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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198012366
Report Date: 04/20/2023
Date Signed: 04/20/2023 02:16:18 PM


Document Has Been Signed on 04/20/2023 02:16 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 CENTER DR 200B
MONTEREY PARK, CA 91754



FACILITY NAME:VILLALOBOS FAMILY CHILD CAREFACILITY NUMBER:
198012366
ADMINISTRATOR:VILLALOBOS, MARTHA ELENAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(562) 923-4185
CITY:DOWNEYSTATE: CAZIP CODE:
90242
CAPACITY:14CENSUS: 2DATE:
04/20/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:55 AM
MET WITH:Martha Villalobos, LicenseeTIME COMPLETED:
02:23 PM
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On Thursday, April 20, 2023, at 10:55 a.m., Licensing Program Analyst (LPA) Mayra Rivera conducted an unannounced annual inspection and met with licensee Martha Villalobos who guided LPA Rivera on a tour of the facility.

During this inspection, 2 children were present. LPA Rivera observed 2 infant children present. Family members residing in the home was discussed with licensee and are background cleared. Operating hours are Monday to Friday, 12:00 a.m. to 11:59 p.m., and care for children ages 0 to 13 years.

This is a two-story home which consists of 6 bedrooms, 4 bathrooms, kitchen, dining room, living room, attached garage, storage room, pool house and backyard (fenced). Day care is provided in the first bedroom adjacent to the living room. Licensee calls it the playroom. The children use the bathroom in the playroom, living room, dining room and backyard (fenced).

Per licensee, areas off limits to children and parents include: 5 bedrooms, licensee's bathroom, storage room, pool house and attached garage. LPA observed the bedroom doors closed and a round childproof ball placed on the doorknobs. LPA observed the garage and pool house closed and locked with a key door. LPA observed on the bottom of the stairs a safety gate installed. The licensee understands that licensing staff may have access to off-limit areas during inspection visit if necessary

At approximately 11:06 a.m., LPA observed license, LIC 610A Emergency Disaster Plan, Pub 394 Notification of Parents Rights, LIC 999 Facility sketch, LIC 9148 Earthquake Preparedness Checklist posted on the wall near the main entrance
SUPERVISOR'S NAME: Karen ChambersTELEPHONE: (323) 981-3368
LICENSING EVALUATOR NAME: Mayra RiveraTELEPHONE: (323) 629-7782
LICENSING EVALUATOR SIGNATURE:
DATE: 04/20/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/20/2023
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
VISIT DATE: 04/20/2023
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At approximately 11:13 a.m., LPA Rivera, inspected the facility for safety, comfort, cleanliness, ventilation and working phone (cell phone and land line). For ventilation, LPA observed central AC/heater and the thermostat temperature to be at 71 degrees. LPA Rivera entered the daycare area and observed the furniture, children materials, playpens and mats to be in good condition and age appropriate.

At approximately 11:18 a.m., LPA observed cleaning compounds items stored inside the bottom kitchen sink cabinet with a child proof lock in place making it inaccessible for children to open. LPA observed the detergents stored inside the cabinets located above the washer and dryer and observed child proof locks in place. Knives, sharp objects and medication are stored inside top cabinet located above the refrigerator making it inaccessible for children to reach. LPA observed a water dispenser and children personal water cups. Licensee provides the meals and is enrolled in for food program. During this visit licensee stated she has no children with food allergies or prescribed or non-prescribed medication. For ill/isolation children utilize the room next to the dining room.

LPA Rivera observed the required 2A10BC fire extinguisher located near the laundry room and the valve on the green area indicating fully charged and serviced on 3/22/23. LPA observed carbon monoxide/smoker detector combo located in the dining room. At approximately 11:24 a.m., LPA tested the carbon monoxide/smoker detector combo and is operable. LPA observed the first aid kit complete with band aids, gauzes, adhesive bandages and located in. LPA observed the earthquake and fire drill log dated 2/28/23.


LPA Rivera entered the restroom and observed the toilet, running water, and hand soap. LPA did not observe items that can pose a potential hazard to children. LPA observed the restroom to be in good condition. LPA reminded Licensee any personal items must be removed or add a childproof lock.

LPA Rivera asked if there are any pets, poisons, firearms, weapons or bodies of water. Licensee stated she has one dog; ground pool and poisons solutions are stored in the garage. At approximately 11:30 a.m., LPA observed the garage door closed and locked (key door). LPA did observe a dog (in the garage), in ground pool and did not observe firearms, or weapons. Licensee was advised that if any poisons (ex; drano, rat poison or items with skull hazard symbol), firearms and weapons are purchased, it is required to be locked with a key or combination lock and firearm and ammunition must be stored separately.

SUPERVISOR'S NAME: Karen ChambersTELEPHONE: (323) 981-3368
LICENSING EVALUATOR NAME: Mayra RiveraTELEPHONE: (323) 629-7782
LICENSING EVALUATOR SIGNATURE:

DATE: 04/20/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/20/2023
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: 04/20/2023
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At approximately 11:32 a.m., LPA inspected the outdoor area used by children for safety, comfort and cleanliness. LPA observed a fireplace and per licensee the fireplace is operable. LPA observed burned wood logs and informed license the area will require to have a fire screen cover. LPA informed; dog feces must be picked up prior to children going out to play. LPA did not observe any children playing outside. LPA observed the backyard to be fenced all around and the side gates closed and locked. LPA observed one storage room (no hazards) and pool house (tenant). LPA observed the pool house and storage door closed and locked (key door). LPA observed the play equipment to be age appropriate, in safe condition, free of sharp, no loose or pointed parts. LPA observed the ground pool to be fenced. LPA measured the height of the fence and the gap. LPA observed the fence to be 5.0 feet high and 5 inches gap and gate swings away from the pool.
Children’s roster, children’s and licensee files were reviewed during the inspection. LPA observed child #1 missing LIC 9227 Individual Sleep Plan and licensee missing MMR.

Children’s roster, children’s and licensee files were reviewed during the inspection. LPA observed child #1 missing LIC 9227 Individual Sleep Plan and licensee missing MMR immunization.
The following was also discussed with licensee:
1. In the absence of the licensee a qualified adult must be present, supervising the children; a qualified adult is an individual who has a valid and current Pediatric first aid/ CPR-adult-child- infant certification and a valid criminal record clearance associated to the facility license.

2. A current roster of children enrolled must be available and maintained for a period of 3 years, even after children are no longer attending the facility.

4. Annual fees must be paid promptly and by the due date or a late fee shall be assessed and/or the license shall be terminated.

5. The fire extinguisher type 2A-10BC must be serviced annually or as often as necessary and smoke and carbon monoxide detectors should be checked, and batteries replaced as needed.

6. Changes should be reported to the Department as soon as they occur such as construction, remodeling, telephone number changes and/or if you move from your home.
SUPERVISOR'S NAME: Karen ChambersTELEPHONE: (323) 981-3368
LICENSING EVALUATOR NAME: Mayra RiveraTELEPHONE: (323) 629-7782
LICENSING EVALUATOR SIGNATURE:

DATE: 04/20/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/20/2023
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: 04/20/2023
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7. Any unusual incidents or injuries must be reported to the Department within 24 hours via telephone and within seven (7) days in writing (refer to LIC 624B). Mandated reporter requirements were reviewed and explained.

8. Fire and safety drills must be performed every six (6) months and documented for review by the Department.

9. Smoking is prohibited in the family childcare home.

10. Children and staff records must be maintained and updated as needed and be available for review by the Department.

11. Dog(s) and/or pets are recommended to be isolated from children in care.

Medication: 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

To improve the quality and value of the new inspection process, a survey will 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 tools, please send them by email 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

Licensee Martha Villalobos was reminded that all adults 18 and over, including employees and volunteers, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a Family Child Care Center. A civil penalty of $100.00 minimum/day up to $500.00 maximum per day/per person will be assessed if this regulation is violated.

SUPERVISOR'S NAME: Karen ChambersTELEPHONE: (323) 981-3368
LICENSING EVALUATOR NAME: Mayra RiveraTELEPHONE: (323) 629-7782
LICENSING EVALUATOR SIGNATURE:

DATE: 04/20/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/20/2023
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: 04/20/2023
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At approximately 11:45 am., LPA observed licensee Pediatric First Aid/ CPR certification dated 6/12/22 , Health and Safety certification dated 3/5/06, AB 1207 Child Abuse Mandated Certificate issued 4/12/22 . Licensee Martha was advised that the mandated reporter training must be completed every 2 years, and is available at www.mandatedreporterca.com Licensee has proof of immunization against Pertussis, influenza declination and missing MMR.

LPA discussed the safe sleep regulations with licensee Martha Villalobos and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPA also informed Martha Villalobos of the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at https://www.cpsc.gov/ and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment.

Licensee has been given technical violations for missing LIC 9227 Individual Sleep Plan, MMR, fire screen cover for outdoor fireplace and dog feces. At 1:24 p.m., parent of child #1, completed the LIC 9227 Individual Infant Sleep Plan.

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

Exit interview conducted and report was reviewed along with appeal rights with the licensee Martha Villalobos.

SUPERVISOR'S NAME: Karen ChambersTELEPHONE: (323) 981-3368
LICENSING EVALUATOR NAME: Mayra RiveraTELEPHONE: (323) 629-7782
LICENSING EVALUATOR SIGNATURE:

DATE: 04/20/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/20/2023
LIC809 (FAS) - (06/04)
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