC 627 and copies of completed forms will be emailed to LPA.
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This requirement is not met as evidenced by LPA's file review. LPA reviewed 7 children's file and 4 files did not have the LIC 627 form, consent to emergency medical care, this poses a potential health and safety risk to the children in care.
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Type B
09/05/2024
Section Cited
HSC1596.662(b)(1)

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(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.
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Licensee agrees to complete the California Child Care Providers - AB1207 mandated reporter training and submit valid certification to LPA via email.
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This requirement is not met as evidence by LPA's review of staff files that confirmed that both Licensee and Assistant do not have a valid certification.
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https://mandatedreporterca.com/training/child-care-providers
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:Judy Laureano
LICENSING EVALUATOR SIGNATURE:
DATE: 08/22/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/22/2024


LIC809 (FAS) - (06/04)
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