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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197418679
Report Date: 08/13/2024
Date Signed: 08/13/2024 03:34:06 PM

Document Has Been Signed on 08/13/2024 03:34 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
EL SEGUNDO CC NORTH, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME:ABERGEL FAMILY CHILD CAREFACILITY NUMBER:
197418679
ADMINISTRATOR/
DIRECTOR:		ABERGEL, ANIESFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(310) 779-2454
CITY:LOS ANGELESSTATE: CAZIP CODE:
90048
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 12DATE:
08/13/2024
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:01 PM
MET WITH:Cleotilde "Oralia" Urban, Assistant #1 TIME VISIT/
INSPECTION COMPLETED:
03:45 PM
NARRATIVE
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Licensing Program Analyst (LPA) Lilia Hernandez conducted an unannounced inspection to the above facility on 08/13/2024. LPAs arrived at the facility at 08:45AM and met with Cleotilde "Oralia" Urban, Assistant #1, who guided LPAs on tour of the facility. There was 1 infant, 11 children over 2 years of age, and Assistant #2 present.

The purpose of the visit is to address deficiencies that were discovered during an initial visit of a complaint investigation conducted by the LPA.

An emergency information card shall be maintained for each child and shall include the child's full name, telephone number and location of a parent or other responsible adult to be contacted in an emergency, the name and telephone number of the child's physician and the parent's authorization for the licensee or registrant to consent to emergency medical care. Each family child care home shall also have a current roster of children.

Assistant #1 was only able to provide LPA with 8 of 12 files for the children in care. Assistant #1 was not able to locate or provide the LIC9040 Facility Roster.

Each family child care home shall have a written disaster plan of action prepared on a form approved by the Department.

LPA asked Assistant #1 regarding their duties under the disaster plan. Assistant #1 was not able to provided any information on her duties on the disaster plan and was not able to provide a copy of the approved LIC610A Emergency Disaster Plan For Family Child Care Homes Disaster Plan.
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SUPERVISORS NAME: Rita Ramos
LICENSING EVALUATOR NAME: Lilia Hernandez
LICENSING EVALUATOR SIGNATURE: DATE: 08/13/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/13/2024
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO CC NORTH, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME: ABERGEL FAMILY CHILD CARE
FACILITY NUMBER: 197418679
VISIT DATE: 08/13/2024
NARRATIVE
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Based on the LPA’s 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 copy of this report, appeal rights, and Notice of Site Visit was provided.

The Notice of Site Visit must remain posted for 30 days during the hours of operation after each site visit by a licensing representative. Failure to maintain posting as required will result in a civil penalty of $100.00.

Exit interview was conducted with Cleotilde Oralia Urban, Assistant #1.

---Page 2 of 2
SUPERVISORS NAME: Rita Ramos
LICENSING EVALUATOR NAME: Lilia Hernandez
LICENSING EVALUATOR SIGNATURE:

DATE: 08/13/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/13/2024
LIC809 (FAS) - (06/04)
Page: 2 of 4
Document Has Been Signed on 08/13/2024 03:34 PM - It Cannot Be Edited


Created By: Lilia Hernandez On 08/13/2024 at 02:28 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: ABERGEL FAMILY CHILD CARE
FACILITY NUMBER: 197418679

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/13/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
08/27/2024
Section Cited
CCR
102417(g)(7)

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An emergency information card shall be maintained for each child and shall include the child's full name, telephone number and location of a parent ... consent to emergency medical care.

This requirement is not met as evidenced by:
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Licensee shall have an emergency information card maintained for each child in care. Licensee will sent copies of all children in care to LPA via email by POC due date.
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Based on interviews and record reviews, the facility did not comply with the section cited above in Assistant #1 was only able to provide LPA with 8 of 12 files for the children in care with emergency information cards which poses a potential health, safety or personal rights risk to persons in care.
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Type B
08/27/2024
Section Cited
CCR102417(g)(8)

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Each family child care home shall have a current roster of children as specified in Health and Safety Code Section 1596.841.

This requirement is not met as evidenced by:
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Licensee shall have a current roster of children and submit a copy to LPA via email by POC due date.
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Based on interview, the facility did not comply with the section cited above in Assistant #1 was not able to locate or provide the LIC9040 Facility Roster which poses 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:Rita Ramos
LICENSING EVALUATOR NAME:Lilia Hernandez
LICENSING EVALUATOR SIGNATURE:
DATE: 08/13/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/13/2024


LIC809 (FAS) - (06/04)
Page: 3 of 4
Document Has Been Signed on 08/13/2024 03:34 PM - It Cannot Be Edited


Created By: Lilia Hernandez On 08/13/2024 at 02:39 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: ABERGEL FAMILY CHILD CARE
FACILITY NUMBER: 197418679

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/13/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
08/27/2024
Section Cited
CCR
102417(g)(9)

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Each family child care home shall have a written disaster plan of action prepared on a form approved by the Department...the assistant provider... shall be instructed in their duties under the disaster plan...

This requirement is not met as evidenced by:
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Licensee shall have a written disaster plan of action prepared in a form approved by the Department. Licensee will submit to LPA via email a copy of the completed LIC610A Emergency Disaster Plan For Family Child Care Homes Disaster Plan and ensure assistant provider be instructed in their duties under the disaster plan by POC due date.
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Based on interviews, the facility did not comply with the section cited above in Assistant #1 was not able to provided any information on her duties on the disaster plan and was not able to provide a copy of the approved LIC610A Emergency Disaster Plan For Family Child Care Homes Disaster Plan which poses 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:Rita Ramos
LICENSING EVALUATOR NAME:Lilia Hernandez
LICENSING EVALUATOR SIGNATURE:
DATE: 08/13/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/13/2024


LIC809 (FAS) - (06/04)
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