198011855-8-11-2022-33-CC-MGAA-CH82E6-20220811171925

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 198011855
Report Date: 08/11/2022
Date Signed: 08/11/2022 05:19:46 PM

Document Has Been Signed on 08/11/2022 05:19 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 CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME:	VARGAS FAMILY CHILD CARE		FACILITY NUMBER:	198011855
ADMINISTRATOR:	VARGAS, AGUEDA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(323) 887-4002
CITY:	MONTEBELLO	STATE: CA	ZIP CODE:	90640
CAPACITY:	14	CENSUS: 16	DATE:	08/11/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	12:47 PM
MET WITH:	Agueda Vargas, Licensee		TIME COMPLETED:	05:30 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	***********This inspection was conducted in Spanish******** Licensing Program Analyst (LPA) Mireya García conducted an unannounced annual required inspection. Due to COVID- 19 precautionary measures were taken, licensing staff present during inspection wore appropriate personal protective equipment. LPA met with licensee, Agueda Vargas who guided analyst on a tour of the facility. The licensee's assistant, Beatriz Atempa and Licensee’s adult daughter and licensee’s friend Rebecca Ramirez Cornejo (Visitor from Mexico) were also present during this inspection. Upon arrival to the home LPA Garcia at 12:43pm., observed unknown adult female come into the home. At 12:47 pm., LPA Garcia rang door bell and observed through the kitchen window Licensee and unknown female in the kitchen area. LPA Garcia waited outside front door and at 12:53pm observed unknown female walk out of the home from the rear side exit with (3) school-age children. Per unknown female disclosure to LPA she was picking up (3) daycare children. Licensee immediately open the door and stated, children were getting picked up by her friend the unknown female who is the pick up person for the (3) day care children. Inside LPA Garcia observed that there were (12) children present with two (2) being infants. At 2:20 pm., the (3) school-age children (Ages, 8, 10, 12) returned to the daycare .Per child #12 they were at the park. Licensee states that there are currently 16 children enrolled. Family members residing in the home are 4 adults (criminal record clearances on file) and no minor children. This is a two-story home which consists of 5 bedrooms, 4 bathrooms, kitchen, dining room, living room, garage, front (fenced) and back yard (fenced). The children use the restroom near the main daycare room, main daycare room and back yard. Per licensee, areas off limits to children and parents include: 4 bedrooms (3 bedrooms located on the second floor and 1 bedroom located on the first floor near the living room and 3 bathroom (2 bathrooms located in the second floor and 1 bathroom located on the first floor near living room). The LPA toured all off limits and all areas used by children during this visit. Report continues on next page 1 of 4.

SUPERVISOR'S NAME: Brandi VanOosten	TELEPHONE: (323) 981-3365
LICENSING EVALUATOR NAME: Mireya Garcia	TELEPHONE: (323) 981-3390
LICENSING EVALUATOR SIGNATURE:	DATE: 08/11/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/11/2022

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 CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME: VARGAS FAMILY CHILD CARE	FACILITY NUMBER: 198011855
	VISIT DATE: 08/11/2022

NARRATIVE

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During this tour, the following was noted: At 12:55 p.m., LPA was toured through the interior of the home. Areas accessible to children were inspected to ensure that they are clean and orderly with ventilation and central heating for safety and comfort. There were safe toys, play equipment and materials observed for children. At 1:10 pm., LPA observed poisons (Raid Ant & Roach, & Flying Insect Killer, Pictures were taken) accessible in the garage cabinet. The licensee does understand that poison must be locked with a key or combination lock. There is a working telephone service maintained in the home.

LPA observed and inspected sleeping equipment for infants. LPA observed four (4) play yards for each infant who is unable to climb out of the play yard. All equipment meets the US Consumer Product Safety Commission safety standards. LPA observed that play yards are free from loose articles and objects. There is no objects hanging above or attached to the side of the play yards. LPA observed that play yards do not hinder the entrance or exit to and from the space they are sleeping in. Bottom mat was observed to be firm and covered with a fitted sheet that is appropriate to the mat size. Each infant has their individual bedding and is washed weekly as required. Soiled bedding is replaced when wet or soiled and is placed in an area inaccessible to infants.

Pacifiers were observed with nothing attached to them. Licensee was advised that infants shall not be swaddled while in care and all infants up to 12 months should be placed on their back for sleeping. LIC 9227 (Individual Sleeping Plan) for infants up to 12 months form was review. Title 22 Regulation Section 102425(j) Infant Safe Sleep was discussed with the Licensee, including but not limited to documentation that shall be maintained. PIN 20-24-CCP Recently approved Safe Sleep Regulations in Effect was discuss, reviewed and a copy in Spanish was provided to the Licensee during this inspection.

Per licensee, there are no weapons, firearms or bodies of water on the premises. Children’s records were reviewed to ensure that each child has an Identification and Emergency form children #1, 12, 13 were missing Identification and Emergency forms. The valve on the required 2A 10BC fire extinguisher indicates fully charged with a service tag dated 06/07/2021. Smoke detector and carbon monoxide detector in the living room/dining room were tested at 1:05 pm., and are in operable condition. The licensee has current Pediatric First Aid and CPR, which will expire 06/2024.

Report continues on next page 2 of 4.

SUPERVISOR'S NAME: Brandi VanOosten	TELEPHONE: (323) 981-3365
LICENSING EVALUATOR NAME: Mireya Garcia	TELEPHONE: (323) 981-3390
LICENSING EVALUATOR SIGNATURE:	DATE: 08/11/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/11/2022

LIC809 (FAS) - (06/04)

Page: 2 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 CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME: VARGAS FAMILY CHILD CARE	FACILITY NUMBER: 198011855
	VISIT DATE: 08/11/2022

NARRATIVE

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Incidental Medical Services (IMS) policy was discussed. Per Licensee there are currently no children enrolled who required IMS. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Family Child Care Homes Section 102417. 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: http://www.ada.gov/childqanda.htm Report continues on next page 3 of 5.

SB792 (Immunization Requirements for Staff and Employees) was discussed with the Licensee.

AB1207 Mandated Child Abuse Reporting – On or before March 30, 2018 any person who works in a child care facility shall complete the training and renew the training every 2 years. Website provided: https://www.mandatedreporterca.com/training/child-care-providers

The following was discussed:

· Individuals who are 18 years of age or older living in the home must obtain a criminal record clearance. Individuals within one month of their 18th birthday must be fingerprinted immediately. Failure to obtain a criminal record background check clearances prior to initial presence in the home will result in an immediate $100.00 dollar or more per day Civil Penalty.
· The Licensee shall be present in the home and shall ensure that children are supervised at all times.
· Children shall not be left in park vehicles.
· The capacity specified on the license shall be the maximum number of children for whom care can be provided.
· Car seats shall only be used for transportation purposes and shall not be used for sleeping.
· All children in care have the right to receive safe, healthful, and comfortable accommodations, furnishings and equipment.
· When a child shows signs off illness, they will be separated from other children until the nature if the illness is determined.

Report continues on next page 3 of 4.

SUPERVISOR'S NAME: Brandi VanOosten	TELEPHONE: (323) 981-3365
LICENSING EVALUATOR NAME: Mireya Garcia	TELEPHONE: (323) 981-3390
LICENSING EVALUATOR SIGNATURE:	DATE: 08/11/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/11/2022

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 CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME: VARGAS FAMILY CHILD CARE	FACILITY NUMBER: 198011855
	VISIT DATE: 08/11/2022

NARRATIVE

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LPA reviewed and issued the LIC 311 - Forms/Records to Keep in Your Family Child Care Home.
CHILDREN’S FORMS/RECORDS, FACILITY FORMS/RECORDS and INFORMATION TO BE POSTED, Disaster drills, posting requirements, children records requirements, mandated child abuse and injury/death reporting, and criminal record transfer requirements were discussed.

LPA advised the licensee how to access forms, regulations and quarterly updates on the Child Care Licensing website at: www.ccld.ca.gov

The following deficiencies are being cited in accordance to Title 22 of the California Code of Regulations and Health & Safety codes. Please refer to LIC809D for documentation of deficiencies cited.

A copy of this report shall be provided to the parent/guardian of children currently enrolled by the next business day or immediately upon return. A copy of this report shall also be provided to the parent/guardian of any newly enrolled children for the next 12 months (1 year). Acknowledgement of Receipt (LIC 9224 form) must be maintained in each child’s file immediately upon receipt from parent. Licensee, Agueda Vargas was provided with a copy of the Acknowledgement of Receipt of Licensing Reports (LIC 9224) Form (English/Spanish).

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

Exit interview conducted and report was reviewed with facility representative, Agueda Vargas.

Report ends here page 4 of 4.

SUPERVISOR'S NAME: Brandi VanOosten	TELEPHONE: (323) 981-3365
LICENSING EVALUATOR NAME: Mireya Garcia	TELEPHONE: (323) 981-3390
LICENSING EVALUATOR SIGNATURE:	DATE: 08/11/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/11/2022

LIC809 (FAS) - (06/04)

Page: 4 of 8

Document Has Been Signed on 08/11/2022 05:19 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 CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME: VARGAS FAMILY CHILD CARE	FACILITY NUMBER: 198011855
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 08/11/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type A

Section Cited

CCR

102417(g)(4)(A)

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: (4) Poisons, detergents, cleaning compounds, medicines, firearms and other items which could pose a danger if readily available to children shall be stored where they are inaccessible to children. (A) Storage areas for poisons, firearms and other dangerous weapons shall be locked. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on LPAs observing poisons (Raid, Flying Insect killer products,) stored in accessible unlocked cabinets in the garage. This poses an immediate health and safety risk to children in care.
	POC Due Date: 08/11/2022
	Plan of Correction
1 2 3 4	Per Licensee she will purchase lock and latch to place padlock on the cabinets where poisons will kept stored to ensure that poisons are kept locked at all times.

Type A

Section Cited

CCR

102416.5(d)(2)

Staffing Ratio and Capacity

(d) 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 who reside at the licensee's home and the assistant provider's children under age 10, shall be either: (2) More than twelve and up to fourteen children only if the criteria in Section 1597.465 of the Health and Safety Code are met. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on LPAs observation of 16 day care children present during today's inspection which poses an immediate health, safety risk to persons in care.
	POC Due Date: 08/11/2022
	Plan of Correction
1 2 3 4	Per Licensee she will no longer accept more than the number of children allowed and will speak to all parents.

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: Brandi VanOosten	TELEPHONE: (323) 981-3365
LICENSING EVALUATOR NAME: Mireya Garcia	TELEPHONE: (323) 981-3390
LICENSING EVALUATOR SIGNATURE:	DATE: 08/11/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/11/2022

LIC809 (FAS) - (06/04)

Page: 5 of 8

Document Has Been Signed on 08/11/2022 05:19 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 CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME: VARGAS FAMILY CHILD CARE	FACILITY NUMBER: 198011855
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 08/11/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

102417(g)(3)

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: (3) Where children are less than five years old are in care, stairs shall be fenced or barricaded. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on LPAs observation of stairs that lead to the second floor were not fenced or barricaded which poses a potential health and safety risk to persons in care.
	POC Due Date: 08/12/2022
	Plan of Correction
1 2 3 4	During LPAs inspection Licensee placed safety gate on the stairs that lead to the second floor however safety gate was not properly secured Licensee states she will secure safety gate or replace the safety gate to ensure that the stairs are barricated and will send LPA Garcia proof of correction via email by POC due date 08/12/22.

Type B

Section Cited

CCR

102425(j)(1)

Infant Safe Sleep

The provider shall supervise infants while they are sleeping and adhere to the following requirements: The provider shall physically check on the infant every 15 minutes. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on LPAs observation adn records review of child #2 & child #3 and Licensee's disclosure of no documentation is available for review of provider physically checking on infants every 15 minutes which poses a potential health and safety risk to persons in care.
	POC Due Date: 08/26/2022
	Plan of Correction
1 2 3 4	Per Licensee, day care staff will check on sleeping infants every 15 minutes and document their condition to check for signs of distress, which includes, but is not limited to labored breathing, flushed skin color, increase in body temperature, and restlessness and will submit to LPA Garcia sleeping logs via email by POC due date 08/26/22.

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: Brandi VanOosten	TELEPHONE: (323) 981-3365
LICENSING EVALUATOR NAME: Mireya Garcia	TELEPHONE: (323) 981-3390
LICENSING EVALUATOR SIGNATURE:	DATE: 08/11/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/11/2022

LIC809 (FAS) - (06/04)

Page: 6 of 8

Document Has Been Signed on 08/11/2022 05:19 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 CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME: VARGAS FAMILY CHILD CARE	FACILITY NUMBER: 198011855
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 08/11/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)

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
1 2 3 4	Based on records review of Licensee's assistant #1 file was missing record for immunization of measles and assistant #2 was missing immunization records. This poses a potential health and safety risk to children in care.
	POC Due Date: 08/26/2022
	Plan of Correction
1 2 3 4	Per Licensee, she will obtain immunization records for day care staff and will submit proof via email to LPA Garcia on or before POC due date 08/26/22.

Type B

Section Cited

CCR

102417(g)(7)

Operation of A Family Child Care Home

(7) An emergency information card shall be maintained for each child and shall include the child's full name, telephone number and location of a parent or other responsible adult to be contacted in an emergency, the name and telephone number of the child's physician and the parent's authorization for the licensee or registrant to consent to emergency medical care. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on records review of Child #1, #12, #13 files were missing emergency information card. This poses a potential health and safety risk to children in care.
	POC Due Date: 08/26/2022
	Plan of Correction
1 2 3 4	Per Licensee, she will have parent complete LIC forms, and will submit LIC700 form via email to LPA Garcia on or before POC due date 08/26/22

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: Brandi VanOosten	TELEPHONE: (323) 981-3365
LICENSING EVALUATOR NAME: Mireya Garcia	TELEPHONE: (323) 981-3390
LICENSING EVALUATOR SIGNATURE:	DATE: 08/11/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/11/2022

LIC809 (FAS) - (06/04)

Page: 7 of 8

Document Has Been Signed on 08/11/2022 05:19 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 CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME: VARGAS FAMILY CHILD CARE	FACILITY NUMBER: 198011855
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 08/11/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

102417(g)(1)

(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
1 2 3 4	LPA Garcia observing that the fire extinguisher has a Fire Marshall tag with service date of 06/07/21. This poses a potential health and safety risk to children in care.
	POC Due Date: 08/26/2022
	Plan of Correction
1 2 3 4	Per Licensee fire extinguisher will be serviced and picture of the service receipt/fire marshal tag will be submitted by POC due date of 08/26/22.

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: Brandi VanOosten	TELEPHONE: (323) 981-3365
LICENSING EVALUATOR NAME: Mireya Garcia	TELEPHONE: (323) 981-3390
LICENSING EVALUATOR SIGNATURE:	DATE: 08/11/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/11/2022

LIC809 (FAS) - (06/04)

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