198012366-8-23-2019-54-CC-TFIS-BFBR5E-20190823124302

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 198012366
Report Date: 08/23/2019
Date Signed: 08/23/2019 12:43:14 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:	VILLALOBOS FAMILY CHILD CARE		FACILITY NUMBER:	198012366
ADMINISTRATOR:	VILLALOBOS, MARTHA ELENA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(562) 923-4185
CITY:	DOWNEY	STATE: CA	ZIP CODE:	90242
CAPACITY:	14	CENSUS: 1	DATE:	08/23/2019
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	10:51 AM
MET WITH:	Jocelyn Gutierrez		TIME COMPLETED:	12:57 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	ANNUAL RANDOM INSPECTION CONDUCTED IN ENGLISH An Annual Random inspection was conducted by Licensing Program Analyst (LPA), Timothy Fields. LPA was guided on a tour of the facility by licensee's adult daughter Jocelyn Gutierrez. Licensee Martha Villalobos was not present during todays inspection. This is a two story home with six bedrooms and three bathrooms. Residing in the home are six adults and one child. Four adults live in the main home and the remaining two adults live in the rear unit. Adult, Anhe Garcia, was present in the facility along with one day care child. After a review of criminal record clearances, Ms. Garcia does have a clearance that is not associated to the facility license. LPA also observed, Jennifer Ozuna has a clearance that is not associated. Jessica Corn who recently moved in the rear unit has not obtained a criminal record clearance. Ms. Corn was not present during todays inspection. According to licensee's daughter she has no access to the main house nor children in care. Care is provided in the living room and the first bedroom, which includes a bathroom, located on the first floor. The remaining two bedrooms and guest bathroom on the first floor are off limits along with the three bedroom and one bathroom on the second floor. The kitchen is accessible through passing. There was no fire place or wall heater observed in the home. Licensee has three dogs. Two are isolated from children in care. The front yard is off limits while the backyard is used for outdoor activity space. Children have no access to a garage. All rooms that are off-limits need to be made inaccessible during operating hours. Storage areas for poisons, detergents, cleaning compounds, medicines, and other items which pose a danger to children were observed to be inaccessible to children in care. LPA observed the home to be kept clean and orderly, with heating and ventilation for safety and comfort. Staircase was observed to be properly barricaded. Capacity and ratio was observed to be in compliance. Ms. Gutierrez complied with inspection authority.

SUPERVISOR'S NAME: Trevino Cochran	TELEPHONE: (323) 981-3350
LICENSING EVALUATOR NAME: Timothy Fields	TELEPHONE: (323) 981-3431
LICENSING EVALUATOR SIGNATURE:	DATE: 08/23/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/23/2019

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 CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME: VILLALOBOS FAMILY CHILD CARE	FACILITY NUMBER: 198012366
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 08/23/2019

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 08/26/2019 Section Cited	1 2 3 4 5 6 7	Criminal Record Clearance Request a transfer of a criminal record clearance as specified in Section 102370(j) The requirement is not met as evidenced by Jessica Corn, Jennifer Ozuna, and Anhe Garcia have not submitting the Criminal
	8 9 10 11 12 13 14	Background Clearance Transfer Request LIC 9182, Live Scan LIC 9163, Criminal Record Statement LIC 508, and copy of their I.D. This poses a potential risk to the health and safety of children in care.	8 9 10 11 12 13 14
	1 2 3 4 5 6 7
	1 2 3 4 5 6 7

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 Cochran	TELEPHONE: (323) 981-3350
LICENSING EVALUATOR NAME: Timothy Fields	TELEPHONE: (323) 981-3431
LICENSING EVALUATOR SIGNATURE:	DATE: 08/23/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/23/2019

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 CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME: VILLALOBOS FAMILY CHILD CARE	FACILITY NUMBER: 198012366
	VISIT DATE: 08/23/2019

NARRATIVE

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Pool cover label should read F1346-91 American Society for Testing Material and it should be able to withstand the weight of an adult without water above cover when standing.
· Dog(s) and or pets should be isolated from children in care.
· It is recommended that a First Aid kit be available on premises.
· Outdoor supervision required at all times. If outdoor area not adequately fenced provider must be with children at all times when outdoors.

The following deficiencies are cited in accordance with Title 22 of California Code of Regulations and discussed with licensee:

Jessica Corn, Jennifer Ozuna, and Anhe Garcia have not submitted the Criminal Background Clearance Transfer Request LIC 9182, Live Scan LIC 9163, Criminal Record Statement LIC 508, and copy of their I.D.

See 809 D attached.

Incidental Medical Services (IMS) policy was discussed. 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. Required measles, pertussis, and influenza vaccinations were discussed.

Exit interview conducted with Jocelyn Gutierrez. Appeal Rights provided and explained. Notice of Site Visit must be posted for (30) days. Failure to do so may result in a $100.00 civil penalty.

Web site address to order forms: http://www.dss.cahwnet.gov/cdssweb/On-lineFor_293.htm#l
INTERNET ADDRESS: http://www.ccld.ca.gov – To access licensing forms, updates and Title 22.

SUPERVISOR'S NAME: Trevino Cochran	TELEPHONE: (323) 981-3350
LICENSING EVALUATOR NAME: Timothy Fields	TELEPHONE: (323) 981-3431
LICENSING EVALUATOR SIGNATURE:	DATE: 08/23/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/23/2019

LIC809 (FAS) - (06/04)

Page: 3 of 4

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: VILLALOBOS FAMILY CHILD CARE	FACILITY NUMBER: 198012366
	VISIT DATE: 08/23/2019

NARRATIVE

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Per Ms. Gutierrez there are no weapons or firearms in the home. Telephone service was in operable condition. There is a properly barricaded swimming pool on the premises. The backyard is adequately fenced. There are age appropriate toys and equipment on the premises. The smoke detectors, carbon monoxide detector, and fire extinguisher (2A 10BC) are in operable condition.

-Pediatric CPR and First Aid expires: 6/20/20
-Child Care Roster, Disaster Plan, and Children's Records were discussed.
-Children records and required licensing forms were discussed as well as mandated child abuse reporting and criminal records clearance (finger prints and child abuse clearance) requirement. Licensee's adult daughter has completed the mandated reporter training. Licensee does not carry liability insurance for the day care.

The following was discussed: Individuals who are 18 years of age or older living or working in the home must be finger print cleared prior to licensure or living/working in the facility. Individuals within one month of their 18th birthday must be fingerprinted immediately. An immediate $100 per day Civil Penalty for a maximum of five days for the first violation and a maximum of 30 days for subsequent violations per individual will be issued. If an individual has a clearance with the Department, a criminal record clearance may be transferred. LIC 9182 Criminal Background Clearance Transfer Request may be used.

During operating hours no smoking, no infant walkers, Johnny jumpers, exersaucers and any other item that falls into that category are allowed in the facility. Earthquake, fire disaster, and safety drill posting requirement were explained in detail on this date.

Licensee has been advised of the following:
· Pools should be inaccessible by a pool cover or a 5-foot fence around the perimeter of the pool. If the fence is made out of chain link, the opening should not allow a golf ball to pass through. Fences made out of mesh will need to be approved by the department. Mesh fence will remain in place whenever licensed care is provided, and as long as the mesh fence makes the swimming pool inaccessible to children as determined by licensing staff.

SUPERVISOR'S NAME: Trevino Cochran	TELEPHONE: (323) 981-3350
LICENSING EVALUATOR NAME: Timothy Fields	TELEPHONE: (323) 981-3431
LICENSING EVALUATOR SIGNATURE:	DATE: 08/23/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/23/2019

LIC809 (FAS) - (06/04)

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