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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198019427
Report Date: 09/20/2022
Date Signed: 09/20/2022 05:23:17 PM


Document Has Been Signed on 09/20/2022 05:23 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 CNTR DR. 200-B
MONTEREY PARK, CA 91754



FACILITY NAME:CARRILLO FAMILY CHILD CAREFACILITY NUMBER:
198019427
ADMINISTRATOR:BLANCA LIDIA CARRILLOFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(626) 374-1633
CITY:WHITTIERSTATE: CAZIP CODE:
90604
CAPACITY:14CENSUS: 7DATE:
09/20/2022
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
03:00 PM
MET WITH:Licensee, Blanca CarrilloTIME COMPLETED:
05:30 PM
NARRATIVE
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Licensing Program Analyst (LPA) Lilli Babcock conducted a Case Management Deficiencies Inspection to address a deficiency observed during an inspection visit conducted on 09/20/22. Due to COVID- 19, LPA wore appropriate personal protective equipment. LPA met with Licensee, Blanca Carrillo, who guided LPA on a tour of the facility. Seven children, aged 1-3, and no adults other than licensee were observed to be present at the facility during this inspection.

During the walk-through of the facility on 9/20/22, LPA Babcock observed that licensee was caring for seven children without an assistant present. The 7 children present during the inspection ranged in age from 1 to 3 years of age per birthdates on the children’s roster (LIC 9040). No school-age children were observed, and licensee verified the roster is current, and birthdates of children listed are correct.

The following deficiency on the attached LIC 809 deficiency page is being cited in accordance with CA code of Regulations Title 22.

A copy of this report shall be provided to the parent/guardian of children currently enrolled by the next business day or immediately upon return. A copy of this report shall also be provided to the parent/guardian of any newly enrolled children for the next 12 months (1 year). Acknowledgement of Receipt (LIC 9224 form) must be maintained in each child’s file immediately upon receipt from parent. Licensee was provided with a copy of the Acknowledgement of Receipt of Licensing Reports (LIC 9224) Form during this visit.

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SUPERVISOR'S NAME: Brandi VanOostenTELEPHONE: (323) 981-3365
LICENSING EVALUATOR NAME: Lilli BabcockTELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:
DATE: 09/20/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/20/2022
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 CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME: CARRILLO FAMILY CHILD CARE
FACILITY NUMBER: 198019427
VISIT DATE: 09/20/2022
NARRATIVE
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A notice of site visit was given and must remain posted for 30 days. Failure to maintain posting as required will result in a civil penalty of $100.00.

Exit interview conducted and report was reviewed with Licensee, Blanca Carrillo.



Report ends here page 2 of 2
SUPERVISOR'S NAME: Brandi VanOostenTELEPHONE: (323) 981-3365
LICENSING EVALUATOR NAME: Lilli BabcockTELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:

DATE: 09/20/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/20/2022
LIC809 (FAS) - (06/04)
Page: 3 of 3
Document Has Been Signed on 09/20/2022 05:23 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 CNTR DR. 200-B
MONTEREY PARK, CA 91754


FACILITY NAME: CARRILLO FAMILY CHILD CARE
FACILITY NUMBER: 198019427

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/20/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
09/21/2022
Section Cited

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Staffing Ratio & Capacity 102416.5(e) If no assistant is present at a Large Family Child Care Home, licensee shall comply with the capacity req for a Small Family Child Care Home as specified in subsections (b) and (c). This requirement was not met as evidenced by:
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Based on observation and interview, the facility did not comply with the section cited above as Licensee was caring for 7 children aged 1-3 with no assistant or child age 6 or above which poses an immediate health, safety or personal rights risk to persons 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: Brandi VanOostenTELEPHONE: (323) 981-3365
LICENSING EVALUATOR NAME: Lilli BabcockTELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:
DATE: 09/20/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/20/2022
LIC809 (FAS) - (06/04)
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