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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 12:08:00 PM

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:Annual/RandomUNANNOUNCEDTIME BEGAN:
09:45 AM
MET WITH:Lourdes VillasenorTIME COMPLETED:
11:45 AM
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Licensing Program Analyst Yesenia Villa (LPA) conducted an unannounced annual random site inspection to ensure the health & safety standards as required by regulations governing family child care homes. Upon arrival, LPA met with Licensee, Lourdes Villasenor and toured the facility. There were 2 children present. Individuals residing in the home are two adults. Licensee’s operating hours are Monday-Friday 7:30am-5:00pm. Per Licensee she has six children enrolled in her day care at this time.

The home is a one story, 2-Bed, 2-Bath home. The following areas are used for day-care: the two back rooms in the home that have been made into play rooms and the restroom in the back. The off limit areas are the living room, dining room, two bedrooms and front restroom. The garage is a detached garage that is off-limits to the children.

Licensee has the Parent’s Rights poster and other appropriate forms posted on wall in the living room. First Aid/CPR certificate are valid thru 06/06/21. Licensee's disaster drill log notes last drill conducted on 05/23/19. Licensee has a working telephone via her cell phone.

Detergents and cleaning supplies were inaccessible to the children in care. Fire extinguisher has been serviced in the last year. There is an operational smoke detector and carbon monoxide in the kitchen. The home has electrical outlet covers throughout and maintains a First Aid Kit. There are adequate age appropriate toys, books, and games. There are no firearms present on the premises as stated by licensee. LPA inspected the backyard and found the garage locked. There are no pools or spas, or other bodies of water. Currently there are no pets.

Children's Roster is readily available and updated. Children’s Files were reviewed. Page 1 of 2

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 2
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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The following were discussed: Individuals who are 18 years of age or older living in the home must be finger print cleared prior to being in the presence of the children in care. Individuals within one month of their 18th birthday must be fingerprinted immediately. No smoking, No infant walkers, No baby bouncers, No Johnny jumpers, No exersaucers and any other item that falls into that category. LPA discussed disaster drills, posting requirements, children records requirements, mandated child abuse and injury/death reporting.

· LPA reviewed LIC 311D with licensee, reminding her of required forms. LPA reviewed SIDs, Never Shake A Baby, and safe sleeping practices. Infants should sleep mouth up, on their backs, free of clutter surrounding their sleeping space.

· 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


No Deficiencies were cited on this visit./Deficiencies were cited in accordance with California Code of Regulations Title 22. See 809-D.

LPA advised the Licensee to access forms and regulations on line at: www.ccld.ca.gov

The Notice of Site Visit (LIC 9213) was posted and Licensee was advised the flyer must remain posted for 30 days during the hours of operation after each site visit by a licensing representative. Failure to maintain posting as required will result in a civil penalty of $100.00.

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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 2