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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 360905637
Report Date: 02/20/2025
Date Signed: 02/20/2025 04:24:24 PM

Document Has Been Signed on 02/20/2025 04:24 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:GUILLEM FAMILY CHILD CAREFACILITY NUMBER:
360905637
ADMINISTRATOR/
DIRECTOR:		PAT GUILLEMFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(909) 988-6696
CITY:ONTARIOSTATE: CAZIP CODE:
91762
CAPACITY: 12TOTAL ENROLLED CHILDREN: 12CENSUS: 7DATE:
02/20/2025
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:45 PM
MET WITH:Pat GuillemTIME VISIT/
INSPECTION COMPLETED:
04:50 PM
NARRATIVE
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Licensing Program Analyst (LPA) Aman Lama arrived at the facility to conduct an annual inspection. Upon arrival, LPA was met with licensee, Pat Guillem, who granted LPA access to the home. LPA then toured the on-limits indoor and outdoor areas of the facility. Also present in the home were licensees’ assistant. The following was observed and/or discussed:
Normal days and hours of operation are listed as: Monday-Friday, 7:00am-4:30pm.

OFF-LIMIT AREAS ARE LISTED AS FOLLOWS: Living room, Bedroom 3, and Pool area in the outdoor area (backyard).


· A working telephone is present and current phone number is on file.

· Appropriate fire extinguisher, smoke detector and carbon monoxide detector were all in working order.

· LPA observed hazards inaccessible to daycare child(ren).

· Licensee stated there are no guns/weapons currently kept in the home. All guns, weapons& ammunition must be key locked separately, made inaccessible & must remain in compliance with Title 22 Regulations.

· Licensee had appropriate postings posted near the entrance of the home.

· Mandated Reporter Training certificate for licensee and assistant are updated.

· Pediatric CPR and First Aid Card for licensee and assistant have been misplaced and not available during today’s inspection.

· Health & Safety Certificate for licensee has been completed and is on file.

· LPA observed Clean, safe and age appropriate toys available for children.

· Documentation of last fire/disaster drill was available. Last drill conducted: 12-17-24.

Gilbert SenaTELEPHONE: (951) 782-4200
Aman LamaTELEPHONE: (951) 970-7385
DATE: 02/20/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/20/2025
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 11
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: GUILLEM FAMILY CHILD CARE
FACILITY NUMBER: 360905637
VISIT DATE: 02/20/2025
NARRATIVE
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·Bodies of water were observed on the property during today’s inspection. Licensee is reminded that all bodies of water including ponds, above ground pools & spas, in-ground pools & spas, and some fountains must be properly fenced per Title 22 Regulations. The Department must be notified before and after installation of any of the above types of bodies of water. In addition, all wading pools or similar product must be emptied immediately after use and stored in an upright position. -SEE LIC809D for new Regulations for pools in Family Child Care Homes (FCCH’s), effective January 01, 2025. LPA provided licensee with the PIN 25-01-CCP.

· The Licensee was informed of their reporting requirements and is provided with the Regional Office’s Unusual Incident Reporting email mailbox: UnusualIncidentReportsDO09@dss.ca.gov

· Resident and/or staff records reviewed indicate that all adults who require caregiver background checks have received all required clearances or exemptions.

· The Licensee can submit transfer forms to associate new individuals or to disassociate someone from the facility at: Associations_Disassociations862@dss.ca.gov

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.

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)/ (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/.

SUPERVISOR'S NAME: Gilbert SenaTELEPHONE: (951) 782-4200
LICENSING EVALUATOR NAME: Aman LamaTELEPHONE: (951) 970-7385
LICENSING EVALUATOR SIGNATURE:

DATE: 02/20/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/20/2025
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
RIVERSIDE CC RO, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501
FACILITY NAME: GUILLEM FAMILY CHILD CARE
FACILITY NUMBER: 360905637
VISIT DATE: 02/20/2025
NARRATIVE
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- 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 5 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.

- To receive Provider Information Notices (PINs), go to the licensing webpage www.ccld.ca.gov, and click on the “Receive Important Updates” located on the right side of the page, immediately above the “Quick Links”. You can add your email address and choose which program(s) to receive PINs for.



- The Duty Officer is available to answer questions Monday – Friday; 8:00am to 5:00pm at: 951-782-4200.

Licensee was informed of the MyChildCarePlan.org website; 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.

During the exit interview, the licensee confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS.

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

Exit interview conducted and report was reviewed with the licensee, Pat Guillem.
SUPERVISOR'S NAME: Gilbert SenaTELEPHONE: (951) 782-4200
LICENSING EVALUATOR NAME: Aman LamaTELEPHONE: (951) 970-7385
LICENSING EVALUATOR SIGNATURE:

DATE: 02/20/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/20/2025
LIC809 (FAS) - (06/04)
Page: 3 of 11
Document Has Been Signed on 02/20/2025 04:24 PM - It Cannot Be Edited


Created By: Aman Lama On 02/20/2025 at 03:33 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: GUILLEM FAMILY CHILD CARE
FACILITY NUMBER: 360905637

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/20/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
HSC
1596.814(a)(1)(B)(i)(II)
Pool Safety
(II) A licensee shall maintain and make available for inspection, upon request by the department, documentation that establishes the cover is compliant with ASTM International Standard F1346-23.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation and licensees own admission, licensee stated she will find out if the cover is compliant with ASTM International Standard F1346-23, but is unsure at the moment. This poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 03/28/2025
Plan of Correction
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Licensee agrees to submit proof of documentation for a cover that is compliant with ASTM International Standard F1346-23 and submit to the department no later than POC due date.
Type B
Section Cited
HSC
1596.814(a)(1)(B)(ii)(I)
Pool Safety
(ii) (I) An alarm that, when placed in a swimming pool, will sound upon detecting an entrance into the water. The alarm shall be turned on and be in working condition during a facility’s operating hours while the swimming pool is not in use.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation and licensees own admission, licensee did not have this device placed in the swimming pool during todays inspection. This poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 03/28/2025
Plan of Correction
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Licensee agrees to purchase and submit proof of an alarm that, when placed in a swimming pool will sound upon detecting entrance into the water. Licensee agrees to submit video proof of this to the department no later than the POC due date.
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:Gilbert Sena
TELEPHONE: (951) 782-4200
LICENSING EVALUATOR NAME:Aman Lama
TELEPHONE: (951) 970-7385
LICENSING EVALUATOR SIGNATURE:
DATE: 02/20/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/20/2025


LIC809 (FAS) - (06/04)
Page: 4 of 11
Document Has Been Signed on 02/20/2025 04:24 PM - It Cannot Be Edited


Created By: Aman Lama On 02/20/2025 at 03:33 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: GUILLEM FAMILY CHILD CARE
FACILITY NUMBER: 360905637

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/20/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
HSC
1596.814(a)(1)(B)(ii)(II)
Pool Safety
(II) A licensee shall maintain and make available for inspection, upon request by the department, documentation that establishes the alarm is compliant with ASTM International Standard F2208.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation and licensees own admisson, Licensee did not have this documentaion of the above mentioned device during todays inspection. This poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 03/28/2025
Plan of Correction
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Licensee agrees to submit proof of documentation for a cover that is compliant with ASTM International Standard F2208 and submit to the department no later than POC due date.
Type B
Section Cited
HSC
1596.814(a)(2)(A)
Pool Safety
(a) A licensed family daycare home operated at a private single-family dwelling with an in-ground swimming pool on the premises shall comply with all of the following requirements: (2) The licensee shall have the following safety equipment visible from the swimming pool and readily available for immediate use: (A) A life ring with a minimum exterior diameter of 17 inches and labeled as approved by the United States Coast Guard.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation and licensees own admission, Licensee did not have this device during todays inspection.This poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 03/28/2025
Plan of Correction
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Licensee agrees to purchase a life ring with a minimum exterior diameter of 17 inches and labeled as approved by the United States Coast Guard and submit picture proof to licensing no later than the POC due date.
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:Gilbert Sena
TELEPHONE: (951) 782-4200
LICENSING EVALUATOR NAME:Aman Lama
TELEPHONE: (951) 970-7385
LICENSING EVALUATOR SIGNATURE:
DATE: 02/20/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/20/2025


LIC809 (FAS) - (06/04)
Page: 5 of 11
Document Has Been Signed on 02/20/2025 04:24 PM - It Cannot Be Edited


Created By: Aman Lama On 02/20/2025 at 03:33 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: GUILLEM FAMILY CHILD CARE
FACILITY NUMBER: 360905637

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/20/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
HSC
1596.814(a)(2)(B)
Pool Safety
(a) A licensed family daycare home operated at a private single-family dwelling with an in-ground swimming pool on the premises shall comply with all of the following requirements: (2) The licensee shall have the following safety equipment visible from the swimming pool and readily available for immediate use: (B) A rescue pole with a body hook and a minimum fixed length of 12 feet.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation and licensees own admisson, Licensee did not have a recue pole with a body hook, 12 feet minimum during todays inspection. This poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 03/28/2025
Plan of Correction
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Licensee agrees to purchase and submit proof of a resue pole with a body hook and minimum fixed length of 12 feet. This is due to the department no later than the POC due date.
Type B
Section Cited
HSC
1596.814(a)(3)
Pool Safety
(a) A licensed family daycare home operated at a private single-family dwelling with an in-ground swimming pool on the premises shall comply with all of the following requirements: (3) A licensee shall perform a daily inspection of the drowning prevention safety features and safety equipment before opening the facility and maintain a log of the inspections to be provided to the department upon request.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation and licensees own admisson, Licensee did not begin the implementation of the log during todays inspection. This poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 02/28/2025
Plan of Correction
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Licensee agrees to begin a log and implement immediately, beginning 02/21/2025. Licensee will submit a log beginning 02/21/2025 all the way to POC due date, on the POC due date. Licensee understands she will need to keep a log moving forward for every day she is open for care.
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:Gilbert Sena
TELEPHONE: (951) 782-4200
LICENSING EVALUATOR NAME:Aman Lama
TELEPHONE: (951) 970-7385
LICENSING EVALUATOR SIGNATURE:
DATE: 02/20/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/20/2025


LIC809 (FAS) - (06/04)
Page: 6 of 11
Document Has Been Signed on 02/20/2025 04:24 PM - It Cannot Be Edited


Created By: Aman Lama On 02/20/2025 at 03:33 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: GUILLEM FAMILY CHILD CARE
FACILITY NUMBER: 360905637

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/20/2025

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 licensees own admission and record review, the licensee did not comply with the section cited above. Licensee did not have proof of CPR/First Aid cards for either herself or her assistant available for review. This poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 03/28/2025
Plan of Correction
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Licensee agrees to submit proof of CPR/First Aid for herself and her assistant no later than POC due date.
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:Gilbert Sena
TELEPHONE: (951) 782-4200
LICENSING EVALUATOR NAME:Aman Lama
TELEPHONE: (951) 970-7385
LICENSING EVALUATOR SIGNATURE:
DATE: 02/20/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/20/2025


LIC809 (FAS) - (06/04)
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