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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 192005364
Report Date: 06/07/2023
Date Signed: 06/07/2023 05:05:58 PM


Document Has Been Signed on 06/07/2023 05:05 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:CASAVIELLES FAMILY CHILD CAREFACILITY NUMBER:
192005364
ADMINISTRATOR:CASAVIELLES ELDA-YANELYSFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(626) 919-7523
CITY:LA PUENTESTATE: CAZIP CODE:
91744
CAPACITY:14CENSUS: 6DATE:
06/07/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Elda CasaviellesTIME COMPLETED:
05:15 PM
NARRATIVE
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On 6/7/2023, Licensing Program Analyst (LPA) Carolyn Tuba conducted an unannounced required 1 year inspection to the above facility. A Covid risk assessment was conducted upon entry. When LPA first arrived to the home she met with assistant, Angela De La Rosa. During the visit LPA asked the Assistant the name of the adult who was inside the home, who was seen by the LPA when first arriving. The Assistant stated that it was her nephew and the Licensee's cousin who had been living here according to her since March or April of 2023. Licensee who arrived at approximately around 9:50 am. also confirmed the adult living in the home and reported that he had not been fingerprinted and asked where she could have them done. LPA advised types of locations and to check her local area. Licensee guided LPA on a tour of the facility. Per Licensee, there are 10 children currently enrolled. There were 6 children present upon arrival – 2 children were between ages 1 and 2 years, of age. The licensee provides breakfast, snack and lunch to the children in care.

The licensee states that there are no minor children currently living in the home. Per Licensee, she currently has 1 assistant. All adults present in the home are fingerprint cleared except for 1 Adult (Licensee's cousin). LPA reminded Licensee that all adults over the age of 18 years old need clearance or exemption prior to working, residing, or volunteering in the licensed childcare home.

This is a one-story home which consists of a single story, three-bedroom, two-bathroom home, living room, dining room, kitchen, garage front yard and backyard gated with iron fencing. The children have no access to living room, kitchen, restroom, three bedrooms and front yard.

Areas accessible to children were inspected as follows: den area that is used for day care purposes, one restroom, and part of the back yard.

Areas off limits include: The entire home that includes kitchen, living room, dining area, one bathroom, and detached garage.
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SUPERVISOR'S NAME: Ana ChicoTELEPHONE: (323) 981-3374
LICENSING EVALUATOR NAME: Carolyn TubaTELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:
DATE: 06/07/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/07/2023
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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Document Has Been Signed on 06/07/2023 05:05 PM - It Cannot Be Edited

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: CASAVIELLES FAMILY CHILD CARE
FACILITY NUMBER: 192005364

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/07/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
102370(d)
Criminal Record Clearance
(d) All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1596.871 shall prior to working, residing or volunteering in a licensed facility:

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on interview, the licensee did not comply with the section cited above in a non-cleared Adult (Licensee's Cousin) living in the home since March or April 2023 does not have fingerprint clearance, which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 06/08/2023
Plan of Correction
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Per Licensee non-cleared Adult will get fingerprinted. Licensee will send LPA a receipt of when fingerprints have been conducted.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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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: Ana ChicoTELEPHONE: (323) 981-3374
LICENSING EVALUATOR NAME: Carolyn TubaTELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:
DATE: 06/07/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/07/2023
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 06/07/2023 05:05 PM - It Cannot Be Edited

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: CASAVIELLES FAMILY CHILD CARE
FACILITY NUMBER: 192005364

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/07/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102425(j)(2)
Infant Safe Sleep
The provider shall supervise infants while they are sleeping and adhere to the following requirements: The provider shall check and document the following:

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on interview, the licensee did not comply with the section cited above in where a 15 minute sleep log is not being conducted per Licensee. LPA provided Licensee a sample to use, which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 06/07/2023
Plan of Correction
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Licensee will begin today conducting a 15 minute sleep log for chilren under 2 years of age.
Type B
Section Cited
HSC
1596.8662(b)(1)
Administration of Child Day Care Licensing
(1) On or before March 30, 2018, a person who, on January 1, 2018, is a licensed child day care provider, administrator, or employee of a licensed child day care facility shall complete the mandated reporter training provided pursuant to paragraphs (2) and (3) of subdivision (a), and shall complete renewal mandated reporter training every two years following the date on which he or she completed the initial mandated reporter training.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, the licensee did not comply with the section cited above Per Licensee Mandated Reporting Training has not been conducted by her or her assitant., which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 06/21/2023
Plan of Correction
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Per Licensee the Mandated Reporting Training will be conducted by licensee and her assitant. LPA advised since they are both Spanish speakers it will be available in thier language. They will provide the certificates to LPA.
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: Ana ChicoTELEPHONE: (323) 981-3374
LICENSING EVALUATOR NAME: Carolyn TubaTELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:
DATE: 06/07/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/07/2023
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 06/07/2023 05:05 PM - It Cannot Be Edited

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: CASAVIELLES FAMILY CHILD CARE
FACILITY NUMBER: 192005364

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/07/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
HSC
1597.622(c)
Administration of Child Day Care Licensing
(c) The family day care home shall maintain documentation of the required immunizations or exemptions from immunization, as set forth in this section, in the person's personnel record that is maintained by the family day care home.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, the licensee did not comply with the section cited above in per Licensee and Assist cannot provide proof of MMR, Tdap and Tuberculosis (TB), as well as non cleared fingerprint adult living in the home does not a current Tuberculosis (TB), which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 07/05/2023
Plan of Correction
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Per Licensee they will seek records of immunizations or will have immunizations administered. Licensee will sumit a copy of their immunizations to LPA.
Type B
Section Cited
CCR
102416(c)
Personnel Requirements
(c) The licensee and other personnel as specified shall complete training on preventive health practices, including pediatric cardiopulmonary resuscitation and pediatric first aid, pursuant to Health and Safety Code Section 1596.866.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, the licensee did not comply with the section cited above in as per Licensee and her assitant CPR/First Aid expired on 4/24/2023, which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 07/05/2023
Plan of Correction
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Per Licensee and her assistant they will be taking Pediatric First Aid and CPR, which includes the EMSA sticker. Licensee will submit proof of completion to LPA.

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: Ana ChicoTELEPHONE: (323) 981-3374
LICENSING EVALUATOR NAME: Carolyn TubaTELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:
DATE: 06/07/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/07/2023
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: CASAVIELLES FAMILY CHILD CARE
FACILITY NUMBER: 192005364
VISIT DATE: 06/07/2023
NARRATIVE
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All areas identified on the facility sketch that are accessible for children to use were inspected for safety, comfort, and cleanliness. There is telephone service via a landline during operation hours of Monday-Friday 6:00 am-6:30 pm and working with age groups of 0-10 years old.

There is a cooling system. The following was observed and reviewed during this inspection.



Detergents, cleaning compounds, and medications were observed to be inaccessible to children. Poisons are locked in a off limits shed in the backyard. The restroom that children use was observed to be safe and sanitary.

LPA did observe a fireplace in the daycare room which was barricaded with a bookshelf and inaccessible for children in care. The valve on the required 2A 10BC fire extinguisher indicates fully charged. Per Licensee, it had been purchased in the last 6 months. Smoke and carbon monoxide detectors were tested and are operable. Per Licensee a fire and disaster drills are conducted every month but have not been documented. LPA advised that they need to be done at least once every six months and provided a sample of a Fire/Emergency drill log to document the date and time of each drill. The last emergency drill conducted per Licensee was in May, 2023.

Emergency Disaster Plan, Parent’s Rights Poster and the Facility License were observed to be posted in the daycare room.

There are toys available for children. Appropriate sleeping arrangements were observed.

Licensee states that they are currently not caring for infants under 12 months but does accept infants. LPA discussed the safe sleep regulations with licensee and discussed the Child Care Licensing Safe Sleep webpage 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. LPA advised the Licensee with regards to safe sleep and that infants under 24 months shall be checked on every 15 minutes and the time of each 15-minute check shall be documented with child’s name,
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SUPERVISOR'S NAME: Ana ChicoTELEPHONE: (323) 981-3374
LICENSING EVALUATOR NAME: Carolyn TubaTELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:

DATE: 06/07/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/07/2023
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: CASAVIELLES FAMILY CHILD CARE
FACILITY NUMBER: 192005364
VISIT DATE: 06/07/2023
NARRATIVE
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date and initials of the person who checked on the child. LPA provided Licensee a sample 15 minute-log as there is no documentation available for review. The LIC 9227 Individual Infant Sleeping Plan shall be completed for each infant up to 12 months of age. LPA provided Licensee with a copy. LPA advised Licensee the Provider Information Notice (PIN) 20-24 CCP: Recently Approved Safe Sleep Regulations in Effect.

Per Licensee she did not have a children’s roster available, so LPA provided a copy to update children’s information. LPA did review children’s files which were complete with all documents required by the Department.

LPA did not observe the following items during the inspection: Infant Walkers, Johnny Jumpers, Saucer Chairs, Trampolines and/or any other item that fall into these categories are not permitted in a family childcare facility.



Smoking is prohibited in a licensed Family Child Care Home. Per Licensee, no one smokes in the home.

Currently, children are using the back yard for outdoor play time. The outdoor play area was observed to be fenced. LPA observed that the outdoor yard has toys, play structures and other materials for children to play with.

There was one small dog on the premises. LPA observed that dog is kept inside the home away from the children.

At 11:20 am LPA reviewed 10 children's files and found that 10 out of 10 were complete.

The licensee is observed to be operating within the license capacity limitations.

The licensee and other personnel have not completed training on preventive health practices including Pediatric First Aid and CPR. The licensee's Pediatric First Aid and CPR expired on 04/24/2023 which includes the EMSA sticker. There are first aid supplies available.

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SUPERVISOR'S NAME: Ana ChicoTELEPHONE: (323) 981-3374
LICENSING EVALUATOR NAME: Carolyn TubaTELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:

DATE: 06/07/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/07/2023
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, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME: CASAVIELLES FAMILY CHILD CARE
FACILITY NUMBER: 192005364
VISIT DATE: 06/07/2023
NARRATIVE
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LPA observed that the Licensee and assistant do have proof of immunization record MMR, Tdap and TB. Mandated Reporter AB 1207 compliant Child Care Training Certificate for Licensee and Assistant was not on file. www.mandatedreporterca.com LPA advised that adult (Licensee’s cousin) requires a Tuberculosis (TB) test within the last year. Licensee states that there are no firearms stored in the home.

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 Pediatric First Aid and CPR training, Immunization's (TDAP, MMR, Influenza), mandated reporter training and a valid criminal record clearance associated to the facility license.



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

LPA advised the licensee to access forms, regulations and quarterly updates online at: www.ccld.ca.gov.

Licensee 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.

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.


Based on the LPA’s observations and records review, the following deficiencies listed on the attached LIC 809D (deficiency page) are being cited in accordance with California Code of Regulations Title 22. Deficiencies that are being cited and need to be cleared to protect the children’s health & safety.
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SUPERVISOR'S NAME: Ana ChicoTELEPHONE: (323) 981-3374
LICENSING EVALUATOR NAME: Carolyn TubaTELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:

DATE: 06/07/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/07/2023
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, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME: CASAVIELLES FAMILY CHILD CARE
FACILITY NUMBER: 192005364
VISIT DATE: 06/07/2023
NARRATIVE
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One (1) Type A and civil penalties of $500 will be assessed. - A copy of this report shall be provided to the parent/guardian of children currently enrolled by the next business day or immediately upon return. A copy of this report shall also be provided to the parent/guardian of any newly enrolled children for the next 12 months (1 year). The Acknowledgement form must be maintained in each child’s file immediately upon receipt from parent. Licensee/Director was provided with a copy of the parent Acknowledgement of Receipt of Licensing Reports Form during this visit.

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

Exit interview was conducted, appeal rights given, and a copy of this report was reviewed with the Licensee, Elda Casavielles

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SUPERVISOR'S NAME: Ana ChicoTELEPHONE: (323) 981-3374
LICENSING EVALUATOR NAME: Carolyn TubaTELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:

DATE: 06/07/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/07/2023
LIC809 (FAS) - (06/04)
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