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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 334810456
Report Date: 02/10/2025
Date Signed: 02/10/2025 05:27:02 PM

Document Has Been Signed on 02/10/2025 05:27 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
RIVERSIDE CC RO, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501
FACILITY NAME:VELASCO FAMILY CHILD CAREFACILITY NUMBER:
334810456
ADMINISTRATOR/
DIRECTOR:		JUANA VELASCOFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(951) 361-3146
CITY:JURUPA VALLEYSTATE: CAZIP CODE:
92509
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 10DATE:
02/10/2025
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:45 PM
MET WITH:Juana VelascoTIME VISIT/
INSPECTION COMPLETED:
05:45 PM
NARRATIVE
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On 02/10/2025 at 12:45 PM, Licensing Program Analyst (LPA) Tiffanie Diep arrived at the facility to conduct an annual inspection. LPA toured inside and outside of the home, reviewed records, and observed and/or discussed the following:
  • LPA was greeted by Licensee Juana Velasco’s spouse/assistant (S2) upon arrival as Licensee was not home at the time. One individual (S3) was also present with children during the inspection and does not have a current criminal record clearance. This is an immediate risk to children in care and is an immediate civil penalty of $100. A deficiency is being cited on the attached LIC 809-D.
  • At approximately 3:00 PM, Licensee returned to the facility.
  • Normal days and hours of operation are Monday through Friday from 6:00 AM to 6:00 PM.
  • Off-limits areas include: the master bedroom, garage, and backyard pool house.
  • The facility was operating within the licensed capacity and appropriate ratios.
  • Appropriate supervision was provided during the inspection.
  • A working telephone was present with current number on file.
  • An appropriate fire extinguisher was present (3A40BC). A functioning dual smoke detector and carbon monoxide detector were present and tested by S2 during the inspection.
  • Fireplace was properly screened by furniture to prevent access by children in care.
  • All hazardous items were stored inaccessible to children.
  • Toxins were locked.
  • LPA verified that weapons and ammunition were stored in separate locked safes. Licensee understands all firearms, weapons, and ammunition must be locked separately and made inaccessible to children in care according to Title 22 Regulations.
  • Facility is a one-story home.
  • Verification of control of property on file (Mortgage Statement).

Continues on LIC 809-C
SUPERVISORS NAME: Ana Noble
LICENSING EVALUATOR NAME: Tiffanie Diep
LICENSING EVALUATOR SIGNATURE: DATE: 02/10/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/10/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.

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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
RIVERSIDE CC RO, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501
FACILITY NAME: VELASCO FAMILY CHILD CARE
FACILITY NUMBER: 334810456
VISIT DATE: 02/10/2025
NARRATIVE
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Continued from LIC 809 (Page 2)
  • Facility sketches, Emergency Disaster Plan (LIC 610A), Earthquake Preparedness Checklist (LIC 9148), and Notification of Parents' Rights poster (PUB 394) were posted.
  • Preventive health and safety training was completed on 08/21/2001.
  • Pediatric CPR certification expired on 12/22/2024. LPA did not observe pediatric first aid certification. LPA discussed the requirement to renew CPR and first aid certification every two years prior to expiration. LPA informed Licensee that certifications are to be pediatric.
  • Mandated Reporter Training certificate expires on 09/12/2025.
  • The backyard has an in-ground pool area that is surrounded by a mesh fence that is five feet high. LPA observed the gate to swing away from the pool and self-close with a self-latching, key lockable device that is 60 inches above the ground. Licensee understands all bodies of water, including in-ground and above-ground pools, hot tubs, spas, and ponds, must be inaccessible to children in care and be properly covered or fenced according to Title 22 Regulations. The Department must be notified prior to installation of these and similar bodies of water. LPA referred Licensee to the Department website for new pool safety requirements effective January 1, 2025: Child Care Provider Webinar 2024 Q4 and PIN 25-01-CCP.
  • Clean, safe, and age-appropriate toys were present in the living room.
  • A current roster of children was on file.
  • Documentation of fire and disaster drills was on file; last drill was conducted on 09/05/2023. LPA discussed the requirement to conduct and document fire and disaster drills at least once every six months.
  • Children’s records were not complete. LPA did not observe completed file for one out of ten day care children present. LPA discussed the requirement to ensure each child’s records are completed and maintained at the facility.
SUPERVISORS NAME: Ana Noble
LICENSING EVALUATOR NAME: Tiffanie Diep
LICENSING EVALUATOR SIGNATURE:

DATE: 02/10/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/10/2025
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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
RIVERSIDE CC RO, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501
FACILITY NAME: VELASCO FAMILY CHILD CARE
FACILITY NUMBER: 334810456
VISIT DATE: 02/10/2025
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Continued from LIC 809-C (Page 3)
  • Staff records were not complete. LPA observed pediatric CPR certification for S2 expired on 12/22/2024. LPA did not observe pediatric first aid certification for S2. LPA informed Licensee that certifications are to be pediatric. LPA reminded Licensee to ensure all staff renew pediatric CPR and first aid certification every two years prior to expiration if left alone with day care children. LPA also observed Mandated Reporter Training certificate for S2 expired on 03/27/2020. LPA discussed the mandated reporter training requirement and Licensee was reminded to ensure all staff renew the course every two years.
  • Licensee was informed of their reporting requirements and was provided with the Regional Office’s Unusual Incident Reporting e-mail at UnusualIncidentReportsDO09@dss.ca.gov.
  • Licensee can submit transfer forms to associate new individuals or to disassociate someone from their facility via e-mail to Associations_Disassociations862@dss.ca.gov.
  • The Duty Officer is available to answer questions Monday through Friday from 8:00 AM to 5:00 PM at (951) 782-4200.

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 five 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-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.
SUPERVISORS NAME: Ana Noble
LICENSING EVALUATOR NAME: Tiffanie Diep
LICENSING EVALUATOR SIGNATURE:

DATE: 02/10/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/10/2025
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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
RIVERSIDE CC RO, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501
FACILITY NAME: VELASCO FAMILY CHILD CARE
FACILITY NUMBER: 334810456
VISIT DATE: 02/10/2025
NARRATIVE
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Continued from LIC 809-C (Page 4)

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) or (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/.

To improve the quality and value of the new inspection process, a survey may be sent to the e-mail address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or CARE Tool, please send e-mail inquiries to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at https://www.cdss.ca.gov/inforesources/community-care-licensing/inspection-process. Licensee was informed of the MyChildCarePlan.org site, 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.

See attached LIC 9102 for advisory note. Based on LPA’s observations, interviews conducted, and records reviewed, deficiencies are being cited on the attached LIC 809-D. LPA Tiffanie Diep informed the licensee, Juana Velasco, that this report dated 02/10/2025 documents one Type A citation which shall be posted for 30 consecutive days as there was an immediate risk to the safety of children in care. LPA also informed Licensee that this report dated 02/10/2025 documents four Type B citations. Type B citations are a potential risk to the health, safety, or personal rights of children in care.
SUPERVISORS NAME: Ana Noble
LICENSING EVALUATOR NAME: Tiffanie Diep
LICENSING EVALUATOR SIGNATURE:

DATE: 02/10/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/10/2025
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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
RIVERSIDE CC RO, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501
FACILITY NAME: VELASCO FAMILY CHILD CARE
FACILITY NUMBER: 334810456
VISIT DATE: 02/10/2025
NARRATIVE
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Continued from LIC 809-C (Page 5)

Also, LPA informed Licensee to provide a copy of this licensing report dated 02/10/2025 that documents any Type A citation to parents/guardians of all children currently enrolled by the next business day or the next day the children are in care, and to any newly enrolled parents/guardians for 12 months from the date of this report. A signed Acknowledgment of Receipt of Licensing Reports (LIC 9224), or other written statement, must be placed in the child’s file for verification.

An exit interview was conducted and report was reviewed with the licensee, Juana Velasco. During the exit interview, Licensee confirmed that there are no registered sex offenders (RSO) living in the facility and LPA completed the RSO profile in the Field Automation System. A notice of site visit was given to Licensee and must remain posted on, or immediately adjacent to, the interior side of the main door for 30 days. A copy of Appeal Rights (LIC 9058) in Spanish was provided to Licensee.
SUPERVISORS NAME: Ana Noble
LICENSING EVALUATOR NAME: Tiffanie Diep
LICENSING EVALUATOR SIGNATURE:

DATE: 02/10/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/10/2025
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 02/10/2025 05:27 PM - It Cannot Be Edited


Created By: Tiffanie Diep On 02/10/2025 at 04:29 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501

FACILITY NAME: VELASCO FAMILY CHILD CARE
FACILITY NUMBER: 334810456

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/10/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
HSC
1596.871(c)(1)(A)
Administration of Child Day Care Licensing
Subsequent to initial licensure, a person specified in subdivision (b) who is not exempt from fingerprinting shall obtain either a criminal record clearance or an exemption from disqualification, pursuant to subdivision(f) of this section or Section 1522.7, from the State Department of Social Services prior to employment, residence, or initial presence in the facility.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation and interviews conducted, the licensee did not comply with the section cited above as LPA observed one individual who was present with children and does not have a current criminal record clearance upon entry into the facility which poses an immediate safety risk to children in care.
A civil penalty of $100 is being assessed and provided.
POC Due Date: 02/11/2025
Plan of Correction
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LPA reminded Licensee of criminal record clearance requirements. Licensee agreed to have S3 complete a Live Scan and will provide LPA with a completed copy of the Live Scan form by close of business on 02/11/2025. Licensee stated S3 will not return to the facility until a criminal record clearance is obtained.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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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 Noble
LICENSING EVALUATOR NAME:Tiffanie Diep
LICENSING EVALUATOR SIGNATURE:
DATE: 02/10/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/10/2025


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Document Has Been Signed on 02/10/2025 05:27 PM - It Cannot Be Edited


Created By: Tiffanie Diep On 02/10/2025 at 04:29 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501

FACILITY NAME: VELASCO FAMILY CHILD CARE
FACILITY NUMBER: 334810456

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/10/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102417(g)(9)(A)
Operation of A Family Child Care Home
(g) The home shall be free from defects or conditions which might endanger a child. Safety precautions shall include but not limited to: (9) Each family child care home shall have a written disaster plan of action prepared on a form approved by the Department. All children, age and ability permitting, and the provider, the assistant provider, and other members of the household, shall be instructed in their duties under the disaster plan. As their age and ability permit, newly enrolled children shall be informed promptly of their duties as required in the plan. (A) Each family child care home shall conduct fire drills and disaster drills at least once every six months.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, interviews conducted, and records reviewed, the licensee did not comply with the section cited above as LPA observed the last fire and disaster drill was conducted on 09/05/2023 which poses a potential safety risk to children in care.
POC Due Date: 03/10/2025
Plan of Correction
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LPA discussed the requirement to conduct and document fire and disaster drills at least once every six months. Licensee agreed to provide documentation of completed drill to LPA by 03/10/2025.
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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Based on observation, interviews conducted, and records reviewed, the licensee did not comply with the section cited above as licensee did not ensure mandated reporter training was completed for all staff which poses a potential safety risk to children in care.
POC Due Date: 03/10/2025
Plan of Correction
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LPA discussed the mandated reporter training requirement and reminded Licensee to ensure all staff renew the course every two years. Licensee agreed to provide completed certificate for S2 to LPA by 03/10/2025.
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 Noble
LICENSING EVALUATOR NAME:Tiffanie Diep
LICENSING EVALUATOR SIGNATURE:
DATE: 02/10/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/10/2025


LIC809 (FAS) - (06/04)
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Document Has Been Signed on 02/10/2025 05:27 PM - It Cannot Be Edited


Created By: Tiffanie Diep On 02/10/2025 at 04:29 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501

FACILITY NAME: VELASCO FAMILY CHILD CARE
FACILITY NUMBER: 334810456

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/10/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102416(c)
Personnel Requirements
(c) The licensee and other personnel as specified shall complete training on preventive health practices, including pediatric cardiopulmonary resuscitation and pediatric first aid, pursuant to Health and Safety Code Section 1596.866.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, interviews conducted, and records reviewed, the licensee did not comply with the section cited above as licensee did not ensure EMSA pediatric CPR and first aid certifications were renewed for all staff by the expiration date which poses a potential safety risk to children in care.
POC Due Date: 03/10/2025
Plan of Correction
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LPA reminded Licensee to ensure all staff renew CPR and first aid certification every two years prior to expiration. Licensee agreed to provide proof of enrollment and/or completed certificates for themselves and S2 to LPA by 03/10/2025.
Type B
Section Cited
CCR
102421(a)
Child's Records
(a) The licensee shall maintain, in each child's record, the signed and dated notice form required in Section 102419(d).

This requirement is not met as evidenced by:
Deficient Practice Statement
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2
3
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Based on observation, interviews conducted, and records reviewed, the licensee did not comply with the section cited above as licensee did not ensure records were completed for one out of ten day care children present which poses a potential health, safety, and personal rights risk to children in care.
POC Due Date: 03/10/2025
Plan of Correction
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LPA discussed the requirement to ensure each child’s records are completed and maintained at the facility. Licensee agreed to provide proof of required documents for C4 to LPA by 03/10/2025.
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 Noble
LICENSING EVALUATOR NAME:Tiffanie Diep
LICENSING EVALUATOR SIGNATURE:
DATE: 02/10/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/10/2025


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