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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197414317
Report Date: 02/10/2023
Date Signed: 02/10/2023 01:24:17 PM


Document Has Been Signed on 02/10/2023 01:24 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:FUENTES FAMILY CHILD CAREFACILITY NUMBER:
197414317
ADMINISTRATOR:FUENTES, DORA A.FACILITY TYPE:
810
ADDRESS:TELEPHONE:
(323) 203-0896
CITY:LOS ANGELESSTATE: CAZIP CODE:
90018
CAPACITY:14CENSUS: 2DATE:
02/10/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:35 AM
MET WITH:Dora Fuentes, LicenseeTIME COMPLETED:
01:30 PM
NARRATIVE
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INSPECTION CONDUCTED IN PARTIAL SPANISH
Licensing Program Analysts (LPA) Denise Gibbs conducted an unannounced annual required inspection at the above facility on 2/10/23 at 11:30 AM. LPA met with Dora Fuentes, Licensee who guided analysts on a tour of the facility. There were two children and no other adults present when LPA arrived. Facility capacity is in compliance for a large Family Child Care Home.

This is a one-story home which consists of four bedrooms, two bathrooms, kitchen, dining room, living room, laundry room, front yard and backyard (fenced). Main care is provided in the living room and bedroom at the front of the house. Per Licensee, areas off limits to children and parents include: dinning room, kitchen, three bedrooms, laundry room, one bathroom (child safety gate separates all rooms) and backyard.

The licensee provides food for children in care. Hours of operation are Monday-Friday, 7am-5pm. 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. All documents were observed and disaster drill was discussed. Lead Flyer was provided. -----------------Page 1
SUPERVISOR'S NAME: Trevino CochranTELEPHONE: (323) 981-3385
LICENSING EVALUATOR NAME: Denise GibbsTELEPHONE: (323) 558-2794
LICENSING EVALUATOR SIGNATURE:
DATE: 02/10/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/10/2023
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 7


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: FUENTES FAMILY CHILD CARE
FACILITY NUMBER: 197414317
VISIT DATE: 02/10/2023
NARRATIVE
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Smoke and carbon monoxide detectors were tested and are operable. Fire extinguisher indicated fully charged but has no service tag or purchase receipt. The home maintains telephone service via landline and cell phone. The home is observed to be clean and orderly. There are toys and other age appropriate material available for children. LPA observed that there is an electric fireplace in the living room that is unplugged. Licensee is aware that is heater is used it must be screened. There is also a floor heater adjacent to the fireplace that is screened. LPA observed fans and open windows for ventilation. LPA observed that detergents, cleaning compounds and medication are stored in the off limits kitchen under the sink and in licensee's off limits bedroom, inaccessible to children. Isolation area for sick children waiting to be picked up is in dinning room near the exit, away from the other children. Per Licensee there are no firearms or weapons stored in the home.

The bathroom that children use is located through the front bedroom. LPA observed cobwebs along the ceiling and doors in the bathroom. Bathroom was observed to have a door leading to an off limits room that can be locked from the inside. LPA advised licensee add a lock or device that children cannot access.

Infant Care: Currently licensee does not have infants in care. Licensee is aware of Safe sleep regulations, including LIC 9227 Infant Sleep Plan for infants under 12 months and 15-minute sleep check documentation for infants 0-24 months.

Currently, children are using the front yard for outdoor play. The outdoor play area was observed to be fenced. Per licensee back yard is off limits. LPA observed a gate on one side of the home making the back yard inaccessible. LPA also observed on the right side of the home there is a driveway that allows access to the backyard. LPA informed licensee that there must be a physical barrier to make backyard off limits to children while they are outdoors. There are no pools or spas, or other bodies of water. Facility does have an older dog that has full access to the outdoor space but stays on the side of the home.



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 and LIC 995A
Notification of Parents’ Rights. Records were discussed with licensee.

Licensee's did not have a file for review.
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SUPERVISOR'S NAME: Trevino CochranTELEPHONE: (323) 981-3385
LICENSING EVALUATOR NAME: Denise GibbsTELEPHONE: (323) 558-2794
LICENSING EVALUATOR SIGNATURE:

DATE: 02/10/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/10/2023
LIC809 (FAS) - (06/04)
Page: 2 of 7
Document Has Been Signed on 02/10/2023 01:24 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: FUENTES FAMILY CHILD CARE
FACILITY NUMBER: 197414317

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/10/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
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 and interview, the licensee did not comply with the section cited above. LPA did not observe service tag or purchase receipt for fire extinguisher, which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 02/28/2023
Plan of Correction
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Per licensee, she will talk to her son and have him get the fire extinguisher serviced or purchase a new one. Picture of service tag or purchase receipt will be emailed to LPA by POC date 2/28/23.
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 in Licensee's file, which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 02/28/2023
Plan of Correction
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Per licensee, she will speak with her son and have him show her how to do the training. Licensee will email LPA proof of completion by POC date 2/28/23
www.mandatedreporterca.com (SPANISH AVAILABLE)
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: Trevino CochranTELEPHONE: (323) 981-3385
LICENSING EVALUATOR NAME: Denise GibbsTELEPHONE: (323) 558-2794
LICENSING EVALUATOR SIGNATURE:
DATE: 02/10/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/10/2023
LIC809 (FAS) - (06/04)
Page: 4 of 7


Document Has Been Signed on 02/10/2023 01:24 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: FUENTES FAMILY CHILD CARE
FACILITY NUMBER: 197414317

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/10/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
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 LICENSEE'S FILE which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 02/28/2023
Plan of Correction
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Per licensee, she will look for her current first aid/CPR card or have the instructor send her a duplicate and email proof to LPA by POC date 2/28/23.
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
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Based on record review, the licensee did not comply with the section cited above in licensee's file, which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 02/28/2023
Plan of Correction
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Per Licensee, she will go to the doctor and get copies of immunization and email to LPA by POC date 2/28/23.
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: Trevino CochranTELEPHONE: (323) 981-3385
LICENSING EVALUATOR NAME: Denise GibbsTELEPHONE: (323) 558-2794
LICENSING EVALUATOR SIGNATURE:
DATE: 02/10/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/10/2023
LIC809 (FAS) - (06/04)
Page: 5 of 7