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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197401712
Report Date: 11/16/2023
Date Signed: 11/16/2023 02:25:31 PM


Document Has Been Signed on 11/16/2023 02:25 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
L.A. DAYCARE-NO.WEST, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245



FACILITY NAME:TOLOSA FAMILY DAY CAREFACILITY NUMBER:
197401712
ADMINISTRATOR:CARMEN CORTESFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(310) 835-3042
CITY:WILMINGTONSTATE: CAZIP CODE:
90744
CAPACITY:14CENSUS: 5DATE:
11/16/2023
TYPE OF VISIT:Required - 3 YearUNANNOUNCEDTIME BEGAN:
10:54 AM
MET WITH:Licensee, Carmen CortesTIME COMPLETED:
02:50 PM
NARRATIVE
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On 11/16/2023, Licensing Program Analyst (LPA), Sarah Garcia conducted an unannounced Annual Required Inspection at the above-mentioned facility. LPA was greeted by licensee, Carmen Cortes. Present during today’s inspection was licensee's husband Jose Cortes, licensee's son Jose Cortes, and staff, Jaqueline Cabrera. During the initial inspection, LPA observed 5 children in care.

Facility operates Monday through Friday from 6:00 a.m. to 5:30 p.m. Currently licensee is available to care for children 0 years old to 6 years old. Facility is Large Family Child Care Home with a max capacity of 14. Licensee provides transportation to the children.

LPA toured the home inside and outside. The home is a single-family home with 3 bedrooms and 2 bathrooms, the living room, kitchen area, outdoor area, and garage. Licensee confirmed the following areas are designated for day care only: living room, bedroom #1, bedroom #2, bathroom #1, bathroom #2, and outdoor area. The bathroom #1 that children use is located inside bedroom #1. LPA inspected bathroom #1 and did not observe a safety latch on the lower cabinet. LPA reminded licensee to place safety latches on the lower cabinet in bathroom #1. The bathroom #2 that children use is outside the kitchen. LPA inspected the bathroom #2 and observed a safety latch under the sink to ensure medications,toxins or cleaning compounds are inaccessible to the children in care. LPA inspected the living room and observed the space to be clean and orderly. LPA observed a baby rocker and advised licensee that those items are prohibited and provided licensee the prohibited items flyer. LPA observed bedroom #1 and observed cots and play yards utilized for sleep. LPA observed the wall heater to not be properly barricaded. Licensee stated the wall heater did not work. LPA advised licensee to place a barricade to ensure inaccessible to children. LPA inspected the kitchen and observed the knives and sharp objects to be on the counter. LPA advised licensee to place the knives in a cabinet and lock them with a safety latch. LPA observed a safety latch under the kitchen sink cabinet to ensure all poisons, detergents, cleaning compounds, medications and other items which can pose a risk to children in care are made inaccessible.


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SUPERVISOR'S NAME: Maureen NealTELEPHONE: (424) 301-3042
LICENSING EVALUATOR NAME: Sarah GarciaTELEPHONE: (424) 301-3066
LICENSING EVALUATOR SIGNATURE:
DATE: 11/16/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/16/2023
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 11/16/2023 02:25 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
L.A. DAYCARE-NO.WEST, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245


FACILITY NAME: TOLOSA FAMILY DAY CARE
FACILITY NUMBER: 197401712

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/16/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
102417(g)(1)
Operation of A Family Child Care Home
(g) The home shall be free from defects or conditions which might endanger a child. Safety precautions shall include but not limited to: (1) Fireplaces and open face heaters shall be screened to prevent access by children. The home shall contain a fire extinguisher and smoke detector device which meet standards established by the State Fire Marshall.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, interview, record review, the licensee does not have a charged and working fire extinguisher which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 11/17/2023
Plan of Correction
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Licensee will purchase a charged fire extinguisher (2A10BC) and provide proof of purchase to LPA. Licensee will provide proof with a receipt or a picture via mail or to the office, El Segundo Child Care Regional Office, 300 N. Continental Blvd, Ste 290A, El Segundo, CA 90245 by 11/17/2023.
Type A
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 observation, interview, record review, the licensee does not have current Pediatric first aid and CPR which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 11/17/2023
Plan of Correction
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Licensee will take the Pediatric CPR and First Aid Course and submit the certificate to LPA via mail or to the office, El Segundo Child Care Regional Office, 300 N. Continental Blvd, Ste 290A, El Segundo, CA 90245 by 11/17/2023.
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: Maureen NealTELEPHONE: (424) 301-3042
LICENSING EVALUATOR NAME: Sarah GarciaTELEPHONE: (424) 301-3066
LICENSING EVALUATOR SIGNATURE:
DATE: 11/16/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/16/2023
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 11/16/2023 02:25 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
L.A. DAYCARE-NO.WEST, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245


FACILITY NAME: TOLOSA FAMILY DAY CARE
FACILITY NUMBER: 197401712

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/16/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102417(d)(1)
Operation of A Family Child Care Home
(d) The home shall provide safe toys, play equipment and materials. (1) Fixtures, furniture, and equipment that have been banned or recalled by the United States Consumer Product Safety Commission shall not be used for children in care or accessible to children in care.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, interview, record review, the licensee was using a baby walker which is a prohibited item in family child care homes which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 11/16/2023
Plan of Correction
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Licensee removed the baby walker on 11/16/2023. Licensee will store the baby walker in a non accessible area and will not utlize the baby walker during hours of operation. Licensee will sign a written declaration stating she will not utlize the baby walker during hours of operation and will store the baby walker.
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 observation, interview, record review, the licensee does not have a mandated reporter certificate which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 11/17/2023
Plan of Correction
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Licensee will take the mandated reporter training course and provide the certificate to LPA via mail or to the office, El Segundo Child Care Regional Office, 300 N. Continental Blvd, Ste 290A, El Segundo, CA 90245 by 11/17/2023.
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: Maureen NealTELEPHONE: (424) 301-3042
LICENSING EVALUATOR NAME: Sarah GarciaTELEPHONE: (424) 301-3066
LICENSING EVALUATOR SIGNATURE:
DATE: 11/16/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/16/2023
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 11/16/2023 02:25 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
L.A. DAYCARE-NO.WEST, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245


FACILITY NAME: TOLOSA FAMILY DAY CARE
FACILITY NUMBER: 197401712

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/16/2023

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 observation, interview, record review, the licensee does not obtain immunization records documenting measles, pertussis, and infleunza immunization which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 11/20/2023
Plan of Correction
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Licensee will submit proof of immunziations from measles, pertussis, and influenza to LPA via mail or to the office, El Segundo Child Care Regional Office, 300 N. Continental Blvd, Ste 290A, El Segundo, CA 90245 by 11/17/2023.
Type B
Section Cited
CCR
102418(a)
Immunizations
(a) Prior to admission to a family day care home, children shall be immunized against diseases as required by the California Code of Regulations, Title 17, beginning with Section 6000.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, interview, record review, the licensee does not have immunization records for 4 out of 6 children's files which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 11/20/2023
Plan of Correction
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Licensee will submit proof of children's immunziations records to LPA via mail or to the office, El Segundo Child Care Regional Office, 300 N. Continental Blvd, Ste 290A, El Segundo, CA 90245 by 11/17/2023.
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: Maureen NealTELEPHONE: (424) 301-3042
LICENSING EVALUATOR NAME: Sarah GarciaTELEPHONE: (424) 301-3066
LICENSING EVALUATOR SIGNATURE:
DATE: 11/16/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/16/2023
LIC809 (FAS) - (06/04)
Page: 4 of 13


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
L.A. DAYCARE-NO.WEST, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME: TOLOSA FAMILY DAY CARE
FACILITY NUMBER: 197401712
VISIT DATE: 11/16/2023
NARRATIVE
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The following areas are OFF LIMITS to the children in care: Bedroom #3 and garage.

LPA inspected the outdoor area and observed safe toys and play equipment. LPA reminded licensee, the outdoor area should be cleaned regularly to ensure it is clean and free from debris. Per the licensee, there are no weapons or firearms on the premises. There are no pools or bodies of water on the premises. Licensee has (3) dogs in the home. LPA discussed the importance of making sure that parents know program has pets in the home. Dogs remain outside in the home.

All electrical outlets were observed to be covered. LPA reminded licensee to ensure all areas that have been designated as OFF LIMITS need to have doors closed, locked, and made inaccessible when children are present.



LPA observed licensee test the carbon monoxide and smoke detector in the home. LPA observed an out of service fire extinguisher, 2:A10:BC. LPA advised licensee to service the fire extinguisher annually. Licensee confirmed program provides meals and snacks. LPA discussed the importance of maintaining a system where allergies and food restrictions are noted. LPA observed a first aid kit with a working thermometer.

Licensee currently does not administer medication. Adequate heating and ventilation for safety and comfort were observed in the space. LPA has fans and a portable heater. The home has working telephone service and LPA confirmed the phone number (424) 399-2020.

Licensee ensures that children in care are supervised at all times and is aware children shall not be left in parked vehicles. Car seats are used for transportation purposes only and are not used for sleeping children.

Capacity as specified on the license is being maintained during today’s inspection.

LPA reviewed 6 children’s files and observed files to be incomplete. LPA observed 4 out of 6 files were missing immunization records. Licensee does not have an earthquake and fire drill log. LPA advised licensee to conduct and document earthquake and fire drills every six months. LPA provided a drill sample log. LPA discussed all necessary forms needed in each children’s file and provided licensee with the LIC 311D- Records to be maintain in the facility and provided licensee with a current copy to use as a reference when auditing files.

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SUPERVISOR'S NAME: Maureen NealTELEPHONE: (424) 301-3042
LICENSING EVALUATOR NAME: Sarah GarciaTELEPHONE: (424) 301-3066
LICENSING EVALUATOR SIGNATURE:

DATE: 11/16/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/16/2023
LIC809 (FAS) - (06/04)
Page: 11 of 13
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
L.A. DAYCARE-NO.WEST, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME: TOLOSA FAMILY DAY CARE
FACILITY NUMBER: 197401712
VISIT DATE: 11/16/2023
NARRATIVE
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Licensee does not have current pediatric CPR and First certification. Licensee’s Mandated Reporter training was not available for review. Website: www.mandatedreporterca.com.

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.



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.

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 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.

During the exit interview, the licensee, Carmen Cortes, confirmed that there are no Registered Sex
Offenders living in the facility and LPA completed the RSO profile in FAS.

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SUPERVISOR'S NAME: Maureen NealTELEPHONE: (424) 301-3042
LICENSING EVALUATOR NAME: Sarah GarciaTELEPHONE: (424) 301-3066
LICENSING EVALUATOR SIGNATURE:

DATE: 11/16/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/16/2023
LIC809 (FAS) - (06/04)
Page: 12 of 13
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
L.A. DAYCARE-NO.WEST, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME: TOLOSA FAMILY DAY CARE
FACILITY NUMBER: 197401712
VISIT DATE: 11/16/2023
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Per Title 22, Division 12, Chapter 3, of the California Code of Regulations, the following deficiencies are being cited: (see next pages, 809D) Licensee was provided with a copy of appeal rights.

LPA Sarah Garcia informed licensee, Carmen Cortes that this report dated 11/16/2023 document(s) (2) Type A citation(s) and (4) Type B citation (s) which shall be posted for 30 consecutive days as there is an immediate and potential risk(s) to the health, safety, or personal rights of children in care.

Also, LPA Garcia informed the licensee to provide a copy of this licensing report dated 11/16/2023 that documents any Type A citation(s) to parents/guardians of all children currently enrolled by the next business day or the next day the children are in care, and to any newly enrolled parents/guardians for 12 months from the date of this report. A signed Acknowledgement of Receipt of Licensing Report (LIC 9224), or other written statement, must be placed in the child's file for verification.

A notice of site visit was given and must remain posted for 30 days.

Exit interview conducted and report along with appeal rights was reviewed with the licensee.

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/inspection-process.

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SUPERVISOR'S NAME: Maureen NealTELEPHONE: (424) 301-3042
LICENSING EVALUATOR NAME: Sarah GarciaTELEPHONE: (424) 301-3066
LICENSING EVALUATOR SIGNATURE:

DATE: 11/16/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/16/2023
LIC809 (FAS) - (06/04)
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