198019972-2-2-2024-33-CC-SLII-D23VFB-20240202152339

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 198019972
Report Date: 02/02/2024
Date Signed: 02/02/2024 03:23:48 PM

Document Has Been Signed on 02/02/2024 03:23 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
MONTEREY PARK CC RO, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME:	ADAME VARGAS FAMILY CHILD CARE		FACILITY NUMBER:	198019972
ADMINISTRATOR:	MARISOL ADAME VARGAS		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(714) 905-3074
CITY:	POMONA	STATE: CA	ZIP CODE:	91766
CAPACITY:	14	CENSUS: 1	DATE:	02/02/2024
TYPE OF VISIT:	Required - 3 Year	UNANNOUNCED	TIME BEGAN:	12:45 PM
MET WITH:	Licensee Marisol Adame Vargas		TIME COMPLETED:	03:45 PM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	Licensing Program Analyst (LPA) Stephanie Li and Licensing Program Manager Claudia Guangorena conducted an unannounced Annual required inspection at the above facility on 2/2/2024 at 12:45pm. The licensing staff met with Licensee Marisol Adame, who guided staff on a tour of the facility. There was 1 child present upon arrival. Facility capacity is in compliance for a Large Family Child Care Home. Hours of operation are Mon-Fri 7:30AM - 7:00 PM. This is a single-story home, that consists of 3 bedrooms, 1 bathroom, kitchen, living room, dining room, attached garage, front and back yard. Areas accessible to children and parents were inspected as follows: living room that is designated as a daycare room, one bathroom located in hallway, and back yard. Children walk through the hallway to get to the bathroom and through the kitchen to get to the back yard. Areas off limits include dining room, kitchen, 3 bedrooms, and attached garage, and front yard. Licensing staff reminded licensee bedrooms must be made inaccessible to children if they are designated to be off limits. Currently residing in the home 2 adults in (Licensee, and husband) and no minors. LPA observed the following required posted documentation in the main entry way of the facility: Facility License, Publication (PUB) 394- Notification of Parent Rights and Licensing Form (LIC) 9148- Earthquake Preparedness form. LPA reviewed facility records for LIC 9040- Facility Roster, LIC 610- Facility Disaster Plan and Disaster drill log. Last drill was conducted in January 2024. The home was observed to be clean and orderly, with central air and heating. Licensing staff observed the smoke detector and carbon monoxide detector to be in operable condition. Licensing staff observed a fire extinguisher 2A:10-B:C last serviced 1/16/2024. The home maintains telephone service via cell phone. There are toys and other age-appropriate material available for children. page 1 of 4

SUPERVISOR'S NAME: Christina Gabelman	TELEPHONE: (323) 981-3380
LICENSING EVALUATOR NAME: Stephanie Li	TELEPHONE: (626) 366-3362
LICENSING EVALUATOR SIGNATURE:	DATE: 02/02/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/02/2024

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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Document Has Been Signed on 02/02/2024 03:23 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
MONTEREY PARK CC RO, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME: ADAME VARGAS FAMILY CHILD CARE	FACILITY NUMBER: 198019972
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 02/02/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type A

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
1 2 3 4	Based on observation, the licensee did not comply with the section cited above as cleaning compounds are stored under the unlocked bathroom sink that children use which poses an immediate health, safety or personal rights risk to persons in care.
	POC Due Date: 02/09/2024
	Plan of Correction
1 2 3 4	LIcensee will place a child safety lock on the bathroom sink cabinet to make inaccessible to children in care and take a photo and send picture to by email by 2/9/2024.

Section Cited


	Deficient Practice Statement
1 2 3 4
	POC Due Date:
	Plan of Correction
1 2 3 4

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: Christina Gabelman	TELEPHONE: (323) 981-3380
LICENSING EVALUATOR NAME: Stephanie Li	TELEPHONE: (626) 366-3362
LICENSING EVALUATOR SIGNATURE:	DATE: 02/02/2024

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/02/2024

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
MONTEREY PARK CC RO, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME: ADAME VARGAS FAMILY CHILD CARE	FACILITY NUMBER: 198019972
	VISIT DATE: 02/02/2024

NARRATIVE

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At 1:00pm, Licensing staff observed the following during the inspection: a decorative fountain by the entry of the home full of rainwater (photos taken), cleaning compounds under the bathroom sink, and knives on the off-limits kitchen counter. Licensing staff advised that because children are walking through the kitchen to get to the back play yard that knives need to be inaccessible. Licensee immediately moved them to a higher cabinet making them inaccessible.

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. Per Licensee there are no firearms or weapons stored in the home. Licensing staff reminded licensee smoking is not allowed in the home.

Licensee uses the back yard for outdoor play. The outdoor play area was observed to be fenced. Licensing staff observed that the outdoor yard has toys and other materials for children to play with. At 1:30pm, Licensing staff observed a small decorative fountain in the back yard in the garden, splintered peeling plywood in the open walkaround space behind the shed, and mosquito bug spray on table in children’s play area making the backyard unsafe for the children in care. (photos of backyard fountain and plywood taken). Licensee immediately removed bug spray from table. Licensee moved plywood to the front side yard and will install gates to make behind shed area inaccessible to children.

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. All required documents were in children’s files.

Staff and Licensee files were reviewed for the following: Proof of immunizations against measles, pertussis and influenza or declination, TB clearance, LIC 9108- Statement Acknowledging Requirement to Report Child Abuse. Pediatric First Aid and CPR certification on expires 4/2024 for licensee. Mandated Reporter Training for licensee expires on 01/12/24. www.mandatedreporterca.com

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SUPERVISOR'S NAME: Christina Gabelman	TELEPHONE: (323) 981-3380
LICENSING EVALUATOR NAME: Stephanie Li	TELEPHONE: (626) 366-3362
LICENSING EVALUATOR SIGNATURE:	DATE: 02/02/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/02/2024

LIC809 (FAS) - (06/04)

Page: 3 of 5

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: ADAME VARGAS FAMILY CHILD CARE	FACILITY NUMBER: 198019972
	VISIT DATE: 02/02/2024

NARRATIVE

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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 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/.

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 Olga Gonzalez, 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.

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SUPERVISOR'S NAME: Christina Gabelman	TELEPHONE: (323) 981-3380
LICENSING EVALUATOR NAME: Stephanie Li	TELEPHONE: (626) 366-3362
LICENSING EVALUATOR SIGNATURE:	DATE: 02/02/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/02/2024

LIC809 (FAS) - (06/04)

Page: 4 of 5

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: ADAME VARGAS FAMILY CHILD CARE	FACILITY NUMBER: 198019972
	VISIT DATE: 02/02/2024

NARRATIVE

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Based on Licensing staff observations, the following deficiencies listed on the attached LIC 809D (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 and safety.

Licensing staff informed licensee a copy of this licensing report dated 02/02/2024 that documents any Type A citation(s) to parents/guardians of all children currently enrolled by the next business day or the next day the children are in care, and to any newly enrolled parents/guardians for 12 months from the date of this report. A signed Acknowledgement of Receipt of Licensing Report (LIC 9224), or other written statement, must be placed in the child's file for verification.

A notice of site visit was given and must remain posted for 30 days as there are immediate risk(s) to the health, safety, or personal rights of children in care.

Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

Exit interview conducted and report was reviewed with Licensee, Marisol Adame. Appeal Rights were issued and discussed.

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SUPERVISOR'S NAME: Christina Gabelman	TELEPHONE: (323) 981-3380
LICENSING EVALUATOR NAME: Stephanie Li	TELEPHONE: (626) 366-3362
LICENSING EVALUATOR SIGNATURE:	DATE: 02/02/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/02/2024

LIC809 (FAS) - (06/04)

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