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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198010360
Report Date: 11/25/2019
Date Signed: 11/25/2019 02:34:11 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 CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME:VELASCO & CASILLAS FAMILY CHILD CAREFACILITY NUMBER:
198010360
ADMINISTRATOR:VELASCO, A. & CASILLAS A.FACILITY TYPE:
810
ADDRESS:TELEPHONE:
(626) 480-8156
CITY:BALDWIN PARKSTATE: CAZIP CODE:
91706
CAPACITY:14CENSUS: 6DATE:
11/25/2019
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
12:01 PM
MET WITH:Deserie Velasco, LicenseeTIME COMPLETED:
02:35 PM
NARRATIVE
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Licensing Program Analyst (LPA) Mireya Garcia conducted an unannounced case management inspection to follow up on an incident that was reported to the Department on 10/28/19. Upon arrival, LPA met with Licensee, Deserie Velasco, who guided LPA on a tour. Census was taken.

On 10/28/19, an unusual incident report was made to the department regarding an incident that involved a child who sustained injury that required medical attention. The facility reported this incident to the Department within the required 24 hours. LPA obtained additional documentation relating to this incident. Based on interviews conducted with Staff and tripping hazards observed (holes on concrete floor front yard, pictures were taken), LPA determined that there was tripping hazards at the licensee’s front yard that caused child to fall which poses a potential risk to the health and safety of the children in care. Per Licensee, staff meeting was immediately conducted regarding children walking not running and adult visual supervision at all times was discussed in addition, facility has since established a new procedure when transporting children in care.

California Code of Regulations, Title 22, Division 12, is being cited on the attached LIC 809D.

A printed copy of this report and appeal rights (LIC 9058) was provided to Deserie Velasco, at the conclusion of the visit and her signature on this form acknowledges receipt of these forms.

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.

Page 1 of 1- End of Report------------
SUPERVISOR'S NAME: Christina GabelmanTELEPHONE: (323) 981-3380
LICENSING EVALUATOR NAME: Mireya GarciaTELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:

DATE: 11/25/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/25/2019
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 CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME: VELASCO & CASILLAS FAMILY CHILD CARE
FACILITY NUMBER: 198010360
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/25/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
01/02/2020
Section Cited

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102417-Operation of a Family Child Care Home:(g) The home shall be free from defects or conditions which might endanger a child.
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This requirement is not met as evidenced by LPAs observation of tripping hazards observed (holes on concrete floor in the front yard, pictures were taken) and based on Staff interviews disclosures. This poses a potential health and safety risk to children in care.
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Per Licensee she will cover holes on the concrete floor front yard and will submit to LPA pictures of corrections via email by POC due date of 01/02/20.

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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: Christina GabelmanTELEPHONE: (323) 981-3380
LICENSING EVALUATOR NAME: Mireya GarciaTELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:
DATE: 11/25/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/25/2019
LIC809 (FAS) - (06/04)
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