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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197413529
Report Date: 06/13/2023
Date Signed: 06/14/2023 01:31:56 PM

Document Has Been Signed on 06/14/2023 01:31 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, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME:RUBIO FAMILY CHILD CAREFACILITY NUMBER:
197413529
ADMINISTRATOR:RUBIO, ALICIAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(323) 971-9772
CITY:LOS ANGELESSTATE: CAZIP CODE:
90044
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 0DATE:
06/13/2023
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
02:00 PM
MET WITH:Miguel Rubio, Husband of LicenseeTIME COMPLETED:
03:40 PM
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Licensing Program Analyst (LPA) Shandra Powell conducted an unannounced Annual/Random required inspection at the above facility on 06/13/2023. LPA arrived at the facility, identified self and met with Miguel Rubio, Husband of Licensee. Licensee is away from the facility for a graduation. No children were in care during inspection. LPA provided Mr. Rubio with a copy of the LIC 126 Entrance Checklist to help facilitate the inspection. A Risk Assessment for COVID-19 was completed before entry. Husband gave tour to LPA of the home. LPA observed living room to be the main child care room with toys, cubbies, doll house and cots for napping. This is a 3 bedroom home with drop down room per husband for storage. LPA observed bathroom #1 in hallway and 1/4 bathroom located in the drop down room next to kitchen. LPA observed an open concept living room, dining room and kitchen area. The dining area has a large family style table with chairs and bench. LPA toured the inside and outside of the home. All areas identified on the facility sketch that are accessible for children to use were inspected for safety, comfort, and cleanliness. The home is a one story home, with attached garage. The attached garage has been converted into a bedroom with a 1/2 bathroom inside. The attached garage can be accessed from the driveway and through Bedroom #1 Per Mr. Rubio all bedrooms will be off limits made inaccessible with child proof knobs. LPA observed one child proof knob on bedroom #1 during inspection. Bathroom #1 and #2 will be off limits to children in care Per Mr. Rubio the children will use the 1/4 bathroom located in the drop down room next to kitchen. Mr. Rubio stated no child care will be conducted in the attached garage which is his room.
SUPERVISORS NAME: Karren Starks
LICENSING EVALUATOR NAME: Shandra Powell
LICENSING EVALUATOR SIGNATURE: DATE: 06/13/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/13/2023
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
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME: RUBIO FAMILY CHILD CARE
FACILITY NUMBER: 197413529
VISIT DATE: 06/13/2023
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All bedrooms are off limits per Mr. Rubio. The Living room, Dining room and Kitchen and backyard will be accessible to children in care. Bathroom #3 (1/4 bathroom) will be available to children in care. LPA did not observe pool, spa, hot tub or other similar bodies of water on the premise.
Per Mr. Rubio, there are no firearms, ammunition or weapons on the premise; none were observed by LPA. Per Mr. Rubio no poisons are located on the premise. Detergents, cleaning compounds, medication and other hazardous items are made inaccessible.
There is at least one working fire extinguisher, smoke detector and carbon monoxide detector in the home (tested during inspection). Air conditioner was located in home.

The home has working telephone service (Cell) and LPA confirmed the phone number is on file.

LPA observed a small room located in the backyard with a small kitchen space and a queen size bed located in front of the small room. Mr. Rubio stated no tenants live in the small room. LPA observed a shed and a swing set and garden in the back yard. Mr. Rubio stated the children will use the back yard for out door play. LPA observed a small dog in kennel. Mr. Rubio stated the dog belongs to his grand kids in Lake Elsinore and the dog will be going back home soon. The outdoor play area will need cleaning and maintenance before children are able to use as a play area. Per Mr. Rubio the back yard will be cleaned before care is provided to children.



LPA observed licensees CPR/First Aid certification expires on 07/2024. Failure to renew CPR/First Aid certification, causes a potential health, safety or personal rights risk to children in care.
The following was observed and reviewed during this inspection located on board on wall in living room: LPA reviewed required posted documentation. Facility License, Publication (PUB) 394 and Earthquake Preparedness form.
SUPERVISORS NAME: Karren Starks
LICENSING EVALUATOR NAME: Shandra Powell
LICENSING EVALUATOR SIGNATURE:

DATE: 06/13/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/13/2023
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, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME: RUBIO FAMILY CHILD CARE
FACILITY NUMBER: 197413529
VISIT DATE: 06/13/2023
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Facility records which were were not reviewed during inspection are as follows - LIC 9040- Facility Roster, LIC 610- Facility Disaster Plan and Disaster and Drill Log. Children’s records were not reviewed during inspection.
To improve the quality and value of the new inspection process, a survey will 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 tools, please send them by email 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/process.

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.

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 [facility representative] 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.

The licensee is also reminded that Baby walkers, bouncers and similar items are not allowed in child care facilities.

SUPERVISORS NAME: Karren Starks
LICENSING EVALUATOR NAME: Shandra Powell
LICENSING EVALUATOR SIGNATURE:

DATE: 06/13/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/13/2023
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, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME: RUBIO FAMILY CHILD CARE
FACILITY NUMBER: 197413529
VISIT DATE: 06/13/2023
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LPA observed a completed First Aid Kit at facility during inspection. LPA observed child proof latches on kitchen cabinets.

LPA provided The Department of Social Services - Community Care Licensing Division website: http://www.ccld.ca.gov


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

Exit interview conducted and report was reviewed with Mr. Rubio, husband to licensee.

SUPERVISORS NAME: Karren Starks
LICENSING EVALUATOR NAME: Shandra Powell
LICENSING EVALUATOR SIGNATURE:

DATE: 06/13/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/13/2023
LIC809 (FAS) - (06/04)
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