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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197494226
Report Date: 08/04/2021
Date Signed: 08/04/2021 02:13:50 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME:CASTILLO FAMILY CHILD CAREFACILITY NUMBER:
197494226
ADMINISTRATOR:CASTILLO, PATRICIOFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(818) 635-5131
CITY:LAKE BALBOASTATE: CAZIP CODE:
91406
CAPACITY:14CENSUS: 10DATE:
08/04/2021
TYPE OF VISIT:Case Management - Annual ContinuationUNANNOUNCEDTIME BEGAN:
09:57 AM
MET WITH:Patricio CastilloTIME COMPLETED:
02:30 PM
NARRATIVE
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On 08/04/2021 at 10:08 am Licensing Program Analyst (LPA) Antonio Almanza, conducted an unannounced case management visit to follow up on annual inspection conducted on 07/19/21. Upon arrival LPA was met by Assistant Staff#1.

Upon arrival there were 11 children and 1 Adult in the Facility. Licensee arrived to the Facility at 10:20 am putting the facility out of ratio.

During today’s visit LPA explained Title 22, Division 12, Chapter 1 regulations:

1. 102425 INFANT SAFE SLEEP (a) There shall be one crib or play yard for each infant who is unable to climb out of the crib or play yard.

2. 102352 Definitions (i) "Infant" means a child under two years of age.

During annual visit conducted on 07/19/21, Licensee informed LPA that he had made modifications to the cribs for children that are able to climb out in order to keep them safe inside and keep them from falling out the crib. During today’s visit LPA observed 3 of 6 cribs with modifications. LPA observed wood attached to the top sides of the crib extending the height of the sides in order to keep children from climbing out of the crib.

During the Annual visit Licensee notified LPA that he has children over the age of two years old sleeping in these modified cribs because they sleep in cribs at home. LPA observed children in this modified cribs. Facility does not currently have children that require a crib to sleep in.

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SUPERVISOR'S NAME: Mary RuizTELEPHONE: (424) 301-3061
LICENSING EVALUATOR NAME: Antonio AlmanzaTELEPHONE: (424) 301-3057
LICENSING EVALUATOR SIGNATURE:

DATE: 08/04/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/04/2021
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 5
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME: CASTILLO FAMILY CHILD CARE
FACILITY NUMBER: 197494226
VISIT DATE: 08/04/2021
NARRATIVE
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During todays visit LPA observed a sign on the wall next to the gate that is used to enter the facility. The sign has the facility name (LADYBUG KidCare) and telephone number (818-668-3117). Per Tittle 22 regulation this sign does not have the facility number (197494226).

Licensee states there are 14 children currently enrolled in the Facility. LPA observed an incomplete facility Roster. There are 8 children on the facility roster and there are no children’s Birthdates for the 8 children on the roster.


Four Type A deficiencies were cited under Title 22, Division 12, Chapter 1 regulations: 102416.5 Staffing Ratio and Capacity; 102425 INFANT SAFE SLEEP; 102423 Personal Rights (see LIC 809Ds); and Health & Safety Code 1596.8595. Each report (documenting a Type A citation) shall remain posted for 30 days along with the Notice of Site Visit (printed out during this inspection).

Two Type B deficiencies were cited under Title 22, Division 12, Chapter 1 regulations: 102359
Advertisements and License Number; 102417, and Operation of a Family Child Care Home (see LIC 809Ds). Each report (documenting a Type A citation) shall remain posted for 30 days along with the Notice of Site Visit (printed out during this inspection).

**In addition; A copy of this report must be provided to the authorized representatives of all currently enrolled children and any newly enrolled child for the following 12 months. The ACKNOWLEDGEMENT OF RECEIPT OF LICENSING REPORTS (LIC9224) shall be signed and kept in each of the children’s records. The report shall be provided no later than the next business day or the next day the child is in care.

An exit interview was conducted and a copy of this report, appeal rights along, Notice of Site Visit and copy of ACKNOWLEDGEMENT OF RECEIPT OF LICENSING REPORTS (LIC9224) were provided to the Licensee.




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SUPERVISOR'S NAME: Mary RuizTELEPHONE: (424) 301-3061
LICENSING EVALUATOR NAME: Antonio AlmanzaTELEPHONE: (424) 301-3057
LICENSING EVALUATOR SIGNATURE:

DATE: 08/04/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/04/2021
LIC809 (FAS) - (06/04)
Page: 2 of 5
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245

FACILITY NAME: CASTILLO FAMILY CHILD CARE
FACILITY NUMBER: 197494226
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/04/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
08/04/2021
Section Cited

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102416.5 Staffing Ratio and Capacity, For a Large Family Child Care Home, the maximum number of children for whom care may be provided at any one time when there is an assistant provider in the home, including children under age 10...
This Requirement is not met as evidenced by:
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Based on observation, interview and record review, The Licensee did not make sure the facility was within ratio, there were 10 children and 1 adult, which poses an [immediate or potential] Health [and or] Safety, [and or] personal rights risk to persons in care.
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Licensee will fill out Declaration acknowledging understanding of capacity and ratios on LIC855 and email on 08/04/2021.
Type A
08/04/2021
Section Cited

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102425 INFANT SAFE SLEEP (3) There shall be no objects hanging above or attached to the side of the crib.


This Requirement is not met as evidenced by:
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Based on observation, interview and record review, The Licensee attached wood to the top sides of 3 of 6 cribs, which poses an [immediate or potential] Health [and or] Safety, [and or] personal rights risk to persons in care.
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Licensee will provide email proof of removal of the cribs or wood from the side by 08/04/2021.
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: Mary RuizTELEPHONE: (424) 301-3061
LICENSING EVALUATOR NAME: Antonio AlmanzaTELEPHONE: (424) 301-3057
LICENSING EVALUATOR SIGNATURE:
DATE: 08/04/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/04/2021
LIC809 (FAS) - (06/04)
Page: 3 of 5
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245

FACILITY NAME: CASTILLO FAMILY CHILD CARE
FACILITY NUMBER: 197494226
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/04/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
08/04/2021
Section Cited

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102423 Personal Rights (a) Each child...shall have certain rights that shall not be waived or abridged ...regardless of consent or authorization from the child's authorized representative... (2) To receive safe...comfortable accommodations, furnishings, and equipment. This Requirement is not met as evidenced by:
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Based on observation, interview and record review, The Licensee did not make sure children received comfortable accommodations, furnishings, and equipment, which poses an [immediate or potential] Health [and or] Safety, [and or] personal rights risk to persons in care.
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Licensee will fill out Declaration (LIC855) acknowledging understanding of Tittle 22 regulations (a)(2) that children that are able to climb out the crib will not sleep in a crib and email on 08/04/2021.

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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: Mary RuizTELEPHONE: (424) 301-3061
LICENSING EVALUATOR NAME: Antonio AlmanzaTELEPHONE: (424) 301-3057
LICENSING EVALUATOR SIGNATURE:
DATE: 08/04/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/04/2021
LIC809 (FAS) - (06/04)
Page: 4 of 5
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245

FACILITY NAME: CASTILLO FAMILY CHILD CARE
FACILITY NUMBER: 197494226
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/04/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
08/06/2021
Section Cited

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102359 Advertisements and License Number (a) Licensees shall reveal each facility license number in all advertisements, publications, or announcements made with the intent to attract clients.
This Requirement is not met as evidenced by:
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Based on observation, interview and record review, The Licensee did not make sure to put Facility License number on sign located in the entrance of the premises, which poses a potential Health or Safety, [and or] personal rights risk to persons in care.
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Licensee will provide LPA with photograph showing compliance with Title 22 Regulations.
Type B
08/06/2021
Section Cited

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102417 Operation of a Family Child Care Home (8) Each family child care home shall have a current roster of children as specified in Health and Safety Code Section 1596.841.

This Requirement is not met as evidenced by:
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Based on observation, interview and record review, The Licensee did not make sure to maintain current roster of children in care, Licensee has a Roster with 8 of 14 children enrolled, which poses a potential Health or Safety, [and or] personal rights risk to persons in care.
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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: Mary RuizTELEPHONE: (424) 301-3061
LICENSING EVALUATOR NAME: Antonio AlmanzaTELEPHONE: (424) 301-3057
LICENSING EVALUATOR SIGNATURE:
DATE: 08/04/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/04/2021
LIC809 (FAS) - (06/04)
Page: 5 of 5