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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 191607306
Report Date: 02/20/2025
Date Signed: 02/20/2025 01:20:27 PM

Document Has Been Signed on 02/20/2025 01:20 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
MONTEREY PARK SW RO, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME:FLORES FAMILY DAY CAREFACILITY NUMBER:
191607306
ADMINISTRATOR/
DIRECTOR:		FLORES, ELVAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(562) 630-7354
CITY:LAKEWOODSTATE: CAZIP CODE:
90712
CAPACITY: 14TOTAL ENROLLED CHILDREN: 3CENSUS: 1DATE:
02/20/2025
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:53 AM
MET WITH:Licensee, Elva FloresTIME VISIT/
INSPECTION COMPLETED:
01:30 PM
NARRATIVE
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On 02/20/2025 at 08:53 am, Licensing Program Analyst (LPA) Jonnisha Culbert conducted an unannounced inspection at the facility noted above and met with Licensee, Elva Flores. The purpose of the visit was to conduct an annual/random inspection. The operating hours of the facility are Monday through Friday from 7am to 5PM. Entrance Checklist (LIC 126) was provided to the Licensee upon arrival. Individuals residing in the home were discussed and noted. At the time of the inspection Licensee, Adult 1, and 3 children were present.

This is a single-family home that consists of four (4) bedrooms, three (3) bathrooms, living room, den, dining room, kitchen, attached garage, two enclosed backyards, and pool area in one of the enclosed backyards.

Areas that are accessible to children include: living room, den, dining room, kitchen, one (1) bathroom, one (1) bedroom, and front yard. Per Licensee, the children eat and play in the playroom (accessible bedroom).

Areas off-limits to children include: three (3) bedrooms, two (2) bathrooms, attached garage, two (2) backyards, and pool area. Per Licensee, children are not allowed outside in backyard.

The following documents were posted: Facility License, Notification of Parents' Rights (PUB 394), Earthquake Preparedness (LIC 9148), and Emergency Disaster Plan (LIC 610A). Licensee has a current Facility Roster (LIC 9040) available for review. LPA observed Disaster and Fire Drill log available for review. The last drill was conducted on 02/03/2025.

Areas used by children were inspected for safety, comfort, heating, cleanliness, and telephone service.


Per Licensee, the home is equipped with central air and heating. LPA observed two fireplaces (one in the den and one in the living room) with chain meshed screen curtains blocked by pictures. Per licensee, the
SUPERVISORS NAME: Karen Chambers
LICENSING EVALUATOR NAME: Jonnisha Culbert
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
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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Document Has Been Signed on 02/20/2025 01:20 PM - It Cannot Be Edited


Created By: Jonnisha Culbert On 02/20/2025 at 12:06 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 CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME: FLORES FAMILY DAY CARE
FACILITY NUMBER: 191607306

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

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102417(g)(4)
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: (4) Poisons, detergents, cleaning compounds, medicines, firearms and other items which could pose a danger if readily available to children shall be stored where they are inaccessible to children.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation and interview, the licensee did not comply with the section cited above in Lysol sprays and off bug repellent was in an area accessible to children. Per licensee, the children do not mess with it. This poses a potential health and safety risk to persons in care.
POC Due Date: 02/20/2025
Plan of Correction
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LPA removed items from the counter and put them in an area inacessible to children.
Type B
Section Cited
HSC
1596.814(a)(1)(A)(i)
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: (1) The swimming pool shall be equipped with, at minimum, the following drowning prevention safety features: (A) An enclosure, including, but not limited to, a fence, wall, or other barrier that isolates the swimming pool from access to the family daycare home and has all of the following characteristics: (i) An access gate that opens away from the swimming pool and is self-closing with a self-latching, key lockable device placed no lower than 60 inches above the ground.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, the licensee did not comply with the section cited above in the access gate to the swimming pool opens towards the pool which poses a potential safety risk to persons in care.
POC Due Date: 03/31/2025
Plan of Correction
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Per licensee, they will fix the gate and emai or text the proof to LPA J. Culbert by proof of correction 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:Karen Chambers
LICENSING EVALUATOR NAME:Jonnisha Culbert
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


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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
MONTEREY PARK SW RO, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME: FLORES FAMILY DAY CARE
FACILITY NUMBER: 191607306
VISIT DATE: 02/20/2025
NARRATIVE
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fireplaces have never been used. LPA reminded licensee that fireplaces are to remain inaccessible to children. LPA checked for detergents, cleaning compounds, and medicines. At 9:20am LPA observed supplements in lower kitchen cabinet. LPA advised licensee to put them in an area inaccessible to children. Licensee moved items to cabinet above countertop.

At 9:24am, LPA observed two cleaning sprays and easy off on counter in living room. This is a potential safety risk to persons in care. Per licensee, the children do not mess with these items, and they are constantly watching the children. LPA advised licensee to move items to an area that is inaccessible to children. Per Licensee, poisons are kept in the attach garage that is not accessible through the home. Outside, LPA observed that garage door was unlocked. LPA reminded licensee that poisons are to remain in areas that are locked and inaccessible to children. LPA observed age-appropriate toys and sleeping mat. Licensee disclosed that there is a pool on the premises.

LPA inspected the pool to ensure it met safety requirements. Upon entering the backyard, LPA observed a gate blocking access to the pool. The gate open towards the pool, and it has a self-latching device. LPA observed a pad lock with a key inside of it. LPA measured the gate. The height of the fence at the entrance is 4ft. 9 inches tall with a vertical clearance from the bottom of the enclosure to the ground measuring 5 inches. LPA observed a life ring with an exterior of 20 inches with a United States Coast Guard Approval Label. Licensee did not meet all safety requirements established under AB2866. Per Licensee, they were unaware of the newly issued requirements. This poses a potential safety risk to persons in care.

LPA observed the required fire extinguisher (3-A:40-BC) that is fully charged and last serviced on 04/09/2024. Licensee was reminded to have the fire extinguisher serviced yearly. A smoke detector and carbon monoxide detectors were observed and are operable.

Per licensee, since children are only here before and after school, they only provide breakfast and afternoon snack. Licensee was reminded that food that is brought from the children's home shall be labeled with the child’s name and properly stored or refrigerated.
SUPERVISORS NAME: Karen Chambers
LICENSING EVALUATOR NAME: Jonnisha Culbert
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
MONTEREY PARK SW RO, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME: FLORES FAMILY DAY CARE
FACILITY NUMBER: 191607306
VISIT DATE: 02/20/2025
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LPA conducted a record review of one (1) Child record and 2 personnel records. Based on the child and personnel record review all records are complete with required documents. Licensee has record of immunization against measles and pertussis. LPA observed licensee has current Pediatric First Aid and CPR that expires 05/2025. Mandated Reporter Certificates for licensee and assistant are valid and they expire on 04/11/2025. LPA reminded licensee that mandated reporter training must be completed every 2 years. Mandated reporter training is available at www.mandatedreprterca.com.

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

Licensee Elva Flores 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.

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-andresources/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

SUPERVISORS NAME: Karen Chambers
LICENSING EVALUATOR NAME: Jonnisha Culbert
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
MONTEREY PARK SW RO, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME: FLORES FAMILY DAY CARE
FACILITY NUMBER: 191607306
VISIT DATE: 02/20/2025
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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/.

Licensee was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain childcare by connecting them to childcare providers and Resource and Referral Agencies (R&Rs) throughout California.

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

B citations were cited during today's visit in accordance with Title 22, California Code of Regulations. Appeal rights were provided to licensee. Please see attached LIC 809D.

Exit interview conducted and report was reviewed with the licensee, Elva Flores.

SUPERVISORS NAME: Karen Chambers
LICENSING EVALUATOR NAME: Jonnisha Culbert
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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