<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 191614561
Report Date: 06/26/2019
Date Signed: 06/26/2019 04:41:53 PM

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:VILLALOBOS, BLANCA FAMILY DAY CAREFACILITY NUMBER:
191614561
ADMINISTRATOR:BLANCA VILLALOBOSFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(310) 399-6766
CITY:VENICESTATE: CAZIP CODE:
90291
CAPACITY:12CENSUS: 12DATE:
06/26/2019
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
01:15 PM
MET WITH:Blanca Villalobos, LIncesee and two AssistantsTIME COMPLETED:
04:30 PM
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
On 6/26/2019, Denise Miranda, Licensing Program Analyst (LPA) conducted an unannounced annual/random visit inspection to ensure the health & safety standards as required by regulations governing family child care homes are being met. Upon arrival, at 1:15pm, LPA met with licensee Blanca Villalobos and two licensee’s assistant were present. LPA informed licensee of nature of the visit and was guided on a tour (inside and outside) of the home. LPA confirmed with licensee that all adults residing/working in the home have criminal record. Upon arrival LPA Miranda observed 12 children in care (which 4 is infant) with licensee and two assistants.
This is a 1 story, 2 bedrooms, 2 bathrooms, kitchen/dining room, living room and outdoor area. There is no pool or any bodies of water on the premises.
Licensee stated the facility is operating Monday-Friday 7:30am-5:30pm.
Main care is provided in the home, rear patio and outdoor activity space. Main care area was observed to have age appropriate furniture, games, toys, and activities. During inspection LPA observed clutter indoors and outdoors that could pose a hazard to children in care (see 809D). The licensee was reminded that children are to be supervised at all times including when playing outside.
Off limit areas include the home's 2 bedrooms and fenced outdoor area behind garage. Off limits bedrooms have doors with locks making rooms inaccessible to children in care. The home was inspected inside and out for safety, comfort, cleanliness, telephone service, heating and ventilation, inaccessibility to poisons, detergents/cleaning compounds, and hazardous items that can pose a danger to children.
Licensee has three pet dogs and four pet chickens (outdoor chicken coup). LPA observed chickens in off limits area, behind lock door and inaccessible to children in care.

At 1:35 pm LPA observed a full charged Fire extinguisher size 2-A:10-B:C Fire Extinguisher
in the kitchen, first aid kit located at the playroom area, working smoke and carbon monoxide detector, age appropriate toys. LPA observed at the playroom. LPA observed licensee current First Aid Infant & Child CPR certifications are valid thru 11/18/2019, Telephone service, central heating, lighting and ventilation were

SUPERVISOR'S NAME: Jennie FerreiraTELEPHONE: (424) 301-3067
LICENSING EVALUATOR NAME: Denise MirandaTELEPHONE: (424) 301-3055
LICENSING EVALUATOR SIGNATURE:

DATE: 06/26/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/26/2019
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 5
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: VILLALOBOS, BLANCA FAMILY DAY CARE
FACILITY NUMBER: 191614561
VISIT DATE: 06/26/2019
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
Licensee was reminded that all infants must be placed on their backs when sleeping to prevent S.I.D.S. (Sudden Infant Death Syndrome), and that the Provider is required to wash hands after every diaper change and to never shake a baby to prevent the Shaken Baby Syndrome.
Licensee was also reminded that only children eating may be in high chairs and that car seats are utilized only for transportation.

LPA reminded licensee every two year to take the Mandated Reporter training: www.mandatedreporterca.com

Licensee 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 child care 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


During this inspection, LPA also provided the following documents about 1) A Safe Infant Environment Sleeping, 2), Never ever shake a Baby by California Department of Social Services, 3) California School Immunization Record form CDPH286, 4) California Law – Car Seat by California Department of Public Health and 5) LIC311D Forms/Records to Keep in your Family Child Care Home, PUB458 Reporting Child Abuse and Neglect.

The facility was found no to be in substantial compliance per Title 22 Regulations. See LIC809D.

A copy of report, a Notice of Site Visit and advisory notes were issued and explained to the Licensee.

SUPERVISOR'S NAME: Jennie FerreiraTELEPHONE: (424) 301-3067
LICENSING EVALUATOR NAME: Denise MirandaTELEPHONE: (424) 301-3055
LICENSING EVALUATOR SIGNATURE:

DATE: 06/26/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/26/2019
LIC809 (FAS) - (06/04)
Page: 5 of 5
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: VILLALOBOS, BLANCA FAMILY DAY CARE
FACILITY NUMBER: 191614561
VISIT DATE: 06/26/2019
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
Senate Bill 792: This bill, commencing September 1, 2016, prohibits a person from being employed or volunteering at a child care facility or family day care if he or she has not been immunized against influenza, pertussis and measles.
New Immunization Requirement: Law enacted by SB 277, beginning January 1, 2016, personal beliefs exemptions will no longer be an option for the vaccines that are currently required for entry into child care or school in California. Personal beliefs exemptions already on file will remain valid until the child reaches the next immunization checkpoint.
New Appeal Process: A licensee may file an appeal, in writing 15 business days from the date of receiving the penalty assessment. All appeals must be sent to:
300 N. Continental Blvd., Suite 290-A El Segundo, CA 90245 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. The fire extinguisher type 2-A:10-B:C must be serviced annually or as often as necessary and smoke and carbon monoxide detectors should check, 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. Any unusual incidents or injuries must be reported to the Department within 24 hours via telephone and within seven (7) days in writing. (use LIC624B for written report). Fire and safety drills must be performed every six months and documented for review by the Department. Children and Staff records must be maintained and updated as needed and must be available for review by the Department.
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. 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.
Emergency Disaster Plan, Parent’s Rights Poster and the Facility License are required to be posted.
Licensee informed fire drill to be completed every 6 month and to keep a log and to ensure records for staff and children as well as a roster are kept for 3 years.
SUPERVISOR'S NAME: Jennie FerreiraTELEPHONE: (424) 301-3067
LICENSING EVALUATOR NAME: Denise MirandaTELEPHONE: (424) 301-3055
LICENSING EVALUATOR SIGNATURE:

DATE: 06/26/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/26/2019
LIC809 (FAS) - (06/04)
Page: 3 of 5
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: VILLALOBOS, BLANCA FAMILY DAY CARE
FACILITY NUMBER: 191614561
VISIT DATE: 06/26/2019
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
evaluated and in good condition.
The licensee states that does not have weapons/firearms in the home and none observed by the LPA. LPA observed perimeter fencing for safety, age appropriate toys. All plants, trees and shrubs are maintained neat and clean.

At 2:15pm LPA reviewed the child’s file were incompleted.
Licensee states at this time is not providing Incidental Medical Services (IMS): This facility plans to provide Incidental Medical Services – IMS. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Family Child Care Homes Section 102417. 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

Incidental Medical Services Include: Blood-Glucose Monitoring for Diabetic Children, Administering Inhaled Medication, Administering EpiPen Jr. and EpiPen or other Epinephrine Auto-Injectors, Glucagon Administration, Gastrostomy Tube Care (G-tube care), Insulin Injections Administration, Anti-Seizure Administration, and Emptying an Ileostomy Bag.



The following was discussed with the licensee:
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 and a valid criminal record clearance associated to the facility license and immunization. Licensee was informed, Absence of Supervision: including, but not limited to, a child left unattended, a child left alone with a person under 18 years of age, and lack of supervision resulting in a child wandering away. (HSC 1597.58(c)(2)). Regulation(s): 102417(k)(1) Children shall not be left in parked vehicles. Civil penalty applies when a child is left unattended in a parked vehicle.
SUPERVISOR'S NAME: Jennie FerreiraTELEPHONE: (424) 301-3067
LICENSING EVALUATOR NAME: Denise MirandaTELEPHONE: (424) 301-3055
LICENSING EVALUATOR SIGNATURE:

DATE: 06/26/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/26/2019
LIC809 (FAS) - (06/04)
Page: 2 of 5
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: VILLALOBOS, BLANCA FAMILY DAY CARE
FACILITY NUMBER: 191614561
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/26/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
07/03/2019
Section Cited
CCR
102417
1
2
3
4
5
6
7
102417(b) Operation of a Family Child Care Home. The home shall be kept clean and orderly, with heating and ventilation for safety and comfort. This does not met the evidences by: on 6/26/19 LPA observed the home was observed not orderly, clean. LPA observed lots of clutter in the kitchen/dining area, living room, backyard, entry to
1
2
3
4
5
6
7
Licensee will have until 7/3/10 to bring the home organized, clean. LPA observed indoors and outddoors was not in compliance according to section 102417. The home must be safe, and clutter free indoor and outdoor. LPA Miranda will make a follow up inspection to observe the corrections.
8
9
10
11
12
13
14
backyard, outdoor laundry area and outdoor rear play space, which poses a potential Health and Safety risk to children in care.
8
9
10
11
12
13
14
Type B
07/26/2019
Section Cited
HSC
1596.813
1
2
3
4
5
6
7
Children enrolled in family day care homes; immunization requirements; rules and regulations. The department shall adopt regulations regarding immunization requirements for children enrolled in family day care homes in accordance with Chapter 1 (commencing with Section 120325) of Part 2 of Division 4105.
1
2
3
4
5
6
7
Licensee agreed to send no later than 7/26/2019 to LPA Miranda copy of of proof of immunization for child#1,2,3 and 4.
8
9
10
11
12
13
14
This does not met the evidence: LPA reviewed child#1,2,3, 4 and 5 and licensee did not have proof of children's immunization. which poses a potential Health and Safety risk to children in care.
8
9
10
11
12
13
14
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: Jennie FerreiraTELEPHONE: (424) 301-3067
LICENSING EVALUATOR NAME: Denise MirandaTELEPHONE: (424) 301-3055
LICENSING EVALUATOR SIGNATURE:

DATE: 06/26/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/26/2019
LIC809 (FAS) - (06/04)
Page: 4 of 5