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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198017313
Report Date: 02/02/2022
Date Signed: 02/02/2022 12:34:36 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) 889-4104
CITY:LONG BEACHSTATE: CAZIP CODE:
90805
CAPACITY:14CENSUS: 2DATE:
02/02/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Licensee - Diana PenaTIME COMPLETED:
12:46 PM
NARRATIVE
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Licensing Program Analyst (LPA) R. Derraco conducted an unannounced required one year inspection to the above facility on 02/02/22. LPA arrived at the facility at 10:00 AM and met with licensee Diana Pena, who guided analyst on a tour of the facility. Also present during this inspection was an assistant S2. Per Licensee, there are 5 children that are currently enrolled. There were 2 children present upon arrival.

This is a one-story home which consists of two bedrooms, one bathroom, kitchen/dining room, living room, front yard and backyard (fenced). The off limit areas include 2 bedrooms, kitchen/dining area, front yard and a portion of the back yard.

The main care area is located in the living room. LPA observed a wall mounted television, a cubby locker used for storage and personal items for children in care, two couches, a Cosco playpen, a computer desk with computer, a pull down fire alarm and a wall mounted heater/air conditioning unit. Age appropriate toys and materials were also observed in the main care area. A smoke detector was observed to be operable in the main care area. Licensee states that she has a carbon monoxide detector however she does not have any batteries for the device. LPA advised licensee a citation under Health and Safety Code (HSC) section 1597.543 will be issued. Licensee states that she uses the play pen to make the off limits kitchen inaccessible to children in care when the play pen is not being used. Licensee states that she will purchase a gate to make the off limits kitchen/dining area inaccessible. The entrance to the bathroom designated for children in care was observed in the off limits kitchen area. The bathroom was observed to be clean and free of defects. Licensee states that all of the children enrolled are in diapers and mostly the adults use the bathroom. A lock beneath the bathroom sink was observed. The outdoor play area was observed to have a patio cover, laundry appliances, 2 tables, an orange locked tool box and additional age appropriate toys and materials. Laundry detergents and additional cleaners were observed to be kept on a shelf above the laundry appliances making them inaccessible to children in care. The patio was observed to be enclosed with a gate
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SUPERVISOR'S NAME: Trevino CochranTELEPHONE: (323) 981-3385
LICENSING EVALUATOR NAME: Randy DerracoTELEPHONE: (323) 981-3431
LICENSING EVALUATOR SIGNATURE:

DATE: 02/02/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/02/2022
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 8
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: 02/02/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
HSC
1597.543
Licensure Requirements
Every family day care home for children shall have one or more carbon monoxide detectors in the facility that meet the standards established in Chapter 8 (commencing with Section 13260) of Part 2 Division 12. The department shall account for the presence of these detectors during inspections.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on [(observation) (interview) (record review)], the licensee did not comply with the section cited above in [count] out of [total count] [(objects) (persons)] [identifiers] which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 02/08/2022
Plan of Correction
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Licensee states she will email LPA a photo of carbon monoxide detector
Type B
Section Cited
HSC
1596.8662(b)(1)
Administration of Child Day Care Licensing
(1) On or before March 30, 2018, a person who, on January 1, 2018, is a licensed child day care provider, administrator, or employee of a licensed child day care facility shall complete the mandated reporter training provided pursuant to paragraphs (2) and (3) of subdivision (a), and shall complete renewal mandated reporter training every two years following the date on which he or she completed the initial mandated reporter training.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on [(observation) (interview) (record review)], the licensee did not comply with the section cited above in [count] out of [total count] [(objects) (persons)] [identifiers] which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 02/10/2022
Plan of Correction
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Licensee will email a copy of completed Mandated Reported Certificate to LPA
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: Trevino CochranTELEPHONE: (323) 981-3385
LICENSING EVALUATOR NAME: Randy DerracoTELEPHONE: (323) 981-3431
LICENSING EVALUATOR SIGNATURE:
DATE: 02/02/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/02/2022
LIC809 (FAS) - (06/04)
Page: 2 of 8
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
VISIT DATE: 02/02/2022
NARRATIVE
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leading to the backyard play area. LPA observed 3 wooden play houses, a basketball hoop, a storage shed and additional age appropriate toys. A wooden fence was observed towards the end of the back yard separating the licensee's two pet dogs from the back yard play area. Licensee states that there are no firearms stored in the home. No bodies of water were observed on the premises. LPA did not observe the following items during the inspection: Infant Walkers, Johnny Jumpers, Saucer Chairs.

Per licensee, isolation area for children showing signs of illness will be located in the main care area. Additional children in care will be temporarily moved to the outdoor play area while the child showing signs of illness awaits parent pick up.

Individuals who reside in the home were noted and discussed. All adults present in the home have obtained a criminal record clearance or exemption prior to working, residing or volunteering in the licensed childcare home. Licensee was reminded that all adults 18 and over living or working in the home, 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.

All areas identified on the facility sketch that are accessible for children to use were inspected for safety,


comfort, and cleanliness. There is telephone service via a cellphone that is used and the cellphone stays at the facility during operation hours.

The valve on the required 2A 10BC fire extinguisher indicates fully charged however licensee was unable to provide a purchase receipt. LPA advised licensee that a technical violation will be issued and reminded licensee to retain the purchase receipt or have the fire extinguisher serviced annually.

Safe sleep guidelines were discussed with licensee. 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
(page 2 of 4)
SUPERVISOR'S NAME: Trevino CochranTELEPHONE: (323) 981-3385
LICENSING EVALUATOR NAME: Randy DerracoTELEPHONE: (323) 981-3431
LICENSING EVALUATOR SIGNATURE:

DATE: 02/02/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/02/2022
LIC809 (FAS) - (06/04)
Page: 8 of 8
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
VISIT DATE: 02/02/2022
NARRATIVE
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equipment.

The licensee has completed training on preventive health practices including Pediatric First Aid and CPR. The licensee's Pediatric First Aid and CPR expires on 04/2023 LPA observed that the Licensee does not have proof of the Mandated Reporter AB 1207 compliant Child Care Training Certificate on file. LPA advised licensee that a citation will be issued under HSC section 1596.8662(b)(1) will be issued. File review was observed to have proper mandated immunization records. Children’s records were reviewed, including emergency information and were observed to be complete. A current children’s roster was available for review.

Emergency Disaster Plan, Parent’s Rights Poster and the Facility License were observed to be posted.

Smoking is prohibited in a licensed Family Child Care Home. Per Licensee, no one smokes in the home.

Incidental Medical Services (IMS):
IMS was discussed with licensee. 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 to access forms, regulations and quarterly updates online at: www.ccld.ca.gov. LPA also discussed Guardian background check system and how to register. LPA observed licensee attempt to register for guardian while conducting inspection. LPA discussed and provided the following documents: PIN 21-02 CCLD - Updates to the implementation of Guardian; Assistant's File Checklist. LPA advised licensee that the checklist is not a resource and cannot be found on the CCLD website.



The following deficiencies listed on the attached LIC 809 (deficiency page) are being cited in accordance with (page 3 of 4)
SUPERVISOR'S NAME: Trevino CochranTELEPHONE: (323) 981-3385
LICENSING EVALUATOR NAME: Randy DerracoTELEPHONE: (323) 981-3431
LICENSING EVALUATOR SIGNATURE:

DATE: 02/02/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/02/2022
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
CCLD Regional Office, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME: PENA FAMILY CHILD CARE
FACILITY NUMBER: 198017313
VISIT DATE: 02/02/2022
NARRATIVE
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California Code of Regulations Title 22 and the California Health and Safety Code.. Deficiencies that are being cited need to be cleared to protect the children’s health & safety.

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 the licensee Diana Pena.

(page 4 of 4)

SUPERVISOR'S NAME: Trevino CochranTELEPHONE: (323) 981-3385
LICENSING EVALUATOR NAME: Randy DerracoTELEPHONE: (323) 981-3431
LICENSING EVALUATOR SIGNATURE:

DATE: 02/02/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/02/2022
LIC809 (FAS) - (06/04)
Page: 6 of 8