192001144-4-27-2022-33-CC-CRES-CDW27J-20220427170850

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 192001144
Report Date: 04/27/2022
Date Signed: 04/27/2022 05:09:04 PM

Document Has Been Signed on 04/27/2022 05:09 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 CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME:	PLASENCIA FAMILY CHILD CARE		FACILITY NUMBER:	192001144
ADMINISTRATOR:	PLASENCIA, DOLORES		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(626) 531-6548
CITY:	MONROVIA	STATE: CA	ZIP CODE:	91016
CAPACITY:	14	CENSUS: 5	DATE:	04/27/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	01:25 PM
MET WITH:	Dolores Plasencia		TIME COMPLETED:	05:15 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	Licensing Program Analyst (LPA) Cynthia Reyes conducted an unannounced 1 year annual inspection on this date. LPA met with Licensee Dolores Plasencia and a copy of the Entrance Checklist for Child Care homes form (LIC 126) was provided. The facility operating hours are from 6 AM to 7 PM, Monday through Friday. A risk assessment was conducted upon entry- Due to COVID- 19 precautionary measures were taken during the entire inspection and all individuals present wore appropriate personal protective equipment. 1:30PM Licensee guided analysts on a tour of the facility. Per Licensee, there are 2 infants currently enrolled. A current children’s roster was available for review. There was 1 infant present upon arrival. The licensee states that 3 adults and 0 children currently live in the home. All adults present in the home have obtained a criminal record clearance or exemption prior to working, residing or volunteering in the licensed child care home. Licensee states that there are no firearms or weapons in the home. Areas that are accessible to children are as follows: Family room, W/Covered fire place, Kitchen bathroom and back yard. Areas off limits: Garage, Master bedroom W/Bath, 2 bedrooms, dinning area, front living room and front yard. Rooms that are off-limits need to be made inaccessible during operating hours The Licensee does understand that licensing staff may have access to off-limit areas during inspection visit if necessary. Continue on next page.

SUPERVISOR'S NAME: Christina Gabelman	TELEPHONE: (323) 981-3380
LICENSING EVALUATOR NAME: Cynthia Reyes	TELEPHONE: (323) 981-3369
LICENSING EVALUATOR SIGNATURE:	DATE: 04/27/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/27/2022

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: PLASENCIA FAMILY CHILD CARE	FACILITY NUMBER: 192001144
	VISIT DATE: 04/27/2022

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The following was observed and reviewed during this inspection.

2PM All areas identified on the facility sketch were inspected for safety, comfort, and cleanliness. There is telephone service via a land line however it is not working as of this date and a cellphone that stays at the facility during operation hours. There is ventilation and heating (central).

Several different cleaning compounds were observed to be accessible to children under the kitchen sink as the plastic locks are worn and are easy to open. The restroom that children use was observed to have Clorox wipes and Lysol accessible to children under the unlocked sink.

LPA Reyes observed a fireplace in the home and is barricaded. The valve on the required 2A 10BC fire extinguisher indicates fully charged with last service date of 12/21/2021. Smoke and carbon monoxide detectors were tested and are operable. All large family day care homes shall conduct fire and disaster drills at least once every 3 months, and document the date and time of each drill. No proof of any drills conducted. Emergency Disaster Plan, Parent’s Rights Poster and the Facility License were observed to be posted on the parent board and visible to parents and all to see.

The home is observed to be clean and orderly. There are toys available for children. Appropriate sleeping arrangements which consist of pack-n-plays for each of the 2 infants in care. Mats are used for the other children.

Licensee states that they are currently caring for infants. LPA discussed the safe sleep regulations with licensee Dolores and discussed the Child Care Licensing Safe Sleep web page at: https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPA also informed licensee of the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at https://www.cpsc.gov/ and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment.

SUPERVISOR'S NAME: Christina Gabelman	TELEPHONE: (323) 981-3380
LICENSING EVALUATOR NAME: Cynthia Reyes	TELEPHONE: (323) 981-3369
LICENSING EVALUATOR SIGNATURE:	DATE: 04/27/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/27/2022

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: PLASENCIA FAMILY CHILD CARE	FACILITY NUMBER: 192001144
	VISIT DATE: 04/27/2022

NARRATIVE

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Smoking is prohibited in a licensed Family Child Care Home. Per Licensee, no one smokes in the home.
LPA did not observe any objects that can pose a danger to children in care. There are 4 small dogs on the premises outside. The licensee is observed to be operating within the license capacity limitations.

At 3 PM Children’s records were reviewed and proof of all children TB was missing. Emergency information and was reviewed and none were observed to have missing information.

The licensee and other personnel have completed training on preventive health practices including Pediatric First Aid and CPR. The licensee Pediatric First Aid and CPR expires on 01/30/2024. There are first aid supplies available.

LPA observed that the Licensee does not have proof of all immunization records for herself. Licensee Mandated Reporter AB 1207 compliant Child Care Training Certificate on file. Mandated reporter training must be completed every 2 years. www.mandatedreporterca.com. Conducted on 02/10/2021.

Licensing staff consulted with licensing regarding COVID-19 health and safety guidelines on this date. LPA Reyes observed children over two years old in care. LPA informed Licensee, that the usage of mask is a mandate and that every adult and child over the age of two should be wearing a mask.

LPA advised the licensee to access forms, regulations and quarterly updates on line at: www.ccld.ca.gov.
Reporting Unusual Incidents: MPROIncidentReports@dss.ca.gov. CCL Resources for Parents & Providers: https://ccld.childcarevideos.org/ Provider Information Notices (PINs): https://www.cdss.ca.gov/inforesources/community-care-licensing/policy/provider-information-notices/child-care

Licensee Dolores was reminded that all adults 18 and over living or working in the home, including employees and volunteers, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a licensed Family Child Care Home. A civil penalty of $100.00 minimum/day up to $500.00 maximum per day/per person will be assessed if this regulation is violated.

SUPERVISOR'S NAME: Christina Gabelman	TELEPHONE: (323) 981-3380
LICENSING EVALUATOR NAME: Cynthia Reyes	TELEPHONE: (323) 981-3369
LICENSING EVALUATOR SIGNATURE:	DATE: 04/27/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/27/2022

LIC809 (FAS) - (06/04)

Page: 3 of 4

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: PLASENCIA FAMILY CHILD CARE	FACILITY NUMBER: 192001144
	VISIT DATE: 04/27/2022

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IMS (Not at this time)
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

4PM To improve the quality and value of the new inspection process, a survey will be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or tools, please send them by email to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/process.

Deficiencies will be cited on a continuation inspection due to computer technical issues.

A notice of site visit was given and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

5:10 PM Exit interview conducted and report was reviewed with Licensee, Dolores Plasencia.

SUPERVISOR'S NAME: Christina Gabelman	TELEPHONE: (323) 981-3380
LICENSING EVALUATOR NAME: Cynthia Reyes	TELEPHONE: (323) 981-3369
LICENSING EVALUATOR SIGNATURE:	DATE: 04/27/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/27/2022

LIC809 (FAS) - (06/04)

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