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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 304312679
Report Date: 06/19/2019
Date Signed: 06/19/2019 10:35:29 AM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME:VILLASENOR, LOURDESFACILITY NUMBER:
304312679
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY:8CENSUS: 2DATE:
06/19/2019
TYPE OF VISIT:Case Management - Licensee InitiatedANNOUNCEDTIME BEGAN:
07:30 AM
MET WITH:Lourdes, VillasenorTIME COMPLETED:
09:30 AM
NARRATIVE
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Licensing Program Analyst (LPA) Yesenia Villa conducted an announced pre-licensing inspection. Applicant is requesting a capacity increase to a large family child care home of 14 children. LPA met with applicant Lourdes Villasenor, there were two toddlers present during the inspection. A review of staff records indicates that all adult residents, staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances. The hours of operation are Monday thru Friday, 7:30 am-5:00pm per applicant. Applicant states she will care for children ages 3 Months to 12 years of age.

A tour of the home was conducted. This is a one story home and has 2 bedrooms and 2 bathrooms. Applicant has designated the following areas of the home as off limits and inaccessible to children: the 2 bedrooms, living room,dining room, restroom located in the front of the home and garage. The garage is a detached garage located adjacent to the home that is off limits to the children. Applicant was advised that all poisons must be locked or under combination lock.

The areas designated for the children will be the two back play rooms and the kitchen when eating under full supervision. Applicant was explained that the doors and off limit areas are to remain inaccessible to the children during day care hours. Applicant states that two adults reside in the home. Applicant states her assistant will be her sister Susana Villasenor. She has obtained all State license requirements and is fingerprint cleared.

Licensee understands the following restrictions and has made adjustments in her home to relocate the day care as described below. "Per Fire Clearance " Garage not approved for Day Care, Not a two story dwelling, Back area of the house is the only approved area to be used for Day Care. Front part of the house not to be used as part of the Day Care."

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SUPERVISOR'S NAME: Judy HansonTELEPHONE: (714) 703-2807
LICENSING EVALUATOR NAME: Yesenia VillaTELEPHONE: (714) 703-2818
LICENSING EVALUATOR SIGNATURE:

DATE: 06/19/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/19/2019
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 3
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME: VILLASENOR, LOURDES
FACILITY NUMBER: 304312679
VISIT DATE: 06/19/2019
NARRATIVE
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During the inspection LPA Villa observed toys in the backyard with spider webs. Although the toys are age appropriate they are not in adequate condition for the children to go out and play. Licensee will send the Department pictures after the toys have been cleaned thoroughly along with the backyard area.Fire extinguisher, smoke detector and carbon monoxide detector are within compliance.

Applicant is missing the proof of 8 hour Preventative Health Practices and Nutrition Course. She has the Pediatric CPR/First Aid certification and is current and expires 06/06/2021. Applicant has proof of immunity against influenza, pertussis and measles on file. Mandated reporter training has been completed 03/22/2018 applicant was advised that training expires every two years.


Cleaning solutions/chemicals, utensils, and sharp knives are all inaccessible. Applicant stated poisons/hazardous items are stored in the garage and none were observed during today's inspection. There are no firearms or ammunition in the home or on the premises. Children will use the backyard for outdoor play time. Backyard is fully fenced, and free of hazards. There are no bodies of water located on the premises of the apartment complex.Applicants understands smoking is prohibited in the home and is to remain free from smoking. Applicants understands children are never to be left in a vehicle or unsupervised. Current seat belt law information was provided for applicant. Applicant does not plan on transporting children.

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. LPA discussed with applicant that a plan must be submitted indicating that IMS services are being provided. The plan must be submitted to the licensing office within 30 days of providing IMS. The plan should describe the facility’s policies and procedures that ensure the proper safeguards are in place. Topics to be covered include but not limited to: Types of IMS to be provided (Blood Glucose Testing; Inhaled Medication; epinephrine; Glucagon; G-Tubes); Records and Authorizations; ·Storage; ·Staff training; Safety precautions; ·When to call 911 ·Reporting Requirements need to be in the plan. Refer to Title 22 Sections 102417 and Health and Safety Code Section 1596.750 and 1507. Technical assistance can be found at http://ccld.ca.gov/PG546.htm and http://ccld.ca.gov/PG2105.htm .
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SUPERVISOR'S NAME: Judy HansonTELEPHONE: (714) 703-2807
LICENSING EVALUATOR NAME: Yesenia VillaTELEPHONE: (714) 703-2818
LICENSING EVALUATOR SIGNATURE:

DATE: 06/19/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/19/2019
LIC809 (FAS) - (06/04)
Page: 2 of 3
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME: VILLASENOR, LOURDES
FACILITY NUMBER: 304312679
VISIT DATE: 06/19/2019
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Title 22 regulations, types of deficiencies, posting requirements, children files, children’s roster, reporting requirements, inactive status, the safe sleep policy for infants in child care, the SIDS flyer, emergency/disaster drills, SB 792, and fingerprint clearances were discussed. Web site addresses http://www.ccld.ca.gov and http://www.dss.cahwnet.gov were given to down load forms and Title 22 regulations. A hard copy of the 2016 “A Child Care Providers Guide to Safe Sleep” was provided to the applicant. The following electronic links were also provided:
English: https//www.cdph.ca.gov/programs/SIDS/Documents/SIDSchildcaresafesleep.pdf
AAP:https://www.healthychildren.org/English/ages-stages/baby/sleep/Pages/A-Parents-Guide-to-Safe-Sleep.aspx
NIH: https://safetosleep.nichd.nih.gov/safesleepbasics/environment/room/text_alternative
Safe to Sleep Campaign: https://safetosleep.nichd.nih.gov/materials

The applicant was advised on how to receive notifications for quarterly updates and provided with a copy of the Winter 2019 Quarterly Update and the Child Care Advocate contact information: childcareadvocatesprogram@dss.ca.gov

This facility meets licensing requirements for a Large family child care home of 14 children- A large family day care home may provide care for more than 12 children and up to and including 14 children, if all of the following conditions are met:At least one child is enrolled in and attending kindergarten or elementary school and a second child is at least six years of age. No more than three infants are cared for during any time when more than 12 children are being cared for. The licensee notifies a parent that the facility is caring for two additional school age children and that there may be up to 13 or 14 children in the home at one time. The facility will receive a license pending in office review by a Licensing Program Manager and the following missing items.



· Proof of (8) hour Preventative Health with (1) hour of nutrition.
· Pictures showing the backyard area is free of debris and toys are clean.


An exit interview was completed with Lourdes Villasenor, Licensee. The report was reviewed and discussed. Appeal Rights were discussed. A notice of site visit was posted, Licensee was advised form must be posted for 30 days. Failure to post for 30 days will result in a $100.00 civil penalty fee. Page 3 of 3
SUPERVISOR'S NAME: Judy HansonTELEPHONE: (714) 703-2807
LICENSING EVALUATOR NAME: Yesenia VillaTELEPHONE: (714) 703-2818
LICENSING EVALUATOR SIGNATURE:

DATE: 06/19/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/19/2019
LIC809 (FAS) - (06/04)
Page: 3 of 3