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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198018013
Report Date: 04/07/2021
Date Signed: 04/07/2021 02:08:01 PM

Document Has Been Signed on 04/07/2021 02:08 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, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME:MEDRANO FAMILY CHILD CAREFACILITY NUMBER:
198018013
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 0CENSUS: 5DATE:
04/07/2021
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
12:30 PM
MET WITH:Jessica Medrano, LicenseeTIME COMPLETED:
01:45 PM
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Due to COVID-19 and precautionary measures, Licensing Program Analyst (LPA) T. Tran conducted a Case Management/Capacity Increase by use of Facetime with Licensee, Jessica Medrano on 04/07/2021. The Fire clearance was granted. About 12:40 p.m. licensee provided a facetime toured of her home inside and outside. Upon Facetime, LPA observed licensee with five napping children in care. LPA did not observed any other adults in the home. Per licensee, her husband and minor children are currently away from home.

Licensee has all the required documents posted in the FCCH including the consolidation posting for Covid-19; Facility License (LIC 203), Emergency Disaster Plan (LIC610a), Notification of Parents' Rights Poster (PUB 394), Child Care Facility Roster (LIC9040). LPA also observed Licensee's current Pediatric CPR (Adult/Infant /Child) and Pediatric First Aid certifications (expire 02/2023), and Fire Extinguisher (2A-10-BC).

This is a single story dwelling consists of 3 bedrooms, 2 bathrooms, a living room, a kitchen, and an attached garage. Child care is provided in the living room. Licensee is fully acknowledged that children may not eat or sleep in the garage. The off-limits areas are the 3 bedrooms, the second bathroom, and the entire backyard. Children do have access to the kitchen area during mealtime. Kitchen area was inspected, all cabinets had proper safety latch. All sharp items kept inaccessible to children in care. The bathroom was inspected for inaccessibility of chemicals/toxins and other potential hazards to children in care. Licensee reports she has no firearms or weapons in the home. The home was found to be clean and orderly with proper ventilation for safety and comfort. LPA observed toys and furniture that were age appropriate and in good repair. LPA did not observe any bodies of water on the premises. Licensee is reminded that smoking is prohibited on the premises during hours of operation.

Licensee was informed of responsibility to report suspected Child Abuse by calling the Child Abuse Hot-line at 1-800-540-4000. Also call the Community Care Licensing office and follow up with a written Unusual Incident/Injury Report (LIC 624B).
SUPERVISORS NAME: Trevino Cochran
LICENSING EVALUATOR NAME: Tiffanie Tran
LICENSING EVALUATOR SIGNATURE: DATE: 04/07/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/07/2021
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, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME: MEDRANO FAMILY CHILD CARE
FACILITY NUMBER: 198018013
VISIT DATE: 04/07/2021
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The licensee was informed that the presence of adults in the home without Criminal Record Clearance or Exemption will be cited and civil penalty assessed for $100 per day. The licensee may find additional information and forms on the Department’s website at www.ccld.ca.gov including information on the Live Scan application (LIC 9163). Appointments can be made for Live Scan at 1-800-315-4507.

LPA discussed and will provide the safe sleep for baby pamphlet when mailing the facility updated license. Each infant shall be constantly supervised and under direct visual observation by an adult person at all times. Under no circumstances shall any infant be left unattended. In order to visually observed and supervise sleeping infants there should be no obstruction to the view of the infants, which could include transparency walls and/or half walls. LPA recommend that infants sleep safest in crib with no bumpers, pillows, blankets, or toys, and on their backs, and every sleep time counts to reduce the risk of SIDS and other sleep-related causes of infant death. Licensee was advised that inaccessibility of hazards must be constantly reassessed depending on the children in care. Licensee must have the facility’s phone number at all times; if the phone number is changed, licensing must be notified. State law prohibits baby walkers, bouncy seats, exersaucers and any other items that fall into that category.

LPA discussed AB633 and informed licensee that, upon receipt of a Type A deficiency, the licensee shall post and provide copies of this licensing report to parent/guardians of children in care at the facility and to parents/guardians of children newly enrolled at the facility during the next 12 months.

Effective today (04/07/2021) Facility is licensed to serve 14 children. The maximum capacity is 12 with no more than 4 infants and a qualified assistant. Without a qualified assistant the license reverts back to the requirements for a small family childcare. Optional care may be provided for a maximum capacity of 14 children with no more than 3 infants, 2 school age children and a qualified assistant, at least one child is enrolled in and attending kindergarten or elementary school an a second child is at least six years of age.

This report must be kept available for public review for three years.

An exit interview was conducted with the licensee. This report along with a notice of site visit, a copy of the appeal rights was via emailed to licensee. Via email with a read receipt or confirmation of receipt of email, which will act as the licensee's signature.

SUPERVISORS NAME: Trevino Cochran
LICENSING EVALUATOR NAME: Tiffanie Tran
LICENSING EVALUATOR SIGNATURE:

DATE: 04/07/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/07/2021
LIC809 (FAS) - (06/04)
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