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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198017313
Report Date: 02/02/2023
Date Signed: 02/02/2023 04:03:56 PM


Document Has Been Signed on 02/02/2023 04:03 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:PENA FAMILY CHILD CAREFACILITY NUMBER:
198017313
ADMINISTRATOR:PENA, DIANAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(562) 889-4104
CITY:LONG BEACHSTATE: CAZIP CODE:
90805
CAPACITY:14CENSUS: 4DATE:
02/02/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:50 PM
MET WITH:Licensee - Diana PenaTIME COMPLETED:
04:20 PM
NARRATIVE
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Licensing Program Analyst (LPA) R. Derraco conducted an unannounced annual inspection to the above facility on 02/02/23. LPA arrived at the facility at 1:50 PM and met with licensee, Diana Pena, who guided analyst on a tour of the facility. Per Licensee, there are 7 children that are currently enrolled. There were 4 children present upon arrival.

This is a one-story home which consists of 2 bedrooms, 1 bathroom, kitchen/dining room, living room, front yard and backyard (fenced). The off limit areas include both bedrooms and the front yard.

The main care area is located in the living room. LPA observed two couches, a wooden cubby locker, an infant high chair feeding table, two play pens, age appropriate toys and children's art supplies. Emergency Disaster Plan, Parent’s Rights Poster and the Facility License were observed to be posted in the main care area. The kitchen was observed with locks on all the cabinets. No sharp or pointy objects were observed to be accessible in the kitchen area. The licensee states that she provides food for children in care. The bathroom designated for children in care was observed to have an operable sink, faucet and toilet. The cabinet beneath the bathroom sink was observed to have cleaning supplies. No lock was observed beneath the kitchen sink. LPA advised the licensee that a citation under California Code of Regulation (CCR) section 102417(g)(4) will be issued. The outdoor play area is located in the backyard. LPA observed additional age appropriate toys, a wooden cubby locker, child sized table and child sized chairs. Adequate shade was observed in the outdoor play area. Per licensee, the outdoor play equipment is currently not being used due to the recent weather and the age of the children in care. Two pet dogs were observed in the outdoor play area. LPA did not observe the following items during the inspection: Infant Walkers, Johnny Jumpers, Saucer Chairs. No bodies of water were observed in the back yard play area. Smoking is prohibited in a licensed Family Child Care Home. Per Licensee, no one smokes in the home.

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SUPERVISOR'S NAME: Trevino CochranTELEPHONE: (323) 981-3385
LICENSING EVALUATOR NAME: Randy DerracoTELEPHONE: (323) 981-3431
LICENSING EVALUATOR SIGNATURE:
DATE: 02/02/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/02/2023
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


Document Has Been Signed on 02/02/2023 04:03 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: PENA FAMILY CHILD CARE
FACILITY NUMBER: 198017313

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/02/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102417(g)(1)
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: (1) Fireplaces and open face heaters shall be screened to prevent access by children. The home shall contain a fire extinguisher and smoke detector device which meet standards established by the State Fire Marshall.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, interview and record review, the licensee did not have a fire extinguisher which meet standards established by the State Fire Marshall, which poses and potential Health, safety and/or personal rights risk to persons in care..
POC Due Date: 02/13/2023
Plan of Correction
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Licensee will email LPA a copy of the service tag or purchase receipt for her fire extinguisher.
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 observation, interview and record review, the licensee did not store detergents and cleaning compounds where they are inaccessible to children, which poses a potential Health, safety and/or personal rights risk to persons in care.
POC Due Date: 02/13/2023
Plan of Correction
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Licensee states she will email LPA a picture of the cleaning compounds being made inaccessible to children in care.
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: 02/02/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/02/2023
LIC809 (FAS) - (06/04)
Page: 2 of 8


Document Has Been Signed on 02/02/2023 04:03 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: PENA FAMILY CHILD CARE
FACILITY NUMBER: 198017313

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/02/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102418(g)
Immunizations
(g) The licensee shall document each child's immunizations as required by the California Code of Regulations, Title 17, Section 6070, and shall maintain such documentation for as long as the child is enrolled.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, interview and record review, the licensee did not document each enrolled child's immunization, which poses a potential Health, safety and/or personal rights risk to persons in care.
POC Due Date: 02/13/2023
Plan of Correction
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Licensee states she will email LPA a copy of the missing immunzation records.
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: Trevino CochranTELEPHONE: (323) 981-3385
LICENSING EVALUATOR NAME: Randy DerracoTELEPHONE: (323) 981-3431
LICENSING EVALUATOR SIGNATURE:
DATE: 02/02/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/02/2023
LIC809 (FAS) - (06/04)
Page: 3 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: 02/02/2023
NARRATIVE
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Individuals who reside in the home were noted and discussed. 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. Licensee states that there are no firearms stored in the home.

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 land line. LPA observed a wall mounted heater / air conditioning unit to be located in the main care area. Day care area was observed with safe toys, play equipment and materials.

Detergents, cleaning compounds, and other items which could pose a danger to children were observed to be stored above the laundry appliances located in the backyard. The licensee states that there are no poisons in the home and understands that storage areas for poisons must be locked, not just inaccessible. The valve on the required 2A 10BC fire extinguisher indicates fully charged. Licensee was unable to provide a service tag or a purchase receipt. LPA advised licensee that a citation under California Code of Regulations (CCR) section 102417(g)(1) will be issued. Smoke and carbon monoxide detectors were tested and are operable.

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.

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 04/20/23. LPA observed that the Licensee has proof of the Mandated Reporter AB 1207 compliant Child Care Training Certificate on file. File review was observed to have proper mandated immunization records. Children’s records were reviewed, including emergency information. LPA observed that two children in care did not have immunization records available for review. LPA advised licensee that a citation under CCR section 102418(g) will be issued. A current children’s roster was available for review and is current. (page 2 of 3)

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

DATE: 02/02/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/02/2023
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: 02/02/2023
NARRATIVE
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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.cdss.ca.gov.

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.

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, appeal rights provided, and report was reviewed with the licensee Diana Pena.

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

DATE: 02/02/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/02/2023
LIC809 (FAS) - (06/04)
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