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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 191596628
Report Date: 06/18/2021
Date Signed: 06/18/2021 12:13:08 PM

COMPREHENSIVE INSPECTION
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 CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME:DELAYO FAMILY DAY CAREFACILITY NUMBER:
191596628
ADMINISTRATOR:DELAYO, MARTHAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(626) 814-9009
CITY:BALDWIN PARKSTATE: CAZIP CODE:
91706
CAPACITY:14CENSUS: 6DATE:
06/18/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
08:43 AM
MET WITH:Martha Delayo, LicenseeTIME COMPLETED:
12:30 PM
NARRATIVE
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Licensing Program Analyst (LPA) Fabiola Vasquez contacted the facility via telephone due to COVID-19 and precautionary measures LPA conducted the screening procedures and received the clearance to go into facility at 08:43 LPA conducted an unannounced inspection. LPA met with licensee, Martha Delayo who guided analyst on a tour of the facility. Present were 2 adults and 6 children, 3 being licensee's grandchildren.
Licensee states that there are currently 6 children enrolled. Days and hours of operation are: Monday to Friday from 06:00 AM to 06:00 PM. The Licensee is within the conditions, limitations, and capacity specified on the license. The children's roster was reviewed and is current.

The home is a one story, 3-Bed, 2-Bath home. The following areas are used for day-care: Daycare room in the rear of the home, 1 bathroom, kitchenette, and backyard (fenced). Off limit areas include: The front of the home which includes 3 bedrooms, 1 bathroom, living room, kitchen and attached garage.

Family members residing in the home are 2 adults (criminal record clearances on file) and no children. There are bird cages with birds in the backyard. The LPA toured all areas used by children during this visit.



Areas accessible to children were inspected to ensure that they are clean and orderly with ventilation and heating, wall heater which is inaccessible. All areas were inspected for safety and comfort. There were safe toys, play equipment and materials observed for children. LPA did not observe stairs, there is a working telephone service maintained in the home. Detergents, cleaning compounds are stored in the laundry room, medications are stored in the main kitchen, and other items which can pose a danger to children are inaccessible. Per licensee there are not poisons in the home. The licensee does understand that poison must be locked with a key or combination lock.

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SUPERVISOR'S NAME: Claudia GuangorenaTELEPHONE: (323) 981-3417
LICENSING EVALUATOR NAME: Fabiola VasquezTELEPHONE: (626) 361-1267
LICENSING EVALUATOR SIGNATURE:

DATE: 06/18/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/18/2021
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 CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME: DELAYO FAMILY DAY CARE
FACILITY NUMBER: 191596628
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/18/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
06/19/2021
Section Cited

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Operation of a Family Child Care Home
*** The home shall contain a fire extinguisher and smoke detector device which meet standards established by the State Fire Marshal.

This requirement was not met as evidenced by
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Based on LPA’s observations fire extinguisher was servised on 04/29/19.

This poses a potential risk to the health and safety of 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: Claudia GuangorenaTELEPHONE: (323) 981-3417
LICENSING EVALUATOR NAME: Fabiola VasquezTELEPHONE: (626) 361-1267
LICENSING EVALUATOR SIGNATURE:
DATE: 06/18/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/18/2021
LIC809 (FAS) - (06/04)
Page: 2 of 6
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 CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME: DELAYO FAMILY DAY CARE
FACILITY NUMBER: 191596628
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/18/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
07/02/2021
Section Cited

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Availability of information regarding detecting and reporting child abuse and neglect; training for mandated reporter who is licensed day care provider, administrator, or employee of a licensed child day care facility; proof of completion
This requirement was not met as evidenced by:
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Based on LPA’s observations
Licensee and Staff #1, were missing the Child Abuse Mandationg Traininng requirement.

This poses a potential risk to the health and safety of children in care.
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Type B
07/02/2021
Section Cited

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In addition to any other required training... each family day care home licensee who provides care shall** immunizations.


This requirement was not met as evidenced by:
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Based on LPA’s observations
Licensee and Staff #1, were missing proof of immunization.

This poses a potential risk to the health and safety of 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: Claudia GuangorenaTELEPHONE: (323) 981-3417
LICENSING EVALUATOR NAME: Fabiola VasquezTELEPHONE: (626) 361-1267
LICENSING EVALUATOR SIGNATURE:
DATE: 06/18/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/18/2021
LIC809 (FAS) - (06/04)
Page: 3 of 6
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 CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME: DELAYO FAMILY DAY CARE
FACILITY NUMBER: 191596628
VISIT DATE: 06/18/2021
NARRATIVE
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There are safe toys, play equipment and materials observed for children. Per licensee she is not caring for infants. LPA did not observe a crib or play yard.

LPA reviewed and discuss safe sleep with licensee.
LIC 9227 (Individual Sleeping Plan) for infants up to 12 months was explained along with PIN 20-24-CCP was issued to the Licensee. Title 22 Regulation Section 102425(j) Infant Safe Sleep was discussed with the Licensee, including but not limited to documentation that shall be maintained.

LPA reviewed and discussed with licensee, rooms that are off-limits need to be made inaccessible during operating hours. No smoking, 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. Car seats shall only be used for transportation purposes and shall not be used for sleeping.

Per licensee, there are no weapons, or firearms, LPA observed a water fountain in the front of the home, per licensee children do not have access to the area.

Children’s records were reviewed to ensure that each child has an Identification, Emergency form, Immunization and Consent for Medical Treatment on File.

The fire extinguisher was purchased 04/29/2019, receipt attached. Fire extinguisher is expired, see 809 D. This is an immediate risk to the health and safety of child.
Smoke detector and carbon monoxide detector in the day-care room were tested, and are in operable condition. The licensee and S1, Pediatric First Aid and CPR, which expired on 05/13/2019. A Technical Assistance was provided. Licensee and S1 do not have proof of immunization against influenza, pertussis, and measles during today’s inspection. This is potential risk to the health and safety of children in care. License and S1 have not taken the mandated reporter training due lack of knowledge of online training.

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SUPERVISOR'S NAME: Claudia GuangorenaTELEPHONE: (323) 981-3417
LICENSING EVALUATOR NAME: Fabiola VasquezTELEPHONE: (626) 361-1267
LICENSING EVALUATOR SIGNATURE:

DATE: 06/18/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/18/2021
LIC809 (FAS) - (06/04)
Page: 4 of 6
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 CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME: DELAYO FAMILY DAY CARE
FACILITY NUMBER: 191596628
VISIT DATE: 06/18/2021
NARRATIVE
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Facility does not provide IMS.
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
SB792 (Immunization Requirements for Staff and Employees) was reviewed and discussed with the Licensee.
AB1207 Mandated Child Abuse Reporting – was reviewed and discussed, on or before March 30, 2018 any person who works in a child care facility shall complete the training and renew the training every 2 years. Website provided: https://www.mandatedreporterca.com/training/child-care-providers Licensee completed training on .
The following was discussed:
· 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.
· The Licensee shall be present in the home and shall ensure that children are supervised at all times.
· Children shall not be left in park vehicles.
· The capacity specified on the license shall be the maximum number of children for whom care can be provided.
· Car seats shall only be used for transportation purposes and shall not be used for sleeping.
· All children in care have the right to receive safe, healthful, and comfortable accommodations, furnishings and equipment.
· When a child shows signs off illness, they will be separated from other children until the nature if the illness is determined.
· Effective January 1, 2010, licensees of family child care homes are required to ensure that at least one staff member with current training in pediatric first aid and pediatric CPR is on site at all times when children are present.

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SUPERVISOR'S NAME: Claudia GuangorenaTELEPHONE: (323) 981-3417
LICENSING EVALUATOR NAME: Fabiola VasquezTELEPHONE: (626) 361-1267
LICENSING EVALUATOR SIGNATURE:

DATE: 06/18/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/18/2021
LIC809 (FAS) - (06/04)
Page: 5 of 6
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 CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME: DELAYO FAMILY DAY CARE
FACILITY NUMBER: 191596628
VISIT DATE: 06/18/2021
NARRATIVE
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LPA reviewed and issued the LIC 311 - Forms/Records to Keep in Your Family Child Care Home.
CHILDREN’S FORMS/RECORDS, FACILITY FORMS/RECORDS and INFORMATION TO BE POSTED, Disaster drills, posting requirements, children records requirements, mandated child abuse and injury/death reporting, and criminal record transfer requirements were discussed.
Last disaster drill was conducted on 05/10/21.
LPA provided a Safe Sleep Awareness Campaign (PIN) 19-02-CCP dated February 20, 2019 packet, Never Shake a Baby (Pub 271), A Child Care Providers Guide to Safe Sleep (SIDS) American Academy of Pediatrics and California Child Passenger Safety Law during today’s inspection. PIN 21-02-CCLD Updates to the implementations of guardian.
The licensee’s email address was obtained during this visit. The licensee was advised that email is public information.
Upon receipt of this report, the licensee shall post ANY licensing report documenting a type “A” citation. This must remain posted for 30 days during hours of operation. In addition to posting this report, the licensee will also provide copies to the parents of the children in care for up to one year.

A copy of the LIC 9224 - Acknowledgement of Receipt of Licensing Reports was provided.
LPA advised the licensee how to access forms, regulations and quarterly updates on the Child Care Licensing website at: www.ccld.ca.gov

The Notice of Site Visit (LIC 9213) – must remain posted for 30 days during the hours of operation after each site visit by a licensing representative. Failure to maintain posting as required will result in a civil penalty of $100.00.

The deficiencies listed on the following pages were observed by the LPA and are being cited in accordance with California Code of Regulations Title 22 and/or the Health and Safety Code. Please see attached LIC 809D.
Deficiencies that are being cited need to be cleared to protect the children’s health & safety.
Exit interview was conducted with Licensee. The Licensee was provided a copy of their appeal rights (LIC 9058) and their signature on this form acknowledges receipt of these forms.

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SUPERVISOR'S NAME: Claudia GuangorenaTELEPHONE: (323) 981-3417
LICENSING EVALUATOR NAME: Fabiola VasquezTELEPHONE: (626) 361-1267
LICENSING EVALUATOR SIGNATURE:

DATE: 06/18/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/18/2021
LIC809 (FAS) - (06/04)
Page: 6 of 6