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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 304312679
Report Date: 05/25/2022
Date Signed: 05/25/2022 03:29:30 PM


Document Has Been Signed on 05/25/2022 03:29 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, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868



FACILITY NAME:VILLASENOR, LOURDESFACILITY NUMBER:
304312679
ADMINISTRATOR:VILLASENOR, LOURDESFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(562) 587-4267
CITY:LA HABRASTATE: CAZIP CODE:
90631
CAPACITY:14CENSUS: 5DATE:
05/25/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:30 PM
MET WITH:Lourdes Villasenor, LicenseeTIME COMPLETED:
03:45 PM
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Licensing Program Analyst (LPA) P Rivas conducted an unannounced required annual inspection. LPA was assisted by Licensee Lourdes Villasenor; present during visit were 3 Preschool age children, 4 infants and one assistant. Licensee was operating within the licensed capacity as specified on license. A review of the Facility Personnel Report Summary on this date indicates all facility residents, staff, or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions. 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. Currently there are 5 adults including the licensee residing in the facility. Facility Day care hours are 745am-430pm, Monday through Friday.
During today’s inspection, LPA and licensee toured the inside and outside areas of the facility. Off limits areas are made inaccessible by means of door knob covers, and baby gates.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. There is at least one working carbon monoxide detector, and fire extinguisher in the home that meet statutory and State Fire Marshall standards, replaced 03/2022. Detergents, cleaning compounds, medicines, and other items which could pose a danger if readily available to children were stored inaccessible to children. Licensee stated there are not firearms and/or other dangerous weapons in the facility, and none were observed during today's inspections. The home has age appropriate toys for the ages served. During today’s inspection LPA verified there is a working phone service. Licensee stated they use the backyard as an outdoor play area. The backyard play area was inspected and is free from hazards. There were no poisons or other items observed which could pose a danger to children or if they were observed, they were locked or inaccessible. There are no bodies of water on the premises. The licensee has a current roster of children in care. Children’s records for children present during LPA’s inspection were reviewed.
SUPERVISOR'S NAME: Rina LopezTELEPHONE: (714) 703-2808
LICENSING EVALUATOR NAME: Pat RivasTELEPHONE: 714-703-2800
LICENSING EVALUATOR SIGNATURE:
DATE: 05/19/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/19/2022
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, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME: VILLASENOR, LOURDES
FACILITY NUMBER: 304312679
VISIT DATE: 05/25/2022
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Due to time Constraints the staff and children's files will be reviewed at a later date.

LPA discussed the safe sleep regulations with licensee Lourdes Villasenor 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.

Notice of Site Visit
A notice of site visit was given and must remain posted for 30 days.

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

Appeal Rights were explained. The Licensee was provided a copy of appeal rights (LIC 9058 01/16) and their signature on this form acknowledges receipt of these rights. All appeals must be in writing and received by the Regional Office within 15 business days. First level appeals should be sent to the regional manager to the address listed above. Exit interview conducted and report was reviewed with the licensee
SUPERVISOR'S NAME: Rina LopezTELEPHONE: (714) 703-2808
LICENSING EVALUATOR NAME: Pat RivasTELEPHONE: 714-703-2800
LICENSING EVALUATOR SIGNATURE:

DATE: 05/25/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/25/2022
LIC809 (FAS) - (06/04)
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