198014584-10-25-2022-54-CC-MAYA-CKJTR9-20221025145711

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 198014584
Report Date: 10/25/2022
Date Signed: 10/25/2022 02:57:27 PM

Document Has Been Signed on 10/25/2022 02:57 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:	CELIS FAMILY CHILD CARE		FACILITY NUMBER:	198014584
ADMINISTRATOR:	CELIS, KELLY		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(562) 429-9646
CITY:	LAKEWOOD	STATE: CA	ZIP CODE:	90712
CAPACITY:	14	CENSUS: 12	DATE:	10/25/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	11:50 AM
MET WITH:	Licensee, Kelly Celis		TIME COMPLETED:	03:00 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	On October 25, 2022 at 11:50 AM, Licensing Program Analyst (LPA) Monique Ayala conducted an unannounced inspection at the facility noted above and met with Licensee, Kelly Celis. The purpose of the inspection was to conduct the Required - 1 Year inspection. The operating hours of the facility is Monday through Friday from 7:30 AM to 5:00 PM. Entrance Checklist (LIC 126) was provided to the Licensee upon arrival. Individuals residing in the home were discussed and noted. At the time of the inspection, two (2) personnel and twelve (12) children were present. All areas identified on the facility sketch were inspected. This facility is a single family home that consists of four (4) bedrooms, 2 bathrooms, living room, dining room, kitchen, play room, detached garage (converted to day care room), and fenced backyard. Areas that are accessible to children include: 4 bedrooms, one (1) bathroom, living room, dining room, kitchen, play room, detached garage (converted to day care room), and fenced backyard. Per Licensee, the children utilize the fenced backyard for outdoor activity. Per Licensee, the detached garage that was converted to a day care room is only used for play and not for napping. Licensee also stated that the bedrooms are used only for napping, and the bedroom doors are closed and locked when not in use. Areas off-limits to children include: 1 bathroom. LPA observed the off-limit bathroom door closed and locked, making the room inaccessible to children in care. Licensee was advised that off-limit areas must be made inaccessible during operating hours or while children in care are present.

SUPERVISOR'S NAME: Valarie Cook	TELEPHONE: (323) 513-3858
LICENSING EVALUATOR NAME: Monique Ayala	TELEPHONE: (323) 246-2016
LICENSING EVALUATOR SIGNATURE:	DATE: 10/25/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/25/2022

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: CELIS FAMILY CHILD CARE	FACILITY NUMBER: 198014584
	VISIT DATE: 10/25/2022

NARRATIVE

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The following documents were posted in a prominent, publicly accessible area: Facility License, Notification of Parents' Rights (PUB 394), Earthquake Preparedness (LIC 9148), and Emergency Disaster Plan (LIC 610A). Licensee has a current Facility Roster (LIC 9040). Licensee also has verification of disaster and fire drills. The last drill was conducted on October 20, 2022.

Areas used by children were inspected for safety, comfort, heating, cleanliness and telephone service. The home does not have any wall heaters, and has central air and heating. The home has a fire place located in the play room that is securely barricaded and not in use. Detergents, cleaning compounds and medicines were made inaccessible to children. Per Licensee, there are no poisons kept in the home. Licensee was advised that if any poisons are purchased, it is required to be locked with a key or combination lock. Per Licensee, there are no bodies of water, firearms and/or weapons on the premises. Per Licensee, the home has 2 dogs that are kept isolated from the children in care. LPA observed age appropriate toys and napping equipment for children. LPA observed electrical outlet covers installed in the child care areas.

LPA observed the required fire extinguisher (3-A:40-B:C) that is fully charged and was last serviced on September 7, 2022. Licensee was reminded to have the fire extinguisher serviced yearly. Smoke detectors and carbon monoxide detectors were tested and are operable. First Aid kit and emergency supplies are available and kept in the kitchen. Licensee was reminded that food that is brought from the child's home shall be labeled with the child’s name and properly stored or refrigerated.

LPA conducted a record review of six (6) children's records, Licensee's record, and 2 personnel records. Based on the record reviews, Licensee did not have verification of the 15 minute physical checks while children are napping available for review for child (C4) and C6. Based on record reviews, staff (S1) and S2 did not have the Preventative Health and Safety Practices certificate of completion available for review.

Licensee has proof of immunization against pertussis, influenza, and a TB clearance. Licensee did not have the immunization record for measles or documentation of exemption available for review. Licensee has a valid Pediatric First Aid and CPR certification (expires October 13, 2024). Licensee completed the required Preventative Health and Safety Practices on August 23, 2008 and Mandated Reporter Training (AB 1207) on October 5, 2021. Licensee was advised that the Mandated Reporter training (AB 1207) must be completed every 2 years and is available at www.mandatedreporterca.com.

SUPERVISOR'S NAME: Valarie Cook	TELEPHONE: (323) 513-3858
LICENSING EVALUATOR NAME: Monique Ayala	TELEPHONE: (323) 246-2016
LICENSING EVALUATOR SIGNATURE:	DATE: 10/25/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/25/2022

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: CELIS FAMILY CHILD CARE	FACILITY NUMBER: 198014584
	VISIT DATE: 10/25/2022

NARRATIVE

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LPA discussed the safe sleep regulations with Licensee 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 Licensee 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.

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

Licensee was reminded that all adults 18 and over living in the home, persons who provide care and supervision to children, and staff who have contact with children, 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 licensed Family Child Care Home. 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.

Community Care Licensing Division (CCLD) regularly sends information to licensed facilities, providers, and stakeholders by way of Provider Information Notices (PINs), Program Quarterly Update Newsletters and other important information communication platforms.

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

SUPERVISOR'S NAME: Valarie Cook	TELEPHONE: (323) 513-3858
LICENSING EVALUATOR NAME: Monique Ayala	TELEPHONE: (323) 246-2016
LICENSING EVALUATOR SIGNATURE:	DATE: 10/25/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/25/2022

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: CELIS FAMILY CHILD CARE	FACILITY NUMBER: 198014584
	VISIT DATE: 10/25/2022

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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.

Deficiencies were cited during today's inspection (refer to deficiency pages).

A Notice of Site Visit (LIC 9213) was given and must remain posted for 30 days.

Exit interview conducted and report was reviewed with Licensee, Kelly Celis.

SUPERVISOR'S NAME: Valarie Cook	TELEPHONE: (323) 513-3858
LICENSING EVALUATOR NAME: Monique Ayala	TELEPHONE: (323) 246-2016
LICENSING EVALUATOR SIGNATURE:	DATE: 10/25/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/25/2022

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 10/25/2022 02:57 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 CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME: CELIS FAMILY CHILD CARE	FACILITY NUMBER: 198014584
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 10/25/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

HSC

1597.622(c)

Administration of Child Day Care Licensing

(c) The family day care home shall maintain documentation of the required immunizations or exemptions from immunization, as set forth in this section, in the person's personnel record that is maintained by the family day care home. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on record review, the licensee did not comply with the section cited above as the Licensee did not have proof of immunization for measles or documentation of exemption available for review which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 11/25/2022
	Plan of Correction
1 2 3 4	Licensee will submit to LPA via e-mail their proof of immunization for measles or documentation of exemption by November 25, 2022.

Type B

Section Cited

CCR

102416.1(a)(6)

Personnel Records

(a) Personnel records shall be maintained on each employee and shall contain the following information: (6) Documentation of completion of training on preventative health practices as required by Section 102416(c). This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on record review, the licensee did not comply with the section cited above in 2 personnel records (S1 and S2) which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 11/25/2022
	Plan of Correction
1 2 3 4	Licensee will submit proof of completion for the Preventative Health and Safety Practices (EMSA-approved) for staff (S1) and S2 to LPA via e-mail by November 25, 2022.

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: Valarie Cook	TELEPHONE: (323) 513-3858
LICENSING EVALUATOR NAME: Monique Ayala	TELEPHONE: (323) 246-2016
LICENSING EVALUATOR SIGNATURE:	DATE: 10/25/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/25/2022

LIC809 (FAS) - (06/04)

Page: 5 of 6

Document Has Been Signed on 10/25/2022 02:57 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 CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME: CELIS FAMILY CHILD CARE	FACILITY NUMBER: 198014584
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 10/25/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

102425(j)(2)(D)

Infant Safe Sleep

Documentation shall be maintained in the infant’s file and be available to the Department for review. Documentation shall include the following: This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on record review, the licensee did not comply with the section cited above in 2 children's records (C4 and C6) out of which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 11/25/2022
	Plan of Correction
1 2 3 4	Licensee will submit documentation for the 15 minute physical checks while children are napping for at least one week for child (C4) and C6 to LPA via e-mail by November 25, 2022.

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: Valarie Cook	TELEPHONE: (323) 513-3858
LICENSING EVALUATOR NAME: Monique Ayala	TELEPHONE: (323) 246-2016
LICENSING EVALUATOR SIGNATURE:	DATE: 10/25/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/25/2022

LIC809 (FAS) - (06/04)

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