198400298-5-11-2021-54-CC-RJOS-C2WNXV-20210511105147

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 198400298
Report Date: 03/09/2021
Date Signed: 05/11/2021 10:52:00 AM

Document Has Been Signed on 05/11/2021 10:52 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, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME:	JIMENEZ FAMILY CHILD CARE		FACILITY NUMBER:	198400298
ADMINISTRATOR:	ANTONIA JIMENEZ		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(310) 740-6168
CITY:	COMPTON	STATE: CA	ZIP CODE:	90220
CAPACITY: 14	TOTAL ENROLLED CHILDREN: 0	CENSUS: 0	DATE:	03/09/2021
TYPE OF VISIT:	Prelicensing	ANNOUNCED	TIME BEGAN:	10:09 AM
MET WITH:	Antonia Jimenez; Applicant		TIME COMPLETED:	11:45 AM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	Licensing Program Analyst (LPA) Reiko Jones-Modeste conducted a pre-licensing inspection at the facility listed above. Due to COVID-19 and precautionary measures the inspection was conducted with the APPLICANT Antonia Jimenez via tele-inspection using FACETIME. LPA met with the APPLICANT who guided analyst on a tour of the facility. Per the Applicant two adults and three children currently reside in the home. All areas identified on the facility sketch were inspected. This is a one-story home that includes three bedrooms, two restrooms, kitchen, living room, dining room, front yard, backyard (fenced) and garage. The home was inspected for safety, comfort, cleanliness, telephone service, heating and ventilation, as well as any hazardous items that may pose a danger to children. Off limits/inaccessible to daycare children: three bedrooms, backyard, garage and one bathroom. The bedrooms were accessible as child safety locks were not observed. Accessible to daycare children: one restroom, living room, dining room and front yard. LPA inspected the accessible areas where care will be provided. LPA observed lots of toys and children’s materials in the living room. The living room will be used for napping. LPA observed napping equipment (mats) however infant sleep equipment was not observed. The children’s restroom was inspected, infant changing table observed. LPA aslo observed some hazards(soaps, lotions) in an accessible cupboard below the sink. LPA observed knives and detergents inaccessible with locks installed on cupboards in the kitchen. LPA also observed the required 2A 10BC fire extinguisher indicating fully charged. Combination Smoke and Carbon Monoxide detectors were tested and operable.

SUPERVISORS NAME: Trevino Cochran
LICENSING EVALUATOR NAME: Reiko Jones
LICENSING EVALUATOR SIGNATURE:	DATE: 03/09/2021

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/09/2021

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)

Page: 1 of 3

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: JIMENEZ FAMILY CHILD CARE	FACILITY NUMBER: 198400298
	VISIT DATE: 03/09/2021

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

Per applicant there are no firearms in the facility at this time. Applicant stated poisons are stored in the locked garage. LPA toured the outdoor play area (front yard) with several different types of children’s outdoor play equipment as well as numerous tables and chairs. Front yard is adequately fenced, LPA did not observe any swimming pool, spa or other bodies of water. There are age appropriate toys and play equipment on site. Back yard was observed inaccessible and free of hazards. Outdoor laundry room located in the rear yard was observed inaccessible with detergents and soaps stored. LPA also observed two small dogs and a chicken(rooster) in rear yard.

LPA observed the following required postings including the Emergency Disaster Plan and Parents Right Poster in the living room, however a Disaster Drill Log was not available. LPA did not observe COVID_19 isolation nor intake to include COVID Postings, hand sanitizer, sign-in sheet and no-touch thermometer. Applicants Mandated Reporter training was observed posted. Wall heater was observed in dining room barricaded.

The following was discussed with the applicant:

Individuals who are 18 years of age or older living in the home must obtain a criminal record clearance. Individuals within one month of their 18th birthday must be fingerprinted immediately. Failure to obtain a criminal record background check clearances prior to initial presence in the home will result in an immediate $100.00 dollar or more per day Civil Penalty.
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, TB clearance, and a valid criminal record clearance associated to the facility license.
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.
The fire extinguisher type 2A-10BC must be serviced annually or as often as necessary and smoke and carbon monoxide detectors should be checked and batteries replaced as needed.
Changes should be reported to the Department as soon as they occur such as construction, remodeling, telephone number changes and/or if you move from your home.
Reporting Requirements: Any unusual incidents or injuries must be reported to the Department within 24 hours via telephone and within seven (7) days in writing.

SUPERVISORS NAME: Trevino Cochran
LICENSING EVALUATOR NAME: Reiko Jones
LICENSING EVALUATOR SIGNATURE:	DATE: 03/09/2021

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/09/2021

LIC809 (FAS) - (06/04)

Page: 2 of 3

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: JIMENEZ FAMILY CHILD CARE	FACILITY NUMBER: 198400298
	VISIT DATE: 03/09/2021

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

Fire and safety drills must be performed every six months and documented for review by the Department.
Smoking is prohibited in a family child care home, 24/7.
Children and Staff records must be maintained and updated as needed and must be available for review by the Department.
No baby bouncers, No infant walkers, No Johnny jumpers, No saucer chairs, No trampolines and any other item that falls into that category are not permitted in the facility.
All adults living and working in the home shall be made of aware of the Departments right to inspection authority.
Mandated reporter training must be taken every 2 years.
Poisons are to be locked away using a combination lock or key.
____________________________________________________________________________________________

During this visit, the LPA reviewed Forms/Records to Keep in Your Family Child Care Home (LIC 311D) with the Applicant. LPA reviewed Sudden Unexpected Infant Death Syndrome (SUID), Shaken Baby The following corrections/concerns must be completed and addressed prior to LICENSURE and are due by: March 23, 2021

1. Required Postings: Missing Disaster Drill log
2. No immunizations for residents/minor children Armando, Santiago and Fernando Jr
3. Bathroom hazards under sink accessible
4. No Infant sleep equipment
5. Outdoor COVID postings and intake(COVID inspection pending)
Exit interview was conducted with the APPLICANT during which appeal rights were explained and provided. Upon receipt the Applicant shall post the Notice of Site Visit. This report and the Notice of Site Visit shall be posted for 30 consecutive days. Failure to maintain posting as required will result in a $100.00 civil penalty. A copy of this report and all other licensing reports must be made available to the public for 3 years.

LPA advised the applicant how to access forms, regulations and quarterly updates on the Child Care Licensing Website at: www.ccld.ca.gov

SUPERVISORS NAME: Trevino Cochran
LICENSING EVALUATOR NAME: Reiko Jones
LICENSING EVALUATOR SIGNATURE:	DATE: 03/09/2021

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/09/2021

LIC809 (FAS) - (06/04)

Page: 3 of 3