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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 191614561
Report Date: 03/12/2020
Date Signed: 03/12/2020 12:37:35 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, 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:
03/12/2020
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
08:30 AM
MET WITH:Licensee Blanca VillalobosTIME COMPLETED:
01:00 PM
NARRATIVE
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On March 12th, 2020 at 8:30am, Licensing Program Analyst Lisa Rios made an unannounced visit was made for the purpose of conducting a Annual Inspection. LPA Rios met with the licensee's daughter and toured the home inside and out. The licensee was shopping for the days lunch and came to the home at 9:30am. There are 0 children residing in the home. There were 12 children present at the time of the visit with two teachers. LPA Rios confirmed that all adults residing/working in the home have criminal record clearances.

The facility is a 2 bedroom 1 bathroom home with a living room and large kitchen. Care is provided in the outside school house, back porch, backyard and living.

The home has a current Plan of Operation and licensee has been instructed to report changes in the plan of operation which affects children. Licensee has been reminded to report children injuries requiring medical treatment and other special incidents. The home has an emergency drill log. All required postings are posted.

LPA Rios observed the required fire extinguisher 2A10BC that was serviced on 7/27/2019 (one in the backyard and one in the kitchen), two working smoke and carbon monoxide detectors located in the outside classroom, , age appropriate toys, napping equipment, complete first aid kit is hanging from the back porch, and emergency supplies located in the backyard classroom. LPA did not observe toxins and hazardous materials accessible to children in the classroom bathroom nor kitchen. Licensee does not have current CPR/Pediatric certification. Licensee states there are no weapons in the home and none observed by the LPA. There is telephone service, heating, lighting and ventilation were evaluated and in good condition. There are NO bodies of water in the premises. A review of the children's files shows that 3 do not have immunization records. See 809D

This Family Child Care Home was not found to be in substantial compliance.

SUPERVISOR'S NAME: Peter FloresTELEPHONE: (424) 301-3077
LICENSING EVALUATOR NAME: Lisa RiosTELEPHONE: (424) 301-3072
LICENSING EVALUATOR SIGNATURE:

DATE: 03/12/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/12/2020
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 8
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: 03/12/2020
NARRATIVE
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The following was discussed:

Assembly Bill (AB) 633: Upon receipt by the licensee, licensees are to provide to parents/guardians the following: Copies of any licensing reports that document a Type A citation- this includes facility visits and substantiated complaint investigations; copy of licensing documents pertaining to a conference conducted by a local licensing agency management representative and the licensee of this family child care home in which issues of noncompliance are discussed or copies of a summary of an accusation indicating the Department's intent to revoke the facility's license. Copies of any of the above licensing documents the licensee has received in the prior 12 months shall be provided to parents/guardians of newly enrolled child at the facility.

Senate Bill (SB) 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.



Mandated Reporter: Beginning on January 1, 2018, AB 1207, requires all licensed providers, applicants, directors and employees to complete training as specified on their mandated reporter duties and to renew their training every two years. Volunteers are encouraged but not required to take the training. Website: www.mandatedreporterca.com
Please Note: We have recently made changes to our website. The general training for mandated reporters is now a required prerequisite for all the profession-specific trainings. The general training is a one-time prerequisite and needs to be completed prior to completing the profession-specific training for the first time using the updated online platform, launched in December 2018. The general training does not need to be retaken when you renew your profession-specific training certificate in subsequent years. Altogether, the general training and the profession-specific trainings meet the training requirements of the California Child Abuse and Neglect Reporting Act (CANRA), Education Code for school personnel, and Health and Safety Code for licensed child care providers.



SUPERVISOR'S NAME: Peter FloresTELEPHONE: (424) 301-3077
LICENSING EVALUATOR NAME: Lisa RiosTELEPHONE: (424) 301-3072
LICENSING EVALUATOR SIGNATURE:

DATE: 03/12/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/12/2020
LIC809 (FAS) - (06/04)
Page: 7 of 8
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: 03/12/2020
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
03/12/2020
Section Cited

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HSC 1596.841 Each child day care facility shall maintain a current roster of children who are provided care in the facility.The roster shall include the name, address, and daytime telephone number of the child's parent or guardian, and the name and telephone number of the child's physician. This roster shall be available to the licensing agency upon request.
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This requiement is not met as evidenced by:
Based on ercords review the licensee was unable to provide a current roster of the children.
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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: Peter FloresTELEPHONE: (424) 301-3077
LICENSING EVALUATOR NAME: Lisa RiosTELEPHONE: (424) 301-3072
LICENSING EVALUATOR SIGNATURE:
DATE: 03/12/2020
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/12/2020
LIC809 (FAS) - (06/04)
Page: 3 of 8
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: 03/12/2020
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
03/12/2020
Section Cited

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Operation of a Family Child Care Home (g)
The home shall be free from defects or conditions which might endanger a child.
This requirement is not met as evidenced by:
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There is a broken window pane in the french door leading to the classroom. There is also a boken and taped up window in the livingroom where children sleep. This poses an immediate risk to the 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: Peter FloresTELEPHONE: (424) 301-3077
LICENSING EVALUATOR NAME: Lisa RiosTELEPHONE: (424) 301-3072
LICENSING EVALUATOR SIGNATURE:
DATE: 03/12/2020
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/12/2020
LIC809 (FAS) - (06/04)
Page: 4 of 8
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: 03/12/2020
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
03/12/2020
Section Cited

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b) ...a licensee of a large family day care home shall ensure that at least one person who has a current certificate in pediatric first aid and pediatric cardiopulmonary resuscitation shall be available at all times when children are present at the facility, or when children are off-site of the facility for facility activities....
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This requirement is not met as evidenced by:
The licensee and her staff have CPR cards that expired back in November.
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Type B
03/12/2020
Section Cited

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2) A current pediatric first aid card issued either by the American Red Cross or by a training program that has been approved by the Emergency Medical Services Authority pursuant to Section 1797.191.
This requiement is not met as evidenced by:
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The licensee and her staff have First Aid ards that expired back in Novemeber.
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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: Peter FloresTELEPHONE: (424) 301-3077
LICENSING EVALUATOR NAME: Lisa RiosTELEPHONE: (424) 301-3072
LICENSING EVALUATOR SIGNATURE:
DATE: 03/12/2020
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/12/2020
LIC809 (FAS) - (06/04)
Page: 5 of 8
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: 03/12/2020
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
03/12/2020
Section Cited

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102416 (1) (3) A certificate of completion of a course or courses in preventive health practices as defined in subdivision (a) or certified copies of transcripts that identify the number of hours and the specific course or courses taken for training in preventive health practices as defined in subdivision (a).
This requirement is not met as evidenced by:
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Based on a file record review the licensee and her staff have not completed preventative health training.
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Type B
03/12/2020
Section Cited

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1596.8662 Proof of Madated Reporter Training
(b) (1)   On or before March 30, 2018, a person who, on January 1, 2018, is a licensed child care provider...shall complete the mandated reporter training...renewal mandated reporter training every two years...
This requirement is not met as evidenced by:
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Based on interview, the Licensee's 2 assistant's have not completed Mandated Reporter training as required per Health and Safety Codes; which poses a potential risk to the health, safety and/or personal rights risk of the 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: Peter FloresTELEPHONE: (424) 301-3077
LICENSING EVALUATOR NAME: Lisa RiosTELEPHONE: (424) 301-3072
LICENSING EVALUATOR SIGNATURE:
DATE: 03/12/2020
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/12/2020
LIC809 (FAS) - (06/04)
Page: 2 of 8
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: 03/12/2020
NARRATIVE
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Update on Incidental Medical Services: Facilities that provide Incidental Medical Services (IMS) must identify those services in their facility’s Plan of Operation and submit an updated Plan of Operation 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.

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

Licensee was reminded that the following are guidelines and recommendations for best practices only. When the regulation is approved providers will be notified through Provider Information Notice (PIN).

*Always place infants on their backs for sleeping


*Use a tight-fitting sheet on the crib or play yard mattress
*Do not hang any items from the crib or above the crib
*Keep all items out of the crib or play yard
*Pacifiers may be used as long as they do not have items attached to them
*Infants should not be swaddled or have any items covering them while sleeping
*The temperature of the room should be comfortable enough for an adult to wear a
SUPERVISOR'S NAME: Peter FloresTELEPHONE: (424) 301-3077
LICENSING EVALUATOR NAME: Lisa RiosTELEPHONE: (424) 301-3072
LICENSING EVALUATOR SIGNATURE:

DATE: 03/12/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/12/2020
LIC809 (FAS) - (06/04)
Page: 6 of 8
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: 03/12/2020
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
03/12/2020
Section Cited

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1597.622(a)(1)
... immunization requirements;...
(a) (1)... a person shall not be employed or volunteer ... he or she has not been immunized against influenza, pertussis, and measles. ... This requirement is not met as evidenced by:
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Licensee was not able to provide a copy of immunizations for any adults providing care an supervision. This poses a potential risk to the children in care.
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Type B
03/12/2020
Section Cited

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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. This requirement is not met as evidenced by:
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Based on a review of the children's files, 3 children do not have immunization records.
This poses a potential health risk to 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: Peter FloresTELEPHONE: (424) 301-3077
LICENSING EVALUATOR NAME: Lisa RiosTELEPHONE: (424) 301-3072
LICENSING EVALUATOR SIGNATURE:
DATE: 03/12/2020
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/12/2020
LIC809 (FAS) - (06/04)
Page: 8 of 8