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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198020102
Report Date: 09/13/2024
Date Signed: 09/13/2024 04:04:06 PM


Document Has Been Signed on 09/13/2024 04:04 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:ESCOBEDO FAMILY CHILD CAREFACILITY NUMBER:
198020102
ADMINISTRATOR:MARIA ESCOBEDOFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(626) 592-4795
CITY:SAN GABRIELSTATE: CAZIP CODE:
91776
CAPACITY:14CENSUS: 8DATE:
09/13/2024
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
02:10 PM
MET WITH:Maria Escobedo - LicenseeTIME COMPLETED:
04:15 PM
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Licensing Program Analyst (LPA) Nolan Tcheng conducted an unannounced annual inspection to the above facility. At 2:10pm, LPA met with licensee Maria Escobedo. Also present during this inspection were licensee's assistants. The licensee states that they currently has 10 children enrolled. A current children’s roster is available and is current. Licensee’s hours of operation are 6am-6pm Monday-Friday.

This is a two-story home which consists of 4 bedrooms, 4 bathrooms, kitchen, dining room, front room, living room, front yard and backyard (fenced). The children use first floor bedroom, living room, dining room, bathroom, and backyard. Per licensee, areas off limits to children and parents include: hallway, family room, kitchen, second floor including 3 bedrooms, front yard, back "treehouse," and garage. All areas identified on the facility sketch were inspected. The licensee provides food for children in care.

The licensee states that 1 adults and 1 minor currently live in the home. Persons living in the home are identified on a confidential document. Licensee states that they currently have three assistant. 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.

At 2:20pm, LPA was led on a tour of the facility by the licensee. Upon entry into the home, the living room was reviewed. This is used as the main child care area. Emergency Disaster Plan, Parent’s Rights Poster and the Facility License are observed to be posted. There were 8 children napping during the inspection. Napping equipment was observed to be cots. There were age appropriate toys and equipment present. Fireplaces and open face heaters are inaccessible to prevent access by children. Where children are less than five years old are in care, stairs are fenced or barricaded. There is a child safety gate which keeps stairs inaccessible to children. Immediately left is the first floor bedroom which is used as a child care area. There was an observed crib and play yard present in the event a child that is enrolled that requires that as sleeping equipment. There are first aid supplies available.


REPORT CONTINUES PAGE 1 of 4
SUPERVISOR'S NAME: Ana ChicoTELEPHONE: (323) 981-3351
LICENSING EVALUATOR NAME: Nolan TchengTELEPHONE: (323) 240-6201
LICENSING EVALUATOR SIGNATURE:
DATE: 09/13/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/13/2024
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 6


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: ESCOBEDO FAMILY CHILD CARE
FACILITY NUMBER: 198020102
VISIT DATE: 09/13/2024
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In the bedroom, there is a small walkway to the bathroom that children in care use. It was observed to be safe and free of hazards. Detergents, cleaning compounds, medications, and other items which could pose a danger are inaccessible to children. The tour continued back through the living room to the small dining area where children in care eat. There were high chairs observed. Per licensee, the high chairs are only used for meal times. Per licensee, first floor bedroom will be used as an area for an ill child until an authorized representative comes to pick up child.

At 12:40pm, fire extinguisher was observed. The valve on the required 2A 10BC fire extinguisher indicates fully charged and was purchased on 09/13/2024, as indicated on receipt. Per State Fire Marshall standards, fire extinguishers shall be serviced annually. Smoke and carbon monoxide detectors were tested and are operable. The licensee states that a cell phone is used and stays at the facility during operating hours.

At 12:45pm, LPA observed the back yard area. The outdoor play area was observed to be fenced. At this time, children are using the back yard for outdoor play time. The children pass through the kitchen/family room area to get to the backyard. LPA observed both walkways to be safe and free of hazards. The backyard had a large slide, bikes, and small equipment for children. There was a large "treehouse" in the backyard that is made inaccessible to children in care. Licensee states it was made for their own child. The licensee is observed to be operating within the license capacity limitations.

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 06/2024. However, Licensee's staff have current Pediatric CPR/First Aid. LPA discussed with licensee to ensure that qualified staff are here at opening and at close. Licensee and other personnel have not completed current mandated reporter training. LPA instructed licensee and staff to complete the Mandated Reporter Child Care Provider training every 2 years. The licensee does have proof of immunization against influenza, tuberculosis, pertussis, and measles. During review, 2 of 4 staff members did not have their immunization records present. LPA explained the requirement to have the records present for review. Children’s records were reviewed, including but not limited to, a copy of the emergency information card that contains all the information specified by regulation.

REPORT CONTINUES PAGE 2 of 4

SUPERVISOR'S NAME: Ana ChicoTELEPHONE: (323) 981-3351
LICENSING EVALUATOR NAME: Nolan TchengTELEPHONE: (323) 240-6201
LICENSING EVALUATOR SIGNATURE:

DATE: 09/13/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/13/2024
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
MONTEREY PARK CC RO, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME: ESCOBEDO FAMILY CHILD CARE
FACILITY NUMBER: 198020102
VISIT DATE: 09/13/2024
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The following was discussed:
-There are 2 small dogs present and two birds. They remain inaccessible to children in care.
-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.

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/inspection-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

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-andresources/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/.

REPORT CONTINUES PAGE 3 of 4

SUPERVISOR'S NAME: Ana ChicoTELEPHONE: (323) 981-3351
LICENSING EVALUATOR NAME: Nolan TchengTELEPHONE: (323) 240-6201
LICENSING EVALUATOR SIGNATURE:

DATE: 09/13/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/13/2024
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
MONTEREY PARK CC RO, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME: ESCOBEDO FAMILY CHILD CARE
FACILITY NUMBER: 198020102
VISIT DATE: 09/13/2024
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Licensee was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain child care by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.

During the exit interview, the licensee confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS.

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 Maria Escobedo, at 3:55pm.



END OF REPORT PAGE 4 of 4
SUPERVISOR'S NAME: Ana ChicoTELEPHONE: (323) 981-3351
LICENSING EVALUATOR NAME: Nolan TchengTELEPHONE: (323) 240-6201
LICENSING EVALUATOR SIGNATURE:

DATE: 09/13/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/13/2024
LIC809 (FAS) - (06/04)
Page: 4 of 6
Document Has Been Signed on 09/13/2024 04:04 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: ESCOBEDO FAMILY CHILD CARE
FACILITY NUMBER: 198020102

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/13/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
HSC
1596.8662(b)(1)
Administration of Child Day Care Licensing
(1) On or before March 30, 2018, a person who, on January 1, 2018, is a licensed child day care provider, administrator, or employee of a licensed child day care facility shall complete the mandated reporter training provided pursuant to paragraphs (2) and (3) of subdivision (a), and shall complete renewal mandated reporter training every two years following the date on which he or she completed the initial mandated reporter training.

This requirement is not met as evidenced by:
Deficient Practice Statement
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4
Based on interview and record review, the licensee did not comply with the section cited above in all staff files did not have an up to date Mandated Reporter Child Care Provider (AB1207) proof of completion, which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 09/20/2024
Plan of Correction
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Per licensee, all staff will complete Mandated Reporter Child Care Provider (AB1207) training and submit proof of completion ot LPA by POC date. Www.MandatedReporterCA.com
Type B
Section Cited
HSC
1597.622(c)
Administration of Child Day Care Licensing
(c) The family day care home shall maintain documentation of the required immunizations or exemptions from immunization, as set forth in this section, in the person's personnel record that is maintained by the family day care home.

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 comply with the section cited above in 2 of 4 staff members did not have copies of immunization records for Pertussis (Tdap), Measles (MMR), Influenza, and Tuberculosis which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 10/14/2024
Plan of Correction
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Per licensee, Staff 2 and 4 will obtain copies of the immunizations for Pertussis, Measles, Influenza, and TB and submit proof to LPA by POC date.
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: Ana ChicoTELEPHONE: (323) 981-3351
LICENSING EVALUATOR NAME: Nolan TchengTELEPHONE: (323) 240-6201
LICENSING EVALUATOR SIGNATURE:
DATE: 09/13/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/13/2024
LIC809 (FAS) - (06/04)
Page: 5 of 6