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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198019404
Report Date: 12/10/2021
Date Signed: 12/10/2021 04:16:24 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:VIRGEN FAMILY CHILD CAREFACILITY NUMBER:
198019404
ADMINISTRATOR:LISSETTE J. VIRGENFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(562) 209-2476
CITY:DOWNEYSTATE: CAZIP CODE:
90242
CAPACITY:14CENSUS: 10DATE:
12/10/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Lissette VirgenTIME COMPLETED:
04:25 PM
NARRATIVE
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Licensing Program Analyst (LPA) Elka Chavez conducted an unannounced annual inspection to the above facility on 12/10/2021. LPA arrived at the facility at 10:00 AM and met with Assistanst, Beverly Lopez and Mariah Espinal who guided analyst on a tour of the facility. Licensee, Lissette Virgen arrived 10 minutes later. Entrance Checklist for Family Child Care Homes was provided to the licensee upon arrival. Per Licensee, there are 12 children that are currently enrolled. A current children’s roster was available for review. There were 10 children present upon arrival.

This is a single-story home which consists of 2 bedrooms, 2 bathrooms, kitchen, dining room, living room, den, office, (FIREPLACE inaccessible) located in the off-limit living room, day-care room, front yard (not fenced), patio (fenced) and backyard (fenced). Areas accessible to children are: Day-care room, bathroom inside the day care room and patio (fenced). Areas off limits to children and parents are: Bedrooms, living room, bathroom located inside the house, office, kitchen, den, dining room, backyard and front yard. LPA observed a latch in the door leading to the off-limit areas of the home. LPA did not observe a barricade in the stairs leading into the den. The licensee understands that licensing staff may have access to off-limit areas during inspection visit if necessary. **Rooms that are off-limits need to be made inaccessible during operating hours**

Individuals who reside in the home were noted and discussed. Per Licensee, there is currently 3 assistants. All adults present in the home have obtained a criminal record clearance. Licensee states that there are no firearms stored in the home. LPA did not observe staff #1 in the facility roster. LPA called the regional office to confirm that staff #1 was not associated to the facility. Licensee resubmitted forms to the regional office for processing.
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 landline and cell phone that is used. Safe toys play equipment and materials were observed.
SUPERVISOR'S NAME: Karen ChambersTELEPHONE: (323) 981-3350
LICENSING EVALUATOR NAME: Elka ChavezTELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:

DATE: 12/10/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/10/2021
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: VIRGEN FAMILY CHILD CARE
FACILITY NUMBER: 198019404
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/10/2021

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Section Cited
Administration of Child Day Care Licensing
Deficient Practice Statement
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1596.8662 Availability of information regarding detecting and reporting child abuse and neglect; training for mandated reporter who is licensed day care provider, administrator, or employee of a licensed child day care facility; proof of completion (b) (1)  ... LPA did not observe staff #1 and #2 to have proof of certificate.This poses a potential health and safety risk to children in care.
POC Due Date: 12/13/2021
Plan of Correction
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Licensee stated that she sent a text to the staff to complete training by 12/13/21. Licensee stated that she will be signing up to receive Provider Information Notices and use the entry checklist as a reminder.
Section Cited
Personnel Records
Deficient Practice Statement
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1597.622 Employees or volunteers at family day care home; immunization requirements; records; exemptions..
based on records review LPA did not observe proof of immunization for staff #1, #2 and #3. This poses a potential health and safety risk to children in care.
POC Due Date: 12/13/2021
Plan of Correction
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Licensee has requested proof of immunization be provided to licensee and she will provide LPA proof by POC due date.
Licensee stated that she will be signing up to receive Provider Information Notices and use the entry checklist as a reminder. Licensee will create a checklist.
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) 981-3350
LICENSING EVALUATOR NAME: Elka ChavezTELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:
DATE: 12/10/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/10/2021
LIC809 (FAS) - (06/04)
Page: 2 of 6
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: VIRGEN FAMILY CHILD CARE
FACILITY NUMBER: 198019404
VISIT DATE: 12/10/2021
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Detergents, cleaning compounds, medications, and other items which could pose a danger to children were
observed to be inaccessible to children. LPA observed cleaning compounds under the kitchen sink without a child safety latch. LPA observed licensee place a child safety latch in the cabinet making in inaccessible to children in care. The licensee states that there are no poisons in the home and understands that storage areas for poisons must be locked with a key or combination lock. The restroom that children use was observed to be safe and sanitary.

The valve on the required 2A10BC fire extinguisher indicates fully charged and was purchased on 6/5/2021. Smoke and carbon monoxide detectors were tested and are operable. LPA observed them in the day-care room.

Licensee states that she is currently caring for 3 infants. Licensee states that the infants sleep in the play yard located in the day-care room. Appropriate sleeping arrangements were observed. Licensee was advised cribs or play yards cannot hinder the entrance or exit from the sleeping space, mattresses shall be firm and covered with a fitted sheet that overlaps the underside, so it cannot be dislodged. Licensee was advised cribs and play yards must be free of loose articles and objects. LPA did not observe any infants swaddled while in care. LPA did not observe a sleep log for the three infants present during today’s inspection. Licensee stated that she was not aware of the requirement. LPA advised the Licensee that infants shall be placed on their backs for sleeping and shall be supervised. Infants shall be checked on every 15 minutes and the time of each 15-minute check shall be documented with child’s name and date. The LIC 9227 Individual Infant Sleeping Plan shall be completed for each infant up to 12 months of age. A copy of the LIC 9227 was provided to Licensee. LPA provide Licensee with a copy of PIN 20-24-CCP - Recently Approved Safe Sleep Regulations In Effect.

Currently, children are using the patio (fenced) for outdoor play time. The outdoor play area was observed to be fenced. LPA observed that the outdoor yard has toys and other materials for children to play with. LPA did not observe any objects that can pose a danger to children on the outdoor yard. The licensee states that supervision is always provided.

The licensee is observed to be operating within the license capacity limitations. LPA did not observe any children left in parked vehicles. Car seats shall only be used for transportation. LPA did not observe any children sleeping in car seats.
SUPERVISOR'S NAME: Karen ChambersTELEPHONE: (323) 981-3350
LICENSING EVALUATOR NAME: Elka ChavezTELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:

DATE: 12/10/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/10/2021
LIC809 (FAS) - (06/04)
Page: 3 of 6
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: VIRGEN FAMILY CHILD CARE
FACILITY NUMBER: 198019404
VISIT DATE: 12/10/2021
NARRATIVE
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The licensee and other personnel have completed training on preventive health practices including Pediatric First Aid and CPR. The licensee's Pediatric First Aid and CPR expires on 02/2023. LPA observed the Pediatric First Aid and CPR from Lifeline Training Resources is not EMSA approved. There are first aid supplies available in the day-care room. LPA advised that if a child shows signs of illness he/she/they shall be separated from other children.

Children’s records were reviewed, including emergency information and were observed to be complete. LPA did not observe proof of immunization against influenza, pertussis, and measles for staff.


LPA observed that staff #3 has a current Mandated Reporter AB 1207 Compliant Child Care Training Certificate on file. LPA did not observe Mandated Reporter AB 1207 Compliant Child Care Training Certificate for staff #1, #2 and licensee. LPA issued a Confidential Names List (LIC 811) to the licensee which documents staff and children’s files reviewed during this inspection.

All homes shall conduct fire and disaster drills at least once every six months and document the date and time of each drill. Last drill documented was conducted on 10/21/21.



There are no pets on the premises. LPA did not observe any pools, spas, hot tubs, fish ponds, or similar bodies of water during the inspection. Emergency Disaster Plan, Parent’s Rights Poster and the Facility License were observed to be posted. LPA did not observe the following items during the inspection: Infant Walkers, Johnny Jumpers, Saucer Chairs, Trampolines and/or any other item that fall into these categories are not permitted in a family child care facility. Smoking is prohibited in a licensed Family Child Care Home. Per Licensee, no one smokes in the 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.
SUPERVISOR'S NAME: Karen ChambersTELEPHONE: (323) 981-3350
LICENSING EVALUATOR NAME: Elka ChavezTELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:

DATE: 12/10/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/10/2021
LIC809 (FAS) - (06/04)
Page: 4 of 6
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: VIRGEN FAMILY CHILD CARE
FACILITY NUMBER: 198019404
VISIT DATE: 12/10/2021
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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 [facility representative] 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 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

To improve the quality and value of the new inspection process, a survey will 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 tools, please send them by email 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.


Based on the LPA’s observations and records review, 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.

Exit interview conducted and report was reviewed with the licensee, Lissette Virgen.
SUPERVISOR'S NAME: Karen ChambersTELEPHONE: (323) 981-3350
LICENSING EVALUATOR NAME: Elka ChavezTELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:

DATE: 12/10/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/10/2021
LIC809 (FAS) - (06/04)
Page: 5 of 6
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: VIRGEN FAMILY CHILD CARE
FACILITY NUMBER: 198019404
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/10/2021

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Section Cited
Deficient Practice Statement
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102425 INFANT SAFE SLEEP(j)(2)(D)(c) based on records review LPA did not observe a sleep log for child #1,4 and 9 on file. This poses a potential health and safety risk to children in care.
POC Due Date: 12/13/2021
Plan of Correction
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Licensee stated that she will provide proof by POC due date and will review Safe Sleep Regulations packet provided by LPA.
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: Karen ChambersTELEPHONE: (323) 981-3350
LICENSING EVALUATOR NAME: Elka ChavezTELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:
DATE: 12/10/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/10/2021
LIC809 (FAS) - (06/04)
Page: 6 of 6