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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198020212
Report Date: 05/18/2022
Date Signed: 05/18/2022 03:32:48 PM


Document Has Been Signed on 05/18/2022 03:32 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 CENTER DR 200B
MONTEREY PARK, CA 91754



FACILITY NAME:VILLAGRAN FAMILY CHILD CAREFACILITY NUMBER:
198020212
ADMINISTRATOR:GUADALUPE VILLAGRANFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(562) 818-8632
CITY:NORWALKSTATE: CAZIP CODE:
90650
CAPACITY:14CENSUS: 3DATE:
05/18/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:30 PM
MET WITH:Licensee Guadalupe VillagranTIME COMPLETED:
03:45 PM
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On 5/18/22 Licensing Program Analyst (LPA) Jeanette Estrada conducted an unannounced required 1 year inspection at the above facility. LPA met with the Licensee Guadalupe Villagran and informed her of the purpose for the visit. Licensee guided LPA on a tour of the facility. There was 1 child present when LPA arrived. At approximately 2:10PM two additional children arrived. Licensee provides care to children ages 3 months to 13 years old and operation days/ hours are Monday through Friday 6AM to 6PM.
This is a one story, 3 bedroom home with a living room, family room, dining room, kitchen, two bathrooms, backyard, pool and garage. Areas on limits to children are family room, bathroom in the laundry room next to the family room and a gated section in the backyard. Areas off limits to children are three bedrooms, second bathroom in the hallway, living room, dining room, kitchen, pool and garage.
All areas identified on the facility sketch that are accessible for children to use were inspected for safety, comfort, and cleanliness. The following was observed and reviewed during this inspection: LPA reviewed required posted documentation for Facility License, Publication (PUB) 394- Notification of Parent Rights and Licensing Form (LIC) 9148- Earthquake Preparedness form. Facility records were reviewed for LIC 9040- Facility Roster, LIC 610- Facility Disaster Plan and Disaster drill log, last drill conducted on 1/5/2022. Licensee had a copy of the Roster available during the inspection. There is an operable carbon monoxide detector and an operable smoke detector in the hallway and there is an additional smoke detector in the family room. The 2A10BC Fire extinguisher located in the kitchen indicated fully charged. The home maintains telephone service (cell phone). Food is provided by Licensee. Licensee was reminded if children bring food from home it must be labeled with the child’s name and properly stored or refrigerated. The home is observed to be clean and orderly. There are toys and other age appropriate materials available for children.
LPA observed safety gates preventing access from the on limits family room into the off limit areas of the home. The on limits restroom is located in the laundry room next to the family room. The laundry area is off limits. LPA observed a safety knob on the bathroom door. Per Licensee children go into the laundry area only when they use the restroom. LPA did not observe any hazards in the restroom.
SUPERVISOR'S NAME: Valarie CookTELEPHONE: (323) 513-3828
LICENSING EVALUATOR NAME: Jeanette EstradaTELEPHONE: (323) 229-6521
LICENSING EVALUATOR SIGNATURE:
DATE: 05/18/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/18/2022
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 CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME: VILLAGRAN FAMILY CHILD CARE
FACILITY NUMBER: 198020212
VISIT DATE: 05/18/2022
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Per Licensee, children conduct all activities in the family room. LPA observed two pack n plays, age appropriate toys and materials in good condition. Sharp objects, detergents and cleaning compounds and medication are inaccessible to children in care and are located in the off limits kitchen in latched cabinets. The home has central A/C and heating. LPA observed fireplace made inaccessible using a cover.
LPA observed that the section of the outdoor yard that children have access to is fenced and has toys and other materials for children to play with. Per Licensee, children are supervised while playing outside.
The Pool is accessible through the outdoor area. It is surrounded by a 5 foot fence which does not obscure the view of the pool and has a gate that swings away from the pool and has a self- latching device. The gate to the pool is kept locked with a key lock. The home is equipped with door and window alarms that alert when either are opened. LPA observed that the alarms are operable. Per Licensee there are no poisons in the home. Licensee understands that all poisons must be locked, not only inaccessible to children. Isolation area for sick children waiting to be picked up is in the living room away from other children. LPA observed a properly stored fire arm in the home inaccessible to children in care. Infant Care: Currently licensee cares for two infants over the age of 12 months. LPA observed two pack n plays visible in the family room. Napping equipment does not block entrances or exits. LPA did not observe loose object, bumpers, objects hanging, or objects attached to the pack n plays. Per licensee pack n plays are cleaned daily. LPA discussed that each infant enrolled must have their own crib/ napping mat and bedding. LPA informed licensee of the new Safe sleep regulations, including LIC 9227 Infant Sleep Plan for infants under 12 months, 15-minute sleep check documentation for infants 0-24 months, and will provide PIN 20-24-CCP. Overnight Care: There is no overnight care provided at the moment. LPA discussed the following: Licensee is aware that they must remain wake while children are awake. If children sleep in separate area from licensee, the door must remain open. If licensee cannot hear children when they wake up, video or audio device can be used.Children’s records were reviewed for (LIC) 282- Affidavit Regarding Liability Insurance, Immunization Records, LIC 700- Identification and Emergency Information, LIC 627- Consent for Medical Treatment, LIC 995A Notification of Parents’ Rights, LIC 9227- Infant sleep form (0-12 months, and documentation of 15-minute Infant Sleep Check (0-24 months). Staff records were reviewed for approved Pediatric First Aid and CPR certification, LIC-501: Personnel Record, LIC 508-Criminal Record Statement, LIC 9052- Employee Rights, Proof of immunizations against measles, pertussis and influenza or influenza declination, TB clearance or risk assessment, LIC 9108- Statement of Child and Mandated Reporter Training Certificate. Licensee and assistant's CPR/First Aid expires on 2/2023. Mandated Reporter certificate expires on 5/12/2024.
SUPERVISOR'S NAME: Valarie CookTELEPHONE: (323) 513-3828
LICENSING EVALUATOR NAME: Jeanette EstradaTELEPHONE: (323) 229-6521
LICENSING EVALUATOR SIGNATURE:

DATE: 05/18/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/18/2022
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: VILLAGRAN FAMILY CHILD CARE
FACILITY NUMBER: 198020212
VISIT DATE: 05/18/2022
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During inspection the child present was observed to be treated with dignity and respect, observed to be receiving safe, healthful and comfortable accommodations, furnishings and equipment, and free from corporal and/or unusual punishment. LPA provided consultation to Licensee on Infant safe sleep regulation, Licensee's records.
Incidental Medical Services (IMS): 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 Center and the ADA, available at: http://www.ada.gov/childqanda.htm 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. LPA discussed the safe sleep regulations with Licensee and discussed the Child Care Licensing Safe Sleep webpage athttps://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleephttps://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.
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 LPA's observations during today's inspection, no citations will be issued. Exit interview conducted and report was reviewed with the Licensee, Guagalupe Villagran. A notice of site visit was given and must remain posted for 30 days.
SUPERVISOR'S NAME: Valarie CookTELEPHONE: (323) 513-3828
LICENSING EVALUATOR NAME: Jeanette EstradaTELEPHONE: (323) 229-6521
LICENSING EVALUATOR SIGNATURE:

DATE: 05/18/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/18/2022
LIC809 (FAS) - (06/04)
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