192007936-12-8-2023-33-CC-VMGA-CYC2SY-20231208163954

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 192007936
Report Date: 12/08/2023
Date Signed: 12/08/2023 04:40:05 PM

Document Has Been Signed on 12/08/2023 04:40 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
MONTEREY PARK CC RO, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME:	MATHEU FAMILY CHILD CARE		FACILITY NUMBER:	192007936
ADMINISTRATOR:	MATHEU, GRACIA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(323) 257-6278
CITY:	LOS ANGELES	STATE: CA	ZIP CODE:	90042
CAPACITY:	12	CENSUS: 8	DATE:	12/08/2023
TYPE OF VISIT:	Required - 3 Year	UNANNOUNCED	TIME BEGAN:	01:10 PM
MET WITH:	Gratzia Quijano		TIME COMPLETED:	05:00 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) Veronica Martinez Garza conducted an unannounced Required 3-year inspection at the above facility on 12/08/23 at 01:10 p.m. LPA met with Gratzia Quijano, licensee’s daughter/assistant who guided analyst on a tour of the facility. Per assistant, Gracia Matheu, licensee went out for the weekend and will return on Sunday. There were 08 napping children present during this inspection. Per assistant, 08 children are enrolled.

Operation hours are Monday through Friday 08:00 a.m. – 05:00 p.m.

This is a one-story home which consists of 2 bedrooms, 2 bathrooms, kitchen, living room, dining room, front and backyard (fenced). Children use the bathroom near the dining room, living room, and front yard for play. Per assistant, areas off limits to children and parents include: 2 bedrooms, kitchen, and back yard. Per assistant, family members residing in the home are 2 adults and 0 minors. All individuals present in the home have obtained a criminal record clearance or exemption prior to working, residing, or volunteering in a licensed home. Individuals living in the home are identified on the attached LIC811.

LPA toured all areas identified on the facility sketch used by children during this visit and were inspected for safety, comfort, and cleanliness. LPA toured the living room and observed a barricaded chimney. LPA observed toys and other age-appropriate materials available for children. Appropriate napping equipment (play yards) and mats were observed in the living room. LPA observed that the play yards and mats do not hinder the entrance or exit to and from the space they are sleeping in. Play yards do not have anything hanging on the sides or on top. LPA did not observe any hazardous materials throughout this inspection; exposed outlets were observed to have covers. There’s also a first aid kit readily available. LPA observed the bathroom children use to be safe and in sanitary conditions. LPA did not observe any hazardous materials. All area’s that are off-limits to children were observed inaccessible. LPA observed the window frames to be chipping, the walls in the living room and dining room have some chipping and the wall appear to have been scribbled by day care children.

Page 1 of 4

SUPERVISOR'S NAME: Ana Chico	TELEPHONE: (323) 981-3374
LICENSING EVALUATOR NAME: Veronica Martinez-Garza	TELEPHONE: (323) 981-3386
LICENSING EVALUATOR SIGNATURE:	DATE: 12/08/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/08/2023

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 6

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MONTEREY PARK CC RO, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME: MATHEU FAMILY CHILD CARE	FACILITY NUMBER: 192007936
	VISIT DATE: 12/08/2023

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

LPA observed the following required posted documentation in the dining room of the facility: Facility License, Publication (PUB) 394- Notification of Parent Rights and Licensing Form (LIC) 9148- Earthquake Preparedness form. LPA reviewed facility records LIC 610- Emergency Disaster Plan and Disaster drill log. Children’s roster was available during this inspection and was observed to be current.

All homes shall conduct fire and disaster drills at least once every six months and document the date and time of each drill. Last drill documented was 11/22/23.

Licensee does understand that licensing staff may have access to off-limit areas during inspection visit if necessary.

**Rooms that are off-limits need to be made inaccessible during operating hours**

Per assistant, food is provided to all children in care. The home maintains telephone service via a landline and cell phone. There is central ventilation and heating.

Detergents, cleaning compounds, medications, and other items which could pose a danger to children were observed to be inaccessible to children. The assistant states that there are no poisons in the home and understands that storage areas for poisons must be locked with a key or combination lock.

Per assistant, there are no firearms or weapons stored in the home.

Per assistant, there are no pets on the premises.

At 03:12 p.m. smoke and carbon monoxide detectors were tested and are operable. The valve on the required 2: A10 BC fire extinguisher indicates fully charged and was serviced on 09/08/23, as indicated on the service tag. Per State Fire Marshall standards, fire extinguishers shall be serviced annually.

Isolation area for sick children waiting to be picked up is in the dining room with supervision.

Currently children are using the front yard for outdoor play and is fully gated. LPA observed the front yard to have adequate shade and age-appropriate play equipment for children in care. LPA also observed a trampoline that seems to be worn out. The trampoline pad skirt and base are torn. LPA observed the trampoline poles that hold the net are flaccid. LPA advised assistant not to allow the use of trampolines as recommended on our website under SHINE Element 6: Physical Activity. LPA provided a copy of the SHINE Element 6: Physical Activity. Trampoline should be replaced and follow manufactures guidelines. Assistant understands that children should be supervised at all times. Per assistant, the trampoline will be tossed away.

Page 2 of 4

SUPERVISOR'S NAME: Ana Chico	TELEPHONE: (323) 981-3374
LICENSING EVALUATOR NAME: Veronica Martinez-Garza	TELEPHONE: (323) 981-3386
LICENSING EVALUATOR SIGNATURE:	DATE: 12/08/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/08/2023

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
MONTEREY PARK CC RO, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME: MATHEU FAMILY CHILD CARE	FACILITY NUMBER: 192007936
	VISIT DATE: 12/08/2023

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

LPA did not observe any pools, spas, hot tubs, fishponds, or similar bodies of water during the inspection.

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

Children’s records were reviewed for (LIC) 282- Affidavit Regarding Liability Insurance, Immunization's Records, LIC 700- Identification and Emergency Information, LIC 627- Consent for Medical Treatment, LIC 995A Notification of Parents’ Rights, LIC 9227- Infant sleep form (0-12 months, and documentation of 15-minute Infant Sleep Check (0-24 months). LPA observed Child 3 (C3 thru 5) are missing proof of 15-minute infant sleep check. LPA provided consultation.

Licensee and assistant’s records were reviewed for approved Proof of immunizations against measles, pertussis and influenza or influenza declination, TB clearance or risk assessment, LIC 9108- Statement Acknowledging Requirement to Report Child Abuse and current Mandated Reporter Training Certificate. Licensee’s Mandated Reporter Training expires on 06/27/23. Licensee’s Pediatric CPR/FA expires 10/2024. Licensee is missing proof of Flu vaccine or declination letter. Assistant #1 is missing proof of a current Mandated Reporter Training as it expired on 06/27/23. Assistant #2 is missing proof of immunizations and Mandated Reporter Training.

AB1207 Mandated Child Abuse Reporting – 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

The assistant is operating within proper capacity and ratios. LPA observed assistant to be present at the home and providing adequate care and supervision.

Licensee is caring for 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-andresources/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 provided PIN 20-24-CCP, and PUB 217 Never Shake a Baby Brochure.

No infant walkers, No baby bouncers, No Johnny jumpers, No exersaucers and any other item that falls into that category.

Page 3 of 4

SUPERVISOR'S NAME: Ana Chico	TELEPHONE: (323) 981-3374
LICENSING EVALUATOR NAME: Veronica Martinez-Garza	TELEPHONE: (323) 981-3386
LICENSING EVALUATOR SIGNATURE:	DATE: 12/08/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/08/2023

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
MONTEREY PARK CC RO, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME: MATHEU FAMILY CHILD CARE	FACILITY NUMBER: 192007936
	VISIT DATE: 12/08/2023

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

Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02- CCP. 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: https://www.ada.gov/resources/child-care-centers/.

Licensee was reminded that all adults 18 and over living or working in the home, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, 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 for a maximum of 5 days or, if the penalty is for a repeat violation, for a maximum of 30 days per person will be assessed if this regulation is violated.

To improve the quality and value of the new inspection process, a survey may 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 CARE tools, please send email inquiries 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/inspection-process.

Assistant was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain child care by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.

Assistant Gratzia Quijano confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS.

The following deficiencies were cited in accordance with Title 22 of the California Code of Regulations and Health & Safety Codes. Please see 809D for documentation of deficiencies.

Exit interview conducted and report was reviewed with the Assistant Gratzia Quijano.

Page 4 of 4

SUPERVISOR'S NAME: Ana Chico	TELEPHONE: (323) 981-3374
LICENSING EVALUATOR NAME: Veronica Martinez-Garza	TELEPHONE: (323) 981-3386
LICENSING EVALUATOR SIGNATURE:	DATE: 12/08/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/08/2023

LIC809 (FAS) - (06/04)

Page: 4 of 6

Document Has Been Signed on 12/08/2023 04:40 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
MONTEREY PARK CC RO, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME: MATHEU FAMILY CHILD CARE	FACILITY NUMBER: 192007936
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 12/08/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

102425(j)(1)

Infant Safe Sleep

The provider shall supervise infants while they are sleeping and adhere to the following requirements: The provider shall physically check on the infant every 15 minutes. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation, the licensee did not comply with the section cited above in Child 3, 4, and 5 are missing the 15 minute documentation log, which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 12/15/2023
	Plan of Correction
1 2 3 4	Per assistant, proof of the 15 minute documentation sleep log will be sent to LPA by POC due date.

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
1 2 3 4	Based on observation, the licensee did not comply with the section cited above in Licensee, assistant #1, and assistant #2 are missing proof of Mandated Reporter Training, which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 01/08/2024
	Plan of Correction
1 2 3 4	Per assistant, proof of Mandated Repoter Training will be submitted to LPA by POC due date.

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 Chico	TELEPHONE: (323) 981-3374
LICENSING EVALUATOR NAME: Veronica Martinez-Garza	TELEPHONE: (323) 981-3386
LICENSING EVALUATOR SIGNATURE:	DATE: 12/08/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/08/2023

LIC809 (FAS) - (06/04)

Page: 5 of 6

Document Has Been Signed on 12/08/2023 04:40 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
MONTEREY PARK CC RO, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME: MATHEU FAMILY CHILD CARE	FACILITY NUMBER: 192007936
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 12/08/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

HSC

1597.622(a)(1)

General Provisions and Definitions

(1) Commencing September 1, 2016, a person shall not be employed or volunteer at a family day care home if he or she has not been immunized against influenza, pertussis, and measles. Each employee and volunteer shall receive an influenza vaccination between August 1 and December 1 of each year. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation, the licensee did not comply with the section cited above in Licensee is missing proof of Influenza vaccine or declination letter. Assistant #2 is missing proof of immunizations, which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 01/08/2024
	Plan of Correction
1 2 3 4	Per assistant, proof of immunizations will be submitted to LPA by POC due date.

Section Cited


	Deficient Practice Statement
1 2 3 4
	POC Due Date:
	Plan of Correction
1 2 3 4

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 Chico	TELEPHONE: (323) 981-3374
LICENSING EVALUATOR NAME: Veronica Martinez-Garza	TELEPHONE: (323) 981-3386
LICENSING EVALUATOR SIGNATURE:	DATE: 12/08/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/08/2023

LIC809 (FAS) - (06/04)

Page: 6 of 6