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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198016656
Report Date: 03/13/2024
Date Signed: 03/13/2024 03:18:31 PM


Document Has Been Signed on 03/13/2024 03:18 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
MONTEREY PARK CC RO, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754



FACILITY NAME:FLORES FAMILY CHILD CAREFACILITY NUMBER:
198016656
ADMINISTRATOR:FLORES, MAYRAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(323) 819-3562
CITY:LOS ANGELESSTATE: CAZIP CODE:
90029
CAPACITY:14CENSUS: 8DATE:
03/13/2024
TYPE OF VISIT:Required - 3 YearUNANNOUNCEDTIME BEGAN:
12:31 PM
MET WITH:Mayra Flores, LicenseeTIME COMPLETED:
03:35 PM
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Licensing Program Analyst (LPA) Staicy Perry and Monique Ayala conducted an unannounced 3 year required inspection at the above facility on 3/13/2024. Licensing staff met with Licensees assistants Calamanda Ochoa and Kenia Herrera, who guided analysts on a tour of the facility. There were 8 children present upon arrival. The licensee was not present. Assistants were not able to disclose where licensee went. At 12:58 Licensee Mayra arrived and stated that she went with her mother to assist her mother in running an errand. Licensee is observed to be operating within the license capacity limitations for a Large Family Child Care Home. A current children’s roster is available and is current. Hours of operation are 23 hours a day from 12:00am-11:00pm Monday through Sunday. LPAs observed another day care in the front house that remains separate from the above facility at all times.

The licensee provides care in the home. This is a one story home which consists of three bedrooms, one bathroom, kitchen, living room and laundry room.



Areas accessible to children were inspected as follows: Kitchen, living room, 3 bedroom and bathroom, play yard (driveway). Licensee also stated she takes the children to nearby park with parental consent.

Areas not accessible to children are as follows: laundry room.

Main care is provided in the playroom which is also the living room and can be accessed from the main side entrance. The children use the bathroom that is down the hall from the living room on the left side. LPAs observed there is no wall heater or fireplace. The house contains central air.

The LPAs toured all areas used by children during this visit. The licensee states that only she lives at the facility. There was a total of three adults present during this inspection, License Mayra and Licensee’s two assistants.
SUPERVISOR'S NAME: Claudia GuangorenaTELEPHONE: (323) 981-3417
LICENSING EVALUATOR NAME: Staicy PerryTELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:
DATE: 03/13/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/13/2024
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
MONTEREY PARK CC RO, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME: FLORES FAMILY CHILD CARE
FACILITY NUMBER: 198016656
VISIT DATE: 03/13/2024
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Persons living in the home are identified on the attached LIC811. 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.

Licensing staff were led on a tour of the facility by the licensees’ assistants. Licensing staff observed the following required posted documentation in the main entry way of the home. Facility License, Publication (PUB) 394- Notification of Parent Rights and Licensing Form (LIC) 9148- Earthquake Preparedness form. LPAs reviewed facility records for LIC 9040- Facility Roster, LIC 610- Facility Disaster Plan and Disaster drill log was observed to be in the hallway. Last drill was conducted on 3/1/24. Licensee stated that she provides all meals for the children. Facility uses CDA Food Program.

The home was observed to be clean and orderly, with central air and heating. LPAs observed age-appropriate toys and equipment present for children. Licensing staff observed the smoke detector in the kitchen to be in operable condition. The carbon monoxide detector located in the living room was operable. Licensing staff observed a fire extinguisher located in the kitchen to be size 1-A:10-B:C, informed licensee the required size is 2-A:10-B:C and should be serviced yearly. A fire extinguisher was observed. The valve on the required 2A 10BC fire extinguisher indicates fully charged and was serviced on September 30, 2023, as indicated on service tag. Per State Fire Marshall standards, fire extinguishers shall be serviced annually. LPAs discussed the importance of ensuring the fire extinguisher is serviced or a new canister is purchased annually. The home does not maintain telephone service via land line or cell phone. Licensee stated that she will purchase cell phone and provide LPA with number. LPAs reminded Licensee Mayra that phone must always remain at the home. Licensee state that she will purchase a cell phone today, 3/13/2024.

Licensing staff observed the following during the inspection knives were seen to be accessible in kitchen drawer and we placed in an inaccessible area by licensee's assistant. Infant crib was observed by LPAs to have one sleeping infant in crib with blankets and blanket bumpers. LPAs did not observe infant 15 minute logs being conducted, per licensee she forgot to start/complete documentation for infants over 12 months. Cleaning compounds in laundry room were seen to be on a rolling cart barricaded by an unlocked gate was made accessible to children in care.
SUPERVISOR'S NAME: Claudia GuangorenaTELEPHONE: (323) 981-3417
LICENSING EVALUATOR NAME: Staicy PerryTELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:

DATE: 03/13/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/13/2024
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
MONTEREY PARK CC RO, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME: FLORES FAMILY CHILD CARE
FACILITY NUMBER: 198016656
VISIT DATE: 03/13/2024
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Licensee states that there are no poisons stored in the home and understands that all poisons must be locked, to be made inaccessible to children. Licensing staff reminded licensee smoking is not allowed in the home. There are first aid supplies available. Per licensee Mayra, bedroom #1 next to living room will be used as an area for an ill child until an authorized representative comes to pick up child. LPAs observed napping equipment in the form of cots, cribs and playpens for the children in care.

The Licensee uses the front yard (driveway) for outdoor play. The outdoor play area was observed to be fenced with an iron black gate. The outdoor yard has toys and other materials for children to play with. Licensing staff observed a motorcycle in driveway as well as black iron fence open. LPAs reminded Licensee Mayra that it’s recommended to, maintain the gate closed at all times of hours of operation of the day care (23 hours a day). LPAs also observed a tool shed that was open with tools inside. Toolshed was observed to be barricaded by 2 battery operated cars that are not functioning at the moment. LPAs did inform licensee to have tool shed locked and closed at all times of day care operation. Licensee will sign a complete a declaration stating that staff will supervise children at all time when there is a vehicle in the driveway, the iron gate will remain closed and storage will remain closed.



-There are no pets on the premises.
-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.
Smoking is prohibited in a license family child care home.


Children’s records were reviewed for (LIC) 282- Affidavit Regarding Liability Insurance, Immunization's Records, LIC 700- Identification and Emergency Information, LIC 627- Consent for Medical Treatment, and LIC 995A Notification of Parents’ Rights. Licensing staff observed files to be complete.
SUPERVISOR'S NAME: Claudia GuangorenaTELEPHONE: (323) 981-3417
LICENSING EVALUATOR NAME: Staicy PerryTELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:

DATE: 03/13/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/13/2024
LIC809 (FAS) - (06/04)
Page: 6 of 8
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MONTEREY PARK CC RO, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME: FLORES FAMILY CHILD CARE
FACILITY NUMBER: 198016656
VISIT DATE: 03/13/2024
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Staff and Licensee files were reviewed for the following: LIC 508- Criminal Record Statement, Proof of immunizations against measles, pertussis and influenza or influenza declination, TB clearance or risk assessment, LIC 9108- Statement Acknowledging Requirement to Report Child Abuse. Pediatric First Aid and CPR certification on expires 12/30/23 for licensee & Licensee’s assistant. Licensing staff advised licensee First Aid and CPR training must be taken in person with an EMSA approved vendor. Mandated Reporter Training for licensee and Licensee's assistant has been completed and expires on 7/12/25. www.mandatedreporterca.com

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 PIN 22-02- CCP. 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: https://www.ada.gov/resources/child-care-centers/. Licensee stated that she does not have an IMS plan on file but currently has no children on medication at this time but will provide medication if needed.

To improve the quality and value of the new inspection process, a survey may 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 CARE tools, please send email inquiries 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/process.

SUPERVISOR'S NAME: Claudia GuangorenaTELEPHONE: (323) 981-3417
LICENSING EVALUATOR NAME: Staicy PerryTELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:

DATE: 03/13/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/13/2024
LIC809 (FAS) - (06/04)
Page: 7 of 8
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MONTEREY PARK CC RO, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME: FLORES FAMILY CHILD CARE
FACILITY NUMBER: 198016656
VISIT DATE: 03/13/2024
NARRATIVE
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Licensee was reminded that all adults 18 and over living or working in the home, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, 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 for a maximum of 5 days or, if the penalty is for a repeat violation, for a maximum of 30 days per person will be assessed if this regulation is violated.

MyChildCarePlan.org – Centers and Family Child Care Homes - Licensee Mayra, was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain childcare by connecting them to childcare providers and Resource and Referral Agencies (R&Rs) throughout California.

Megan’s Law - Family Child Care Homes - During the exit interview, Licensee confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS.

Based on Licensing staff observations and records review, the following deficiencies listed on the attached LIC 809D (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 and safety.


Licensing staff informed licensee Mayra Flores that this report dated 03/13/24 shall be posted for 30 consecutive days as there are immediate risk(s) to the health, safety, or personal rights of children in care.

Licensing staff informed licensee a copy of this licensing report dated 03/13/24 that documents any Type A citation(s) to parents/guardians of all children currently enrolled by the next business day or the next day the children are in care, and to any newly enrolled parents/guardians for 12 months from the date of this report. A signed Acknowledgement of Receipt of Licensing Report (LIC 9224), or other written statement, must be placed in the child's file for verification.



A notice of site visit was given and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

Exit interview conducted and report was reviewed with Licensee, Mayra Flores.
SUPERVISOR'S NAME: Claudia GuangorenaTELEPHONE: (323) 981-3417
LICENSING EVALUATOR NAME: Staicy PerryTELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:

DATE: 03/13/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/13/2024
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 03/13/2024 03:18 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
MONTEREY PARK CC RO, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754


FACILITY NAME: FLORES FAMILY CHILD CARE
FACILITY NUMBER: 198016656

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/13/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
102425(b)
Infant Safe Sleep
(b) Cribs or play yards shall be free from all loose articles and objects.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, the licensee did not comply with the section cited above, LPAs observed infant cribs to have sleeping infants in crib with blankets and blanket bumpers. which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 03/13/2024
Plan of Correction
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Licensee removed all items inside and around infant cribs during todays inspection. LPAs took photo.
Type A
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
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Based on observations and record review, the licensee did not comply with the section cited above in physically checking on infants every 15 minutes, which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 03/13/2024
Plan of Correction
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Licensee will implement immidiately infant safe sleep logs and provide LPA with proof its being completed by POC date.
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: Claudia GuangorenaTELEPHONE: (323) 981-3417
LICENSING EVALUATOR NAME: Staicy PerryTELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:
DATE: 03/13/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/13/2024
LIC809 (FAS) - (06/04)
Page: 2 of 8


Document Has Been Signed on 03/13/2024 03:18 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
MONTEREY PARK CC RO, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754


FACILITY NAME: FLORES FAMILY CHILD CARE
FACILITY NUMBER: 198016656

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/13/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102417(g)(4)
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.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observations, the licensee did not comply with the section cited above in having laundary detergant to be accessiableto the children which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 03/18/2024
Plan of Correction
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Licensee will add a gate to seperate kitchen and laundry room. Licensee will provide anphtot via email to LPA by OC date of 3/18/2024. l
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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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: Claudia GuangorenaTELEPHONE: (323) 981-3417
LICENSING EVALUATOR NAME: Staicy PerryTELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:
DATE: 03/13/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/13/2024
LIC809 (FAS) - (06/04)
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