192010484-4-8-2025-54-CC-SSAZ-DFJTN6-20250408145212

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 192010484
Report Date: 04/08/2025
Date Signed: 04/08/2025 02:52:23 PM

Document Has Been Signed on 04/08/2025 02:52 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 CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME:	AYALA FAMILY CHILD CARE		FACILITY NUMBER:	192010484
ADMINISTRATOR/ DIRECTOR:	AYALA, DONIELLE FELINE		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(310) 999-2508
CITY:	CARSON	STATE: CA	ZIP CODE:	90745
CAPACITY: 14	TOTAL ENROLLED CHILDREN: 14	CENSUS: 9	DATE:	04/08/2025
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	12:20 PM
MET WITH:	D. Ayala, Licensee		TIME VISIT/ INSPECTION COMPLETED:	03:12 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 Analysts (LPAs) Susann Sanchez and Christine Nolan conducted an unannounced annual required inspection at the above facility. LPAs met with Donielle Ayala, Licensee who guided analysts on a tour of the facility. There were eight children, one infant present during today's inspection with the Licensee and a assistant. Facility capacity is in compliance for a Large Family Child Care Home. Hours of operation are Mon-Fri 7:00 AM - 5:30PM. This is a two story home which consists of four bedrooms and three bathrooms. Areas used by the children include the living room, dining room, den (play room), downstairs restroom, kitchen, and back yard. Per Licensee, areas off limits to children and parents include: complete second floor, all bedrooms, two restrooms, front yard and garage. Food is provided by Licensee. Licensee was reminded if children bring food from home it must be labeled with the child’s name and properly stored or refrigerated. Individuals residing in the home have been discussed and noted. All adults present in the home have obtained a criminal record clearance or exemption. All areas identified on the facility sketch that are accessible for children to use were inspected for safety, comfort, and cleanliness. The following was observed and reviewed during this inspection: LPA reviewed required posted documentation for Facility License, Publication (PUB) 394- Notification of Parent Rights and Licensing Form (LIC) 9148- Earthquake Preparedness form. Facility records were reviewed for LIC 9040- Facility Roster, LIC 610- Facility Disaster Plan and Disaster drill log, last drill conducted on 03/03/25. Fire extinguisher indicated fully charged and is located in the dining area. Smoke and carbon monoxide were tested and operable. The home maintains telephone service via cell phone phone. The home is observed to be clean and orderly. There are toys and other age appropriate material available for children.

Valarie Cook	TELEPHONE: (323) 513-3858
Susann Sanchez	TELEPHONE: (323) 981-3366
	DATE: 04/08/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/08/2025

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 CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME: AYALA FAMILY CHILD CARE	FACILITY NUMBER: 192010484
	VISIT DATE: 04/08/2025

NARRATIVE

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Licensee does for infant. LPAs reminded Licensee of the following: napping equipment can not block entrances or exits. Infant mattresses needs to be firm with tightly fitted sheets. Cribs or Play Yards cannot have loose object, bumpers, objects hanging, or objects attached to the play yards. Each infant should have their own play yard and bedding. Licensee has used the new Safe sleep regulations and the 15 minute sleep check documentation for infants 0-24 months in the past when she had infants enrolled. Licensee does not provide any overnight care at this time.

Currently, children are using the back yard for outdoor play. The outdoor play area was observed to be fenced. LPA observed that the outdoor yard has toys and other materials for children to play with. LPA did not observe any objects that could be hazardous to children in care. Per Licensee, sometimes children go walking to Friendship Park. Per Licensee, children play with water pad in the front yard only during summer time. There are no pools or spas, or other bodies of water.

Children’s records were reviewed for (LIC) 282- Affidavit Regarding Liability Insurance, Immunization Records, LIC 700- Identification and Emergency Information, LIC 627- Consent for Medical Treatment, LIC 995A Notification of Parents’ Rights, 15 minute Infant Sleep Check (0-24 months)

Staff records were reviewed for approved LIC-501: Personnel Record, LIC 508- Criminal Record Statement, Proof of immunization 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 which 04/04/2024.
At 1:35pm, during file review, LPA observed an online Pediatric First Aid and CPR certification which is not EMSA approved. Type B is cited.
At 1:35pm, Licensee's assistant was missing measles (MMR) and pertussis(TDap). A technical violation was given.

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 Center and the ADA, available at: http://www.ada.gov/childqanda.htm

SUPERVISOR'S NAME: Valarie Cook	TELEPHONE: (323) 513-3858
LICENSING EVALUATOR NAME: Susann Sanchez	TELEPHONE: (323) 981-3366
LICENSING EVALUATOR SIGNATURE:	DATE: 04/08/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/08/2025

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 CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME: AYALA FAMILY CHILD CARE	FACILITY NUMBER: 192010484
	VISIT DATE: 04/08/2025

NARRATIVE

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Licensee 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.

Licensee was reminded that all adults 18 and over, including employees and volunteers, expect 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 up assessed if this regulation is violated.

During the exit interview Licensee D. Ayala, confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS.

The following deficiencies listed on the attached LIC 809 (deficiency page) are being cited in accordance with California Code of Regulations Title 22, Division 12, Chapter 1 and Section CCR & H&S.

A notice of site visit was given and must remain posted for 30 days. Appeal Rights were given and explained. Exit interview conducted and report was reviewed with the Licensee, D. Ayala.

SUPERVISOR'S NAME: Valarie Cook	TELEPHONE: (323) 513-3858
LICENSING EVALUATOR NAME: Susann Sanchez	TELEPHONE: (323) 981-3366
LICENSING EVALUATOR SIGNATURE:	DATE: 04/08/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/08/2025

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 04/08/2025 02:52 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 CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME: AYALA FAMILY CHILD CARE	FACILITY NUMBER: 192010484
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 04/08/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)

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
1 2 3 4	Based on record review and Licensee interview, the licensee did not comply with the section cited above in which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 05/08/2025
	Plan of Correction
1 2 3 4	Licensee stated that she will complete an EMSA approved CPR & First Aid by POC due date of 05/08/25.

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.

Valarie Cook	TELEPHONE: (323) 513-3858
Susann Sanchez	TELEPHONE: (323) 981-3366
	DATE: 04/08/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/08/2025

LIC809 (FAS) - (06/04)

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