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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198018734
Report Date: 12/18/2023
Date Signed: 12/18/2023 11:12:23 AM


Document Has Been Signed on 12/18/2023 11:12 AM - 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:VALENCIA FAMILY CHILD CAREFACILITY NUMBER:
198018734
ADMINISTRATOR:MICHELLE VALENCIAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(323) 331-8786
CITY:LOS ANGELESSTATE: CAZIP CODE:
90033
CAPACITY:14CENSUS: 7DATE:
12/18/2023
TYPE OF VISIT:Required - 3 YearUNANNOUNCEDTIME BEGAN:
08:03 AM
MET WITH:Michelle Valencia, LicenseeTIME COMPLETED:
11:15 AM
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Licensing Program Analyst (LPA) Staicy Perry and Licensing Program Manager Claudia Guangorena conducted an unannounced 3 year required inspection at the above facility on 12/18/2023 at 8:00 am. Licensing staff met with Licensee Michelle Valencia, who guided staff on a tour of the facility. There were 3 children present upon arrival (one being licensees son), at approximately 8:14am an additional child arrived for a total of 4 children. Then at approximately at 8:48am an additional child arrived for a total of 5 children. At 9:00am 2 more children arrived making it a total of 7 children present. The 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 Mon-Fri 7:30 AM - 5:30 PM. At 9:42am one child left due to being ill.

The licensee provides care in the home. This is a one story home which consists of 3 bedrooms, 1 bathroom, kitchen, dining room, living room, and a fireplace which has been made inaccessible to the children by a metal cover that is Velcro, tightly covering/ barricading the fireplace. Licensee did inform LPAs that the gas company came out to shut off gas on the fireplace. There is a front and backyard that is fenced. Areas accessible to children and parents were inspected as follows: The children use the bathroom, living room, dining room and kitchen area. Parents and children enter through the front gate that leads to the door of the Family Child Care. Areas off limits include bedrooms #1, bedroom #2 and Bedroom #3 and front yard. The LPAs toured all areas used by children during this visit. Licensing staff reminded licensee bedrooms must be made inaccessible to children if they are designated to be off limits.



Currently residing in the home are three adults (licensee, licensees’ son and licensee’s husband) and 3 minors (licensee's two daughters and son). There was a total of 3 adults present during this inspection, Licensee, Licensee’s Assistant, Licensee son. Persons living in the home are identified on the attached LIC 811. 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. Page 1
SUPERVISOR'S NAME: Claudia GuangorenaTELEPHONE: (323) 981-3417
LICENSING EVALUATOR NAME: Staicy PerryTELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:
DATE: 12/18/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/18/2023
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 4


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: VALENCIA FAMILY CHILD CARE
FACILITY NUMBER: 198018734
VISIT DATE: 12/18/2023
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Licensing staff were led on a tour of the facility by the licensee. Licensing staff observed the following required posted documentation in the main entry way on the door of the facility: 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. Last drill was conducted on 12/4/2023.


The home was observed to be clean and orderly, with an AC in dining room window. Licensing staff observed age-appropriate toys and equipment present for children. Licensing staff observed the smoke detector in the living room to be in operable condition. The carbon monoxide detector located in the dining room area is in operable condition. Licensing staff observed a fire extinguisher located in the kitchen, the valve on the required 2-A-10-B-C fire extinguisher indicates fully charged and was last purchased on 10/11/2023, as indicated on attached receipt with proof of purchase. 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 maintains telephone service via land line and cell phone that is maintained at child care at all times.There are toys and other age-appropriate material available for children. Licensee provides meals for the children and uses a food program.

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. Licensee stated that reading area with pillows is used as an isolation area for an ill child until an authorized representative comes to pick up child. LPAs observed napping equipment in the form of cots for the children in care as well as a crib for the infants.


The Licensee uses the back yard for outdoor play. The outdoor play area was observed to be fenced. The outdoor yard has toys and other materials for children to play with. Licensing staff observed a tarp for shade along with toys and other age-appropriate material available for children.
-There are 2 small dogs on the outside premises in the dog run.
-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. Page 2
SUPERVISOR'S NAME: Claudia GuangorenaTELEPHONE: (323) 981-3417
LICENSING EVALUATOR NAME: Staicy PerryTELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:

DATE: 12/18/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/18/2023
LIC809 (FAS) - (06/04)
Page: 4 of 4
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: VALENCIA FAMILY CHILD CARE
FACILITY NUMBER: 198018734
VISIT DATE: 12/18/2023
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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 file for child #1 was not available for review.

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 08/16/23. www.mandatedreporterca.com

LPA discussed the safe sleep regulations with licensee and discussed the Child Care Licensing Safe Sleep web page 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/.


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

DATE: 12/18/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/18/2023
LIC809 (FAS) - (06/04)
Page: 3 of 4
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: VALENCIA FAMILY CHILD CARE
FACILITY NUMBER: 198018734
VISIT DATE: 12/18/2023
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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.

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, 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.

At this time, the licensee is in compliance with California Title 22 Regulations. Therefore, there are no citations being issued today.



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 was conducted with Licensee, Michelle Valencia. The Licensee was provided a copy of their appeal rights (LIC 9058) and their signature on this form acknowledges receipt of these forms.

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

DATE: 12/18/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/18/2023
LIC809 (FAS) - (06/04)
Page: 2 of 4