<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197413529
Report Date: 09/18/2024
Date Signed: 09/18/2024 01:50:00 PM

Document Has Been Signed on 09/18/2024 01:50 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. DAYCARE-NO.WEST, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME:RUBIO FAMILY CHILD CAREFACILITY NUMBER:
197413529
ADMINISTRATOR/
DIRECTOR:		RUBIO, ALICIAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(323) 971-9772
CITY:LOS ANGELESSTATE: CAZIP CODE:
90044
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 3DATE:
09/18/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:15 PM
MET WITH:JOSCELYN RUBIO, ASSISTANT AND ALICIA RUBIOTIME VISIT/
INSPECTION COMPLETED:
02:05 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
On 9/18/2024 Licensing Program Analyst (LPA) Loyce Phillips conducted an unannounced case mangaement-other visit. Upon arrival LPA met with Assistant, Joscelyn Rubio. LPA observed 3 infants in care. Also present during inspection was Licensee's spouse. All adults have a criminal record clearance on file. LPA is conducting a follow-up case management to ensure the Health, Safety, and Personal Rights as required by Title 22 Regulations governing California Child Care Homes are met by Licensee. Licensee, Alica Rubio joined the visit at 12:30pm.

During walk through visit conducted on 7/31/2024 at 9:00am LPA observed the following:


- Infant crib had blankets and other items inside the crib.
- Changing table was located in the storage area. LPA provided best practice on placement of the changing table.
- Damaged Little Tikes plastic bench table.
- The storage area shall be made off limits to children in care. LPA provided best practices and technical assistance regarding walking through off-limit areas.

During today's visit, LPA observed the following:


- Infant cribs and pack n' plays were free of objects.
-The changing table located in the storage area has been moved into the hallway.
- All damaged toys and items have been removed from the facility.
-The storage area is off limits to children in care. Children will use the side door to exit and enter the facility from back yard
- LPA conducted a file review to ensure sleep logs and LIC 9227 were completed. LPA observed sleep logs were not up to date for infants in care.
- LPA reviewed and provided a copy of LIC 311D to assistant and Licensee.

809-C
SUPERVISORS NAME: Karren Starks
LICENSING EVALUATOR NAME: Loyce Phillips
LICENSING EVALUATOR SIGNATURE: DATE: 09/18/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/18/2024
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 3
Document Has Been Signed on 09/18/2024 01:50 PM - It Cannot Be Edited


Created By: Loyce Phillips On 09/18/2024 at 01:07 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
, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245

FACILITY NAME: RUBIO FAMILY CHILD CARE
FACILITY NUMBER: 197413529

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/18/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
09/27/2024
Section Cited
CCR
102425(j)(2)(A)(B)

1
2
3
4
5
6
7
102425(j)(2)(A)(B)Infant Safe Sleep(j) The provider shall supervise infants while they are sleeping and adhere to the following requirements:(2)The provider shall check and document the following: (A)Labored breathing.(B)Signs of distress which includes but is not limited to flushed skin color, increase in body temperature and restlessness.
1
2
3
4
5
6
7
Licensee will complete and keep an updated sleep log on file for all infants in care. Licensee will make sleep logs readily available to the Department.
8
9
10
11
12
13
14
This requirement was not met as evidenced by: 3 children did not have updated sleep logs on file and 1 child did not have a sleep log at all, which poses a potential health, safety or personal rights risk to persons in care.
8
9
10
11
12
13
14

1
2
3
4
5
6
7
1
2
3
4
5
6
7

1
2
3
4
5
6
7
1
2
3
4
5
6
7
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:Karren Starks
LICENSING EVALUATOR NAME:Loyce Phillips
LICENSING EVALUATOR SIGNATURE:
DATE: 09/18/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/18/2024


LIC809 (FAS) - (06/04)
Page: 2 of 3
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
L.A. DAYCARE-NO.WEST, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME: RUBIO FAMILY CHILD CARE
FACILITY NUMBER: 197413529
VISIT DATE: 09/18/2024
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
Per Title 22, Division 12, Chapter 3, of the California Code of Regulations deficiency is cited See LIC 809 D.

An exit interview was conducted, a copy of this report was read and provided to Licensee. This report shall be made available to the public upon request. LIC 9213 Notice of Site Visit was provided and required to be posted for 30 day

SUPERVISORS NAME: Karren Starks
LICENSING EVALUATOR NAME: Loyce Phillips
LICENSING EVALUATOR SIGNATURE:

DATE: 09/18/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/18/2024
LIC809 (FAS) - (06/04)
Page: 3 of 3