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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198017313
Report Date: 08/16/2019
Date Signed: 08/16/2019 03:55:44 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:PENA FAMILY CHILD CAREFACILITY NUMBER:
198017313
ADMINISTRATOR:PENA, DIANAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(562) 889-4109
CITY:LONG BEACHSTATE: CAZIP CODE:
90805
CAPACITY:14CENSUS: 4DATE:
08/16/2019
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
03:30 PM
MET WITH:Diana PenaTIME COMPLETED:
04:10 PM
NARRATIVE
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Licensing Program Analyst (LPA) Warren Birks conducted an unannounced case management inspection.Upon arrival LPA observed Licensee Diana Pena (caring for one infant and three preschool children). LPA observed a car seat at the foot of the Licensee in the living room accessible. As soon as LPA informed Licensee to remove the car seat a child ran to play in the seat at the foot of the Licensee. The child was never strapped in and the Licensee had 100% supervision of the child.

LPA informed licensee that the car seat needs to be inaccessible from the daycare area. The Licensee removed the car seat from the daycare area. The Licensee was cited Personal Rights (safe healthful accommodations) regarding the child in the car seat.

The Notice of Site Visit (LIC 9213) – must remain posted for 30 days during the hours of operation after each site visit by a licensing representative. Failure to maintain posting as required will result in a civil penalty of $100.00. Exit interview conducted with Licensee Pena..
SUPERVISOR'S NAME: Karen ChambersTELEPHONE: (323) 980-4934
LICENSING EVALUATOR NAME: Warren BirksTELEPHONE: 323-981-3373
LICENSING EVALUATOR SIGNATURE:

DATE: 08/16/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/16/2019
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: PENA FAMILY CHILD CARE
FACILITY NUMBER: 198017313
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/16/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
08/16/2019
Section Cited
CCR
102423(a)(2)
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Each child receiving services from a family child care home shall have certain rights that shall not be waived or abridged by the licensee regardless of consent or authorization from the child's authorized representative. These rights include, but are not limited to, the following: To receive safe, healthful, and comfortable accommodations, furnishings, and equipment.
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Licensee removed the car seat immediately.
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This requirement was not met as evidenced by: LPA observed car seat in living room accessible. No child was strapped in and Licensee had 100% supervision. This poses a potential risk to 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: Karen ChambersTELEPHONE: (323) 980-4934
LICENSING EVALUATOR NAME: Warren BirksTELEPHONE: 323-981-3373
LICENSING EVALUATOR SIGNATURE:

DATE: 08/16/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/16/2019
LIC809 (FAS) - (06/04)
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