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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197418856
Report Date: 07/11/2019
Date Signed: 07/11/2019 03:44:14 PM

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:CASTELLON FAMILY CHILD CAREFACILITY NUMBER:
197418856
ADMINISTRATOR:CASTELLON, CAROLINAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(323) 294-5943
CITY:LOS ANGELESSTATE: CAZIP CODE:
90062
CAPACITY:14CENSUS: 18DATE:
07/11/2019
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
11:30 AM
MET WITH:Carolina CastellonTIME COMPLETED:
04:00 PM
NARRATIVE
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Licensing Program Analysts (LPAs) Denise Gibbs and Ana Chico met with licensee, Carolina Castellon, who guided analyst on a tour of the home for an unannounced Annual Random Inspection. Upon arrival, LPAs observed 18 children in care, supervised by the licensee, 1 assistant and 1 volunteer. Child #17 and #18 were the Licensee's children whom are over 10 years old. Eight (8) children were School-Age, 5 Preschoolers, and 3 Infants. Licensee was informed that she is not within ratio according to Title 22 California Code of Regulations. This is a single story home, 3-bedrooms, 2-bathrooms, kitchen, living room, dining room, front yard and back yard. All adults in the home, including the volunteer, are associated and fingerprint cleared. Licensee’s operating hours are Monday-Friday 6am-7pm.

Primary care is provided in the living room located in the front of the home. Off limit areas include the home's three bedrooms (child safety knobs),1 bathroom (inside master bedroom), and front yard. LPAs observed age appropriate toys and learning materials for children. All furniture is neat, clean and in good repair. Children use the bathroom adjacent to the main care area. Hygine products are kept in a bathroom cabinet. LPAs reminded the licensee that all products must be be inaccessible to children in care. The home was inspected inside for safety, comfort, cleanliness, telephone service, heating and ventilation. The home has central air and heat. Children nap on mats in the main care area. Infant playpens are visible in main care area as well. LPA's observed boppy pillows and blankets in one of the playpens and a boppy pillow in another playpen. Licensee was advised on safe sleep practices and removed all items from playpens during inspection. There were no infants sleeping at at the time of the inspection.

Detergents/cleaning compounds, and hazardous items that can pose a danger to children are inaccessible (under kitchen sink with latch). Insect spray was observed to be inaccessible to children via latch. Licensee removed the insect spray to a shed which is locked and inaccessible to children playing outdoors. Per licensee, there are no weapons or firearms in the facility and LPA did not observe any weapons or firearms. The required smoke detector and Carbon Monoxide detector are in operable condition. Page 1 of 4
SUPERVISOR'S NAME: Trevino CochranTELEPHONE: (323) 981-3385
LICENSING EVALUATOR NAME: Denise GibbsTELEPHONE: (323) 558-2794
LICENSING EVALUATOR SIGNATURE:

DATE: 07/11/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/11/2019
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 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 CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME: CASTELLON FAMILY CHILD CARE
FACILITY NUMBER: 197418856
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/11/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
08/12/2019
Section Cited
CCR
102417(g)(8)
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Operation of a Family Child Care Home
Each family child care home shall have a current roster of children as specified in Health and Safety Code Section 1596.841. This poses a potential health and safety risk to children in care.
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Per Licensee, she will update the Roster and email proof to LPA.
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This requirement was not met as evidenced by LPAs observing 6 daycare children missing from roster.
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Type B
08/12/2019
Section Cited
CCR
102418
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Immunizations

The licensee shall document each child's immunizations and shall maintain such documentation for as long as the child is enrolled. This poses a potential health and safety risk to children in care.

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Per Licensee, she will ask parents for records and email proof to LPA.
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This requirement was not met as evidenced by LPAs observing Child #12, #13 and #14 missing immunization records
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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: Trevino CochranTELEPHONE: (323) 981-3385
LICENSING EVALUATOR NAME: Denise GibbsTELEPHONE: (323) 558-2794
LICENSING EVALUATOR SIGNATURE:

DATE: 07/11/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/11/2019
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 CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME: CASTELLON FAMILY CHILD CARE
FACILITY NUMBER: 197418856
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/11/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
08/12/2019
Section Cited
HSC
102421(a)(b)
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Child's Records
The licensee shall maintain, in each child's record, the signed and dated notice form required in Section 102419(d). The licensee shall maintain, in each child's record, a copy of the emergency information card required in Section 102417(g)(7).
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Per Licensee, She will have parents fill out the form and email to LPA.
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This poses a potential health and safety risk to children in care.
This requirement was not met as evidenced by LPAs observing Child #12, #13, and # 14 missing documents.
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Type B
08/12/2019
Section Cited
CCR
102417(g)(1)
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Operation of a Family Child Care Home
The home shall contain a fire extinguisher which meet standards established by the State Fire Marshal.
This poses a potential health and safety risk to children in care.
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Per Licensee, she will either go to the fire station and have it serviced or she will buy a new fire extinguisher and provide the receipt to LPA by email.
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This requirement was not met as evidenced by LPAs observing the 2A10BC fire extinguisher missing a service tag or receipt of purchase.
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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: Trevino CochranTELEPHONE: (323) 981-3385
LICENSING EVALUATOR NAME: Denise GibbsTELEPHONE: (323) 558-2794
LICENSING EVALUATOR SIGNATURE:

DATE: 07/11/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/11/2019
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 CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME: CASTELLON FAMILY CHILD CARE
FACILITY NUMBER: 197418856
VISIT DATE: 07/11/2019
NARRATIVE
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State law prohibits baby walkers, bouncy seats, exersaucers and any other items that fall into that category. All infants must be placed on their backs when sleeping to prevent S.I.D.S. (Sudden Infant Death Syndrome), and the Provider is required to wash hands after every diaper change and to never shake a baby to prevent the Shaken Baby Syndrome. Only children eating may be in high chairs and that car seats are utilized only for transportation. LPA informed and discussed Safe Sleep regulation with licensee and provided licensee with CCLD website to view Safe Sleep Information.

Requirements for fingerprint clearances and associations were discussed with the licensee. Licensee can be cited a civil penalty of $100 per day, up to $500.00 (5 days) for the 1st offense and up to $3000.00 for the 2nd offense within a 12-month period. The licensee was advised of the requirement to report unusual incidents and/or injuries to the parent/guardian and licensing within the time frame specified by the regulation. The "Notification of Parent's Rights" (PUB394) poster must be posted in an area accessible to parents. The information regarding new legislation with regards to exemptions and Parent’s Rights was also discussed.

The licensee was informed of The Child Care Advocate Program (CCAP) that is administered from within the Community Care Licensing Division. CCAP participates in many community activities and special projects in order to disseminate information on the State’s licensing role, provide information to the public and parents on child care licensing, and provide many other helpful resources to the licensees and the public. CCAP’s direct contact information is as followed: Phone number: (916) 654-1541


Email Address: childcareadvocatesprogram@dss.ca.gov

The home was not in compliance per Title 22 regulations, Type A & B deficiencies will be cited today 7/111/2019.

Exit interview was conducted with Carolina Castellon, Appeal Rights and a signed copy of this report was provided to licensee.

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SUPERVISOR'S NAME: Trevino CochranTELEPHONE: (323) 981-3385
LICENSING EVALUATOR NAME: Denise GibbsTELEPHONE: (323) 558-2794
LICENSING EVALUATOR SIGNATURE:

DATE: 07/11/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/11/2019
LIC809 (FAS) - (06/04)
Page: 4 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 CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME: CASTELLON FAMILY CHILD CARE
FACILITY NUMBER: 197418856
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/11/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
08/12/2019
Section Cited
CCR
102419(d)(1)
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Admission Procedures and Parental and Authorized Representative's Rights

The licensee shall request the child's parent or authorized representative to sign and date the bottom portion of the notice form LIC 995A.
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Per Licensee, she will have parents fill out this form and email it to LPA.
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This poses a potential health and safety risk to children in care.
This requirement was not met as evidenced by LPAs observing Child #12, #13, and #14 missing signed form LIC 995A.
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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: Trevino CochranTELEPHONE: (323) 981-3385
LICENSING EVALUATOR NAME: Denise GibbsTELEPHONE: (323) 558-2794
LICENSING EVALUATOR SIGNATURE:

DATE: 07/11/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/11/2019
LIC809 (FAS) - (06/04)
Page: 8 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 CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME: CASTELLON FAMILY CHILD CARE
FACILITY NUMBER: 197418856
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/11/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
07/11/2019
Section Cited
CCR
102416.5(a)
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Staffing Ratio and Capacity

The capacity specified on the license shall be the maximum number of children for whom care may be provided at any one time.
This poses an immediate health and safety risk to children in care.
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Per Licensee, she will terminate services for child # 12 and #16. She will also monitor schedules and deny drop in care.
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This requirement was not met as evidenced by LPAs observing 16 daycare children present.
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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: Trevino CochranTELEPHONE: (323) 981-3385
LICENSING EVALUATOR NAME: Denise GibbsTELEPHONE: (323) 558-2794
LICENSING EVALUATOR SIGNATURE:

DATE: 07/11/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/11/2019
LIC809 (FAS) - (06/04)
Page: 5 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 CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME: CASTELLON FAMILY CHILD CARE
FACILITY NUMBER: 197418856
VISIT DATE: 07/11/2019
NARRATIVE
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The Notice of Site Visit (LIC 9213) – must remain posted for 30 days during the hours of operation after each site visit by a licensing representative. Failure to maintain posting as required will result in a civil penalty of $100.00.

Whenever a type A is cited: “Upon receipt, licensee shall post and provide copies of this licensing report to parents/guardians of children in care at the facility and to parents/guardians of children newly enrolled at the facility during the next 12 months.”

The following was discussed with the licensee:

The licensee was advised how to access forms and Regulations for Family Child Care online at www.ccld.ca.gov . Licensee was made aware that it is their responsibility to know the regulations as well as anyone who assists in providing care. Licensee was advised on how to access quarterly reports, forms, and regulations for Child Care online at www.ccld.ca.gov.

The licensee was advised that inaccessibility of hazards must be constantly reassessed depending on the children in care. Regulation prohibits the smoking of tobacco on the premises.


AB 1207: Beginning on January 1, 2018, this law requires all licensed providers, applicants, directors and employees to complete training as specified on their mandated reporter duties and to renew their training every two years. Volunteers are encouraged but not required to take the training. Website: www.mandatedreporterca.com

Senate Bill 792: this bill, commencing September 1, 2016, prohibits a person from being employed or volunteering at a child care facility or family day care if he or she has not been immunized against influenza, pertussis and measles.

New Appeal Process: A licensee may file an appeal, in writing 15 business days from the date of receiving the penalty assessment. --------------------------------Page 3 of 4
SUPERVISOR'S NAME: Trevino CochranTELEPHONE: (323) 981-3385
LICENSING EVALUATOR NAME: Denise GibbsTELEPHONE: (323) 558-2794
LICENSING EVALUATOR SIGNATURE:

DATE: 07/11/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/11/2019
LIC809 (FAS) - (06/04)
Page: 3 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 CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME: CASTELLON FAMILY CHILD CARE
FACILITY NUMBER: 197418856
VISIT DATE: 07/11/2019
NARRATIVE
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Per Licensee, the fire extinguisher is less than a year old, however, extinguisher was missing a service tag and receipt of purchase. LPA's advised Licensee to keep the receipt of purchase with the fire extinguisher at all times until a service tag is added.. Fireplace is barricaded with a screen.

Children have access to the backyard from the kitchen. LPA observed that the backyard is fenced and free of hazards. There are no pools or spas, or other bodies of water. Currently there are no pets. The First Aid kit was observed and is complete. Licensee has the following posting requirements: License, Emergency Disaster plan and Parents Rights Poster. Licensee's disaster drill log notes last drill was conducted on 3/11/19. Children’s Roster is missing 6 children. First Aid/CPR certificate for staff #1 expires 3/2/2021 and for staff #2 expires 5/11/2020. Licensee’s and assistant's records were reviewed and are complete. Children #12, #13 and #14 are missing records.

Update on Incidental Medical Services: Facilities that provide Incidental Medical Services (IMS) must identify those services in their facility’s Plan of Operation and submit an updated Plan of Operation to the Department. Incidental Medical Services Include: Blood-Glucose Monitoring for Diabetic Children, Administering Inhaled Medication, Administering EpiPen Jr. and EpiPen or other Epinephrine Auto-Injectors, Glucagon Administration, Gastrostomy Tube Care (G-tube care), Insulin Injections Administration, Anti-Seizure Administration, and Emptying an Ileostomy Bag.

At this time licensee does not have children requiring Incidental Medical Services – IMS. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Family Child Care Homes Section 102417. 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

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SUPERVISOR'S NAME: Trevino CochranTELEPHONE: (323) 981-3385
LICENSING EVALUATOR NAME: Denise GibbsTELEPHONE: (323) 558-2794
LICENSING EVALUATOR SIGNATURE:

DATE: 07/11/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/11/2019
LIC809 (FAS) - (06/04)
Page: 2 of 8