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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198014584
Report Date: 11/26/2019
Date Signed: 11/26/2019 04:29:03 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:CELIS FAMILY CHILD CAREFACILITY NUMBER:
198014584
ADMINISTRATOR:CELIS, KELLYFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(562) 429-9646
CITY:LAKEWOODSTATE: CAZIP CODE:
90712
CAPACITY:14CENSUS: 10DATE:
11/26/2019
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
12:45 PM
MET WITH:Kelly Celis, LicenseeTIME COMPLETED:
04:50 PM
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Licensing Program Analysts (LPAs) Susann Sanchez and Alicia Mooberry conducted an unannounced random inspection to the above facility. Upon arrival, LPAs saw Staff #2 outside the house. When LPAs entered the facility, there was a volunteer feeding an infant. LPAs did not see individual on the association list. LPAs asked individual how old she/he was and he/she stated "18 years of age." LPAs called the office for confirmation, officer on duty stated that no one by that name is associated. Staff #3 continued giving LPAs the tour of the facility. Licensee arrived about 20 minutes later and continued the tour. Licensee then stated that volunteer was a minor.

The licensee states that she currently has 14 children enrolled and 10 (3 infants & 7 children) children were present during inspection. A current children’s roster is available and is current. This is a one-story home which consists of 4 bedrooms, 2 bathrooms, kitchen, dining area, living room (FIREPLACE: was blocked by a fence), family room (brown bear classroom) front yard, backyard (fenced), back room (black bear classroom). Per licensee, only off limits area to children and parents include: front bathroom. Hours of operation are 7:30am 5:30pm. The licensee provides food for children in care.

The licensee states that 3 adults and 3 children currently live in the home. Licensee states that she currently has two assistant during operating hours. All individuals present in the home have obtained a criminal record clearance or exemption prior to working, residing or volunteering in a licensed home. Per licensee, there are no weapons, firearms or bodies of water on the premises.

All areas identified on the facility sketch that children use, were inspected for safety, comfort, cleanliness, telephone service. The following was observed and reviewed during this inspection.

SUPERVISOR'S NAME: Brandi VanOostenTELEPHONE: (323) 981-3365
LICENSING EVALUATOR NAME: Susann SanchezTELEPHONE: (323) 981-3366
LICENSING EVALUATOR SIGNATURE:

DATE: 11/26/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/26/2019
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 5
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: CELIS FAMILY CHILD CARE
FACILITY NUMBER: 198014584
VISIT DATE: 11/26/2019
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PHYSICAL PLANT
Detergents, cleaning compounds, medications, and other items which could pose a danger are inaccessible to children. All poisons and cleaning supplies are kept in high cabinet in the garage and kitchen and are locked.

Wall heaters have been shut off by The Gas Company. The valve on the required 2A 10BC fire extinguisher indicates fully charged and was serviced on 09/20/2019, as indicated on service tag. Per State Fire Marshall standards, fire extinguishers shall be serviced annually. Smoke and carbon monoxide detectors were tested and are operable. The licensee's Pediatric First Aid and CPR expires on 11/2020. There are first aid supplies available. All homes shall conduct fire and disaster drills at least once every six months, and document the date and time of each drill. Last drill documented was conducted on 09/05/2019.

There are toys available for children. The licensee states that there is a land line on the premises and a cell phone is used and stays at the facility during operating hours. The backyard outdoor play area was observed to be fenced. At this time, children are using the back yard for outdoor play time. Licensee stated that they use the front yard if needed. The licensee states that supervision is provided at all times.

The licensee is observed to be operating within the license capacity limitations. Children’s records were reviewed, including but not limited to, a copy of the emergency information card that contains all the information specified by regulation. LPA issued a Confidential Names List (LIC 811) to the licensee which documents staff and children’s files reviewed during this inspection and will be mailed to Licensee.

H&S 1597.622: 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. The licensee does have proof of immunization against influenza, pertussis, and measles.
PETS: There is two dogs, one rabbit, and a gieco.
POSTING REQUIREMENTS: Emergency Disaster Plan, Parent’s Rights Poster and the Facility License are observed to be posted in the family room.
PROHIBITED: Infant Walkers, Johnny Jumpers, Saucer Chairs, and/or any other item that falls into these categories are not permitted in a family child care facility. DO NOT SLEEP CHILDREN IN CAR SEATS. SMOKING IS PROHIBITED IN A LICENSED FAMILY CHILD CARE HOME.
SUPERVISOR'S NAME: Brandi VanOostenTELEPHONE: (323) 981-3365
LICENSING EVALUATOR NAME: Susann SanchezTELEPHONE: (323) 981-3366
LICENSING EVALUATOR SIGNATURE:

DATE: 11/26/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/26/2019
LIC809 (FAS) - (06/04)
Page: 2 of 5
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: CELIS FAMILY CHILD CARE
FACILITY NUMBER: 198014584
VISIT DATE: 11/26/2019
NARRATIVE
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 Infant Care: Licensee is currently caring for infants. LPAs advised the licensee to sleep infants where they can be directly supervised at all times and advised the licensee against sleeping infants in a separate rooms. The licensee stated the following as a supervision plan for infants: Licensee states that infants will try to sleep in the front room or in her master bedroom. Licensee has baby monitors. Licensee has four Pack N Plays, one brand is Chico and one Graco. LPA provided the licensee with a copy of the Child Care Provider’s Guide to Safe Sleep, by American Academy of Pediatrics and Helping you to reduce the risk of SIDS. LPA consulted and explained Child Abuse Reporting, Updated Patent’s Rights Poster with Complaint Hotline information, Never Shake a Baby, Sudden Infant Death Syndrome (SIDS), and Safe Sleeping practices.

Incidental Medical Services (IMS):
The licensee states that she will provide IMS. Per licensee, there are no children enrolled that require IMS at this time. 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.

LPA advised the licensee how to access forms, regulations and quarterly updates on line at: dss.ca.gov. AB1207 Mandated Child Abuse Reporting – http://mandatedreporterca.com/ Licensee and asisstant both have Mandated Reporter certificates. Expires on 09/20/2021

Any unusual incidents or injuries must be reported to the Department within 24 hours via telephone and within seven (7) days in writing. (use LIC624B for written report). Licensees shall reveal each facility license number in all advertisements, publications, or announcements made with the intent to attract clients.



Based on the LPA’s observations and records review, the following deficiencies listed on the attached LIC 809 (deficiency page) are being cited in accordance with California Code of Regulations Title 22. Deficiencies that are being cited need to be cleared to protect the children’s health & safety.
SUPERVISOR'S NAME: Brandi VanOostenTELEPHONE: (323) 981-3365
LICENSING EVALUATOR NAME: Susann SanchezTELEPHONE: (323) 981-3366
LICENSING EVALUATOR SIGNATURE:

DATE: 11/26/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/26/2019
LIC809 (FAS) - (06/04)
Page: 3 of 5
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: CELIS FAMILY CHILD CARE
FACILITY NUMBER: 198014584
VISIT DATE: 11/26/2019
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Upon receipt of a report documenting a Type A deficiency or substantiated complaint, the licensee shall do the following:

1. Health and Safety Code Section 1596.8595 (c) - A licensed child care facility or home shall provide to the parents of each child receiving services in the facility copies of any licensing report that documents any Type A citation that represents an immediate risk to the health, safety, or personal rights of children in care as specified in paragraph (1) of subdivision (a) of Section 1596.893b. Failure to comply with paragraph (1) shall result in an immediate civil penalty of one hundred dollars ($100).

2. Each licensed child day care facility shall post a copy of any licensing report pertaining to the facility that documents either a facility inspection or a complaint investigation that results in a citation for a violation that, if not corrected, will create a direct and immediate risk to the health, safety, or personal rights of children in care. Failure to comply with paragraph (1) shall result in an immediate civil penalty of one hundred dollars ($100).

3. Upon enrollment of a new child in a facility, the licensee shall provide to the parents or legal guardians of the newly enrolling child copies of any licensing report that the licensee has received during the prior 12-month period that documents any Type A citation that represents an immediate risk to the health, safety, or personal rights of children in care as set forth in paragraph (1) of subdivision (a) of Section 1596.893b.

4. The licensee shall require each recipient of the licensing report described to sign a statement (LIC 9224) indicating that he or she has received the document and the date it was received. The Acknowledgement form (LIC 9224) must be maintained in each child’s file immediately upon receipt from parent. A copy of the parent Acknowledgement of Receipt of Licensing Reports Form was provided during this inspection.

Exit interview was conducted with Kelly Celis, Licensee, including, but not limited to Appeal Procedures, Site Visit and Initial Appeal Rights.

The Notice of Site Visit (LIC 9213) – must remain posted for 30 days during the hours of operation after each site visit made by a licensing representative. Failure to maintain posting as required will result in a civil penalty of $100.00.
SUPERVISOR'S NAME: Brandi VanOostenTELEPHONE: (323) 981-3365
LICENSING EVALUATOR NAME: Susann SanchezTELEPHONE: (323) 981-3366
LICENSING EVALUATOR SIGNATURE:

DATE: 11/26/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/26/2019
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
CCLD Regional Office, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME: CELIS FAMILY CHILD CARE
FACILITY NUMBER: 198014584
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/26/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
11/27/2019
Section Cited

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Criminal Record Clearance.
The volunteer is directly supervised by the licensee or a facility employee with a criminal record clearance or exemption. The volunteer is not left alone with children in care. This requirement was not met as evidenced LPA during inspection. LPAs observed a volunteer inside alone with children.
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This poses an immediate risk to the health and safety of children in care.
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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: Brandi VanOostenTELEPHONE: (323) 981-3365
LICENSING EVALUATOR NAME: Susann SanchezTELEPHONE: (323) 981-3366
LICENSING EVALUATOR SIGNATURE:
DATE: 11/26/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/26/2019
LIC809 (FAS) - (06/04)
Page: 5 of 5