198011139-1-23-2024-54-CC-FWHE-CZRVZ5-20240123155210

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 198011139
Report Date: 01/23/2024
Date Signed: 01/23/2024 03:52:18 PM

Document Has Been Signed on 01/23/2024 03:52 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
MONTEREY PARK SW RO, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME:	MATEOS FAMILY CHILD CARE		FACILITY NUMBER:	198011139
ADMINISTRATOR:	MATEOS, LUCILA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(323) 752-3914
CITY:	LOS ANGELES	STATE: CA	ZIP CODE:	90003
CAPACITY:	14	CENSUS: 9	DATE:	01/23/2024
TYPE OF VISIT:	Annual/Required	UNANNOUNCED	TIME BEGAN:	01:30 PM
MET WITH:	Lucila Mateos		TIME COMPLETED:	04:45 PM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	Licensing Program Analyst (LPA) Franchesca White conducted an Unannounced Required Annual inspection to the above facility. LPA disclosed the purpose of the inspection and met with Licensee, Lucila Mateos, who guided the LPA on a tour of the facility. Also present were two adults who live in the home and who have criminal record clearance. There are four people living in the home and all have criminal record clearance. There were eight (8) day care children and one (1) infant napping present during today’s inspection. Licensee states that there are currently four children enrolled. The children's roster was reviewed and is current. Per licensee, the facility’s hours of operation are 6am to 6pm, 5 days a week. Emergency Disaster Plan, License, and Parents’ Rights were posted at the time of inspection. Disaster drill log was also available during today’s inspection, last disaster drill conducted on 1/08/2024 . This is a single story home which consists of three bedrooms and two bathrooms, kitchen, dining room, living room, back covered patio, and backyard. Areas used by the children include the living room used for napping, one restroom located through hallway in front of living room, kitchen used for eating, back covered patio, and backyard. Per Licensee, areas off limits to children and parents include three bedrooms. Per licensee, off limit areas are locked during operating hours, LPA observed doors to be locked. All areas identified on the facility sketch as accessible to children were inspected to ensure that they are clean and orderly with ventilation and heating for the safety of the children. LPA observed fans all through out home and windows open. There is a working telephone maintained in the home. At 1:35 PM, LPA observed living room area which Licensee states is used for napping to be free of hazards at time of inspection. At 1:38 PM, LPA observed Kitchen area, towards the rear of the home, to be well maintained, counter tops to be free of clutter, and to have operable child safety locks on all cabinets. At 1:40 PM, LPA observed knives and other .....................................................Report Continues 1 of 4 Pages.........................................................

SUPERVISOR'S NAME: Denise Gibbs	TELEPHONE: (323) 981-3385
LICENSING EVALUATOR NAME: Franchesca White	TELEPHONE: 323-981-3350
LICENSING EVALUATOR SIGNATURE:	DATE: 01/23/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/23/2024

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
MONTEREY PARK SW RO, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME: MATEOS FAMILY CHILD CARE	FACILITY NUMBER: 198011139
	VISIT DATE: 01/23/2024

NARRATIVE

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hazardous items to be kept in cabinet that has operable child safety locks at time of inspection. At 1:45 PM, LPA observed restroom used by the children to have adequate handwashing supplies available, step stool for children by sink, locks on under bathroom sink, and bathroom floor and counters to be free of hazards at time of inspection. Children will have access to Main Care Area, back covered patio, through a back door in the Kitchen. At 1:50 PM, LPA observed back covered patio to have carpet on floor, cubbies for children's belongings, child size tables and chairs, cubbies with wooden blocks, puzzles, book shelf, play kitchen, and other age appropriate toys, free of loose and sharp parts. LPA observed electrical cover outlets all through the home. LPA observed, detergents, cleaning compounds kept in a locked cabinet in kitchen at time of inspection. Licensee understands that medications, and other items which can pose a danger to children have to be inaccessible. The Licensee states that there are no poisons in the home. The Licensee does understand that poison must be locked with a key or combination lock.

Per licensee, the children will have access to backyard area. At 1:55 PM, LPA observed backyard has black soft cushioning material all through out, dome climbing apparatus, and adequate perimeter fencing through-out the yard. LPA observed age appropriate toys such as blocks and plastic play structure free of loose and sharp parts available for the children in the backyard and all trees, shrubs, and plants are maintained. LPA observed handwashing station in backyard. At 2:00 PM, LPA observed small dog kept in front yard of home separated by a gate.

The valve on the required 2A 10BC fire extinguisher indicates fully charged. Smoke and carbon monoxide detectors are in operable condition. Per Licensee, First Aid kit is kept in the bathroom and outside play area, LPA observed First Aid kit and was inventoried for necessary supplies. The Licensee has current Pediatric First Aid and CPR. Proof of immunization against influenza, pertussis, and measles was readily available during today’s inspection. The Licensee has also taken the Mandated Reporter Training 7/15/2022
—CPR Card valid until: 02/2025
—Fire Extinguisher was last serviced on: 1/2024
—Children records and required licensing forms were discussed as well as mandated child abuse reporting and criminal record clearance requirement.

......................................................................Report Continues 2 of 4 Pages..............................................

SUPERVISOR'S NAME: Denise Gibbs	TELEPHONE: (323) 981-3385
LICENSING EVALUATOR NAME: Franchesca White	TELEPHONE: 323-981-3350
LICENSING EVALUATOR SIGNATURE:	DATE: 01/23/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/23/2024

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
MONTEREY PARK SW RO, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME: MATEOS FAMILY CHILD CARE	FACILITY NUMBER: 198011139
	VISIT DATE: 01/23/2024

NARRATIVE

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Per Licensee, there are no weapons, firearms in the home and there are no bodies of water around the premises. LPA observation did not see any bodies of water around the premises. Per licensee, they provide food for children in care.

The following were discussed:
To improve the quality and value of the new inspection process, a survey may 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 CARE tools, please send email inquiries 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.

Criminal Record Clearance

Licensee Lucila Mateos 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.

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 Lucila Mateos was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain childcare by connecting them to childcare providers and Resource and Referral Agencies (R&Rs) throughout California.

..................................................................Report Continues 3 of 4 Pages..............................................

SUPERVISOR'S NAME: Denise Gibbs	TELEPHONE: (323) 981-3385
LICENSING EVALUATOR NAME: Franchesca White	TELEPHONE: 323-981-3350
LICENSING EVALUATOR SIGNATURE:	DATE: 01/23/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/23/2024

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
MONTEREY PARK SW RO, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME: MATEOS FAMILY CHILD CARE	FACILITY NUMBER: 198011139
	VISIT DATE: 01/23/2024

NARRATIVE

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Lucila Mateos confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS.

Based on Title 22, observations, record review, and interviews the following deficiencies will be cited and referenced on 809D.

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

Exit interview conducted and report was reviewed with the licensee Lucila Mateos. A copy of the report and Appeal rights were given.

..............................................................................End of Report 4 of 4 Pages..............................................

SUPERVISOR'S NAME: Denise Gibbs	TELEPHONE: (323) 981-3385
LICENSING EVALUATOR NAME: Franchesca White	TELEPHONE: 323-981-3350
LICENSING EVALUATOR SIGNATURE:	DATE: 01/23/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/23/2024

LIC809 (FAS) - (06/04)

Page: 5 of 5

Document Has Been Signed on 01/23/2024 03:52 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
MONTEREY PARK SW RO, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME: MATEOS FAMILY CHILD CARE	FACILITY NUMBER: 198011139
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 01/23/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type A

Section Cited

HSC

1596.871(c)(1)(A)

Administration of Child Day Care Licensing

Subsequent to initial licensure, a person specified in subdivision (b) who is not exempt from fingerprinting shall obtain either a criminal record clearance or an exemption from disqualification, pursuant to subdivision (f) of this section or Section 1522.7, from the State Department of Social Services prior to employment, residence, or initial presence in the facility. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Baseed on interview, record review the licensee did not comply with the section cited above in Licensee's Assistant did not have criminal background clearance at time of inspection. which poses an immediate health, safety or personal rights risk to persons in care.
	POC Due Date: 01/24/2024
	Plan of Correction
1 2 3 4	Licensee provided Assistant with paperwork to go be fingerprinted immediately. LPA saw assistant leave during inspection.

Section Cited


	Deficient Practice Statement
1 2 3 4
	POC Due Date:
	Plan of Correction
1 2 3 4

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: Denise Gibbs	TELEPHONE: (323) 981-3385
LICENSING EVALUATOR NAME: Franchesca White	TELEPHONE: 323-981-3350
LICENSING EVALUATOR SIGNATURE:	DATE: 01/23/2024

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/23/2024

LIC809 (FAS) - (06/04)

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