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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 191596628
Report Date: 12/28/2023
Date Signed: 12/28/2023 03:00:00 PM

Document Has Been Signed on 12/28/2023 03:00 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
L.A. DAY CARE-EAST, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME:DELAYO FAMILY DAY CAREFACILITY NUMBER:
191596628
ADMINISTRATOR:DELAYO, MARTHAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(626) 814-9009
CITY:BALDWIN PARKSTATE: CAZIP CODE:
91706
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 4DATE:
12/28/2023
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
01:20 PM
MET WITH:Licensee, Martha DelayoTIME COMPLETED:
03:40 PM
NARRATIVE
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Licensing Program Analyst (LPA) Mary Silva conducted an unannounced POC (Plan of Correction) inspection to insured that the Type B deficiencies cited on 11/22/2023 have been cleared. LPA met with Martha Delayo, licensee who guided analysts on a tour of the facility. There were four children present. Licensee's assistant David Delayo was also present during this inspections. The following was observed:

- Fire Extinguisher size 2A 10BC with proof of purchase

- Missing 15 minute sleep log for child # 1

- First Aid CPR certification for licensee and assistant expired on June 2023

- Mandated Reporter Training expired on July 2023 for licensee and assistant www.mandatedreporterca.com

- Licensee has not conducted disaster drill at least every six months

LPA advised the licensee how to access forms, regulations and quarterly updates on the Child Care Licensing Website at: www.ccld.ca.gov

Based on the LPA observations and records review, the following deficiencies listed on the attached LIC 809D (deficiency page) are being cited in accordance with California Code of Regulations Title 22. Deficiencies that are being cited need to be cleared to protect the children’s health & safety.


A notice of site visit was given and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100. Appeal right given.

Exit interview conducted and report was reviewed with Licensee, Martha Delayo.

SUPERVISORS NAME: Christina Gabelman
LICENSING EVALUATOR NAME: Mary Silva
LICENSING EVALUATOR SIGNATURE: DATE: 12/28/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/28/2023
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 4
Document Has Been Signed on 12/28/2023 03:00 PM - It Cannot Be Edited


Created By: Mary Silva On 12/28/2023 at 02:07 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
, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME: DELAYO FAMILY DAY CARE
FACILITY NUMBER: 191596628

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/28/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
01/18/2024
Section Cited
CCR
102425(j)(1)

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The provider shall supervise infants while they are sleeping and adhere to the following requirements: The provider shall physically check on the infant every 15 minutes.

This requirement is not met as evidenced by:
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Facility will provide copy of infant sleep log by POC due date.
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Based on observation and interview, the licensee did not comply with the section cited above, facility does not maintain 15 minute infant sleep log which poses/posed a potential health, safety or personal rights risk to persons in care.
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Type B
01/18/2024
Section Cited
HSC1596.8662(b)(1)

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(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:
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Licensee will submit mandated reporter training certificate by POC due date.
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Based on record review, the licensee did not comply with the section cited above mandated reporter training expired for licensee and assistant which poses/posed a potential health, safety or personal rights risk to persons in care.
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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:Christina Gabelman
LICENSING EVALUATOR NAME:Mary Silva
LICENSING EVALUATOR SIGNATURE:
DATE: 12/28/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/28/2023


LIC809 (FAS) - (06/04)
Page: 2 of 4
Document Has Been Signed on 12/28/2023 03:00 PM - It Cannot Be Edited


Created By: Mary Silva On 12/28/2023 at 02:17 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
, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME: DELAYO FAMILY DAY CARE
FACILITY NUMBER: 191596628

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/28/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
01/18/2024
Section Cited
CCR
102417(g)(1)

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(g) The home shall be free from defects or conditions which might endanger a child. Safety precautions shall include but not limited to: (1) Fireplaces and open face heaters shall be screened to prevent access by children. The home shall contain a fire extinguisher and smoke detector device which meet standards established by the State Fire Marshall.

This requirement is not met as evidenced by:
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Licensee will purchase a new Fire Extinguisher size 2A 10BC and submit proof of purchase by POC due date.
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Based on observation, the licensee did not comply with the section cited above Fire Extinguisher indicates to be fully charged with no service tag which poses/posed a potential health, safety or personal rights risk to persons in care.
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Type B
01/18/2024
Section Cited
CCR102417(g)(9)(A)

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(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.
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Facility will conduct disaster drill and submit verification by due date.
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Based on observation, the licensee did not comply with the section cited above Facility completed disaster drill May 2021which poses/posed a potential health, safety or personal rights risk to persons in care.
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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:Christina Gabelman
LICENSING EVALUATOR NAME:Mary Silva
LICENSING EVALUATOR SIGNATURE:
DATE: 12/28/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/28/2023


LIC809 (FAS) - (06/04)
Page: 3 of 4
Document Has Been Signed on 12/28/2023 03:00 PM - It Cannot Be Edited


Created By: Mary Silva On 12/28/2023 at 02:23 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
, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME: DELAYO FAMILY DAY CARE
FACILITY NUMBER: 191596628

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/28/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
01/18/2024
Section Cited
CCR
102416(c)

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(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:
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Licensee and assistant will submit First Aid and CPR certificate by due date.
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Based on record review, the licensee did not comply with the section cited above, First Aid and CPR certification expired for licensee and assistant.which poses/posed a potential health, safety or personal rights risk to persons in care.
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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:Christina Gabelman
LICENSING EVALUATOR NAME:Mary Silva
LICENSING EVALUATOR SIGNATURE:
DATE: 12/28/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/28/2023


LIC809 (FAS) - (06/04)
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