197493699-3-9-2022-54-CC-KCHE-CCD2LP-20220309162952

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 197493699
Report Date: 02/25/2022
Date Signed: 03/09/2022 04:30:19 PM

Document Has Been Signed on 03/09/2022 04:30 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, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME:	VILLALOBOS FAMILY CHILD CARE		FACILITY NUMBER:	197493699
ADMINISTRATOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY: 8	TOTAL ENROLLED CHILDREN: 13	CENSUS: 3	DATE:	02/25/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	01:15 PM
MET WITH:	Licensee, Christopher Villalobos		TIME COMPLETED:	04:45 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	Licensing Program Analyst (LPA)Katrina Chicote conducted an Unannounced Required – 1 Year inspection to the above facility on 03/09/22 at 1:15 PM. LPA conducted COVID-19 screening call prior to entering facility. Upon arrival, LPA disclosed the purpose of the inspection and met with Licensee, Christopher Villaobos, who guided the LPA on a tour of the facility. Adult in the home were discussed and all have criminal record clearance. There were no day care children present upon arrival. Licensee stated that he is going to pick up day care children from school. Licensee states that there are currently 13 children enrolled. The children's roster was reviewed and is current. Per Licensee, the facility’s hours of operation are 24 hours/day. LPA notified Licensee they cannot provide care longer than 23 hours at one time. Emergency Disaster Plan, License, and Parents’ Rights were posted at the time of inspection. Disaster drill log was also available during today’s inspection, last disaster drill conducted on 02/09/22. This is a single-story home which consists of three bedrooms and one bathroom, kitchen, and living room. Areas used by the children include the living room (located upon entry), Bedroom 1 and Bedroom 2 for activity space (located through doors to the left of home), Bathroom 1 (located down hallway), and Kitchen for eating (located to rear of home through living room). Per Licensee, areas off limits to children and parents include Bedroom 3. Per Licensee, off limit areas are locked during operating hours, LPA observed doors to be locked. All areas identified on the facility sketch as accessible to children were inspected to ensure that they are clean and orderly with ventilation and heating for the safety of the children. There is a working telephone maintained in the home. At 1:17 PM, LPA observed Bedroom 1 to have child size tables and chairs, large legos, stuffed animals, and other age appropriate toys, free of loose and sharp parts available for Report continues- Page 1 of 4

SUPERVISORS NAME: Trevino Cochran
LICENSING EVALUATOR NAME: Katrina Chicote
LICENSING EVALUATOR SIGNATURE:	DATE: 02/25/2022

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/25/2022

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
CCLD Regional Office, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME: VILLALOBOS FAMILY CHILD CARE	FACILITY NUMBER: 197493699
	VISIT DATE: 02/25/2022

NARRATIVE

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children. At 1:18 PM, LPA observed Bedroom 2 to have five arcade games available for children in care. At 1:19 PM, LPA observed Living Room to have large sectional couch and TV hanging on wall. At 1:20 PM, LPA observed Kitchen to have child size table and chairs, floor and counters to be clean and free of hazards, and low cabinets to have operable child safety locks at time of inspection. At 1:22 PM, LPA observed Bathroom 1 to have operable toilet and sink, adequate hand washing and toileting supplies, floor free of hazards, and operable child safety lock on cabinet under sink. LPA observed electrical cover outlets all through the home. Detergents, cleaning compounds, medications, sharp knives, and other items which can pose a danger to children are inaccessible. LPA observed these items stored in under cabinet sink and in drawer in kitchen that LPA observed has operable child safety lock. The Licensee states that there are no poisons in the home. The Licensee does understand that poison must be locked with a key or combination lock.

Per Licensee, they provide food for children in care.

Per Licensee, the children will have access to front yard area for outdoor play. At 1:16 PM, LPA observed front yard has grass, concrete driveway, and adequate perimeter fencing through-out the yard. LPA observed play structure with swings and slide on grassy area of front yard, large plastic connect four game, and other age appropriate toys free of loose and sharp parts available for the children in the front yard under a canopy shade and all trees, shrubs, and plants are maintained.

Per Licensee, there are no weapons, firearms in the home and there are no bodies of water around the premises. Per Licensee, there are no pets. LPA confirms that weapons/firearms, bodies of water, or pets were not observed at time of inspection.

At 1:18 PM, LPA observed the valve on the required 2A 10BC fire extinguisher indicates fully charged with service tag. Smoke and carbon monoxide detectors are in operable condition. At 1:22 PM, LPA observed First Aid kit hanging in Kitchen next to refrigerator and was inventoried for necessary

Report continues- Page 2 of 4

SUPERVISORS NAME: Trevino Cochran
LICENSING EVALUATOR NAME: Katrina Chicote
LICENSING EVALUATOR SIGNATURE:	DATE: 03/09/2022

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/09/2022

LIC809 (FAS) - (06/04)

Page: 2 of 5

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME: VILLALOBOS FAMILY CHILD CARE	FACILITY NUMBER: 197493699
	VISIT DATE: 02/25/2022

NARRATIVE

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supplies. The Licensee has current Pediatric First Aid and CPR. Proof of immunization against influenza, pertussis, and measles were observed during file review.
—CPR Card valid until: 02/02/24
—Fire Extinguisher was last serviced on: 06/16/21
—Mandated Reporter AB1207 Completed: 06/18/21

Licensee had to leave to pick up after school children at 1:40 PM and returned to continue inspection at 4:15 PM.

The following were discussed:
Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Family Child Care Homes Section 102417. When any IMS is provided, a Plan for Providing IMS must be submitted to the Department. The following information 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: http://www.ada.gov/childqanda.htm

Licensee (or facility representative) 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.

Rooms that are off-limits need to be made inaccessible during operating hours. NO smoking, NO infant walkers, NO Johnny jumpers, NO saucer chairs, NO incline sleepers and any other item that falls into that category are permitted in the facility. Effective January 1, 2010, licensees of family child care homes are required to ensure that at least one staff member with current training in pediatric first aid and pediatric CPR is on site at all times when children are present.
Report Continues - Page 3 of 4

SUPERVISORS NAME: Trevino Cochran
LICENSING EVALUATOR NAME: Katrina Chicote
LICENSING EVALUATOR SIGNATURE:	DATE: 03/09/2022

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/09/2022

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, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME: VILLALOBOS FAMILY CHILD CARE	FACILITY NUMBER: 197493699
	VISIT DATE: 02/25/2022

NARRATIVE

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The Licensee was advised that inaccessibility of hazards must be constantly reassessed depending on the children in care.

LPA discussed the safe sleep regulations with licensee [or facility representative] 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.

Senate Bill 792: this bill, commencing September 1, 2016, prohibits a person from being employed or volunteering at a child care facility or family day care if he or she has not been immunized against influenza, pertussis and measles. LPA discussed the influenza waiver during the visit.

The facility was found in compliance per Title 22 regulations, there will be no deficiencies cited today 03/09/22.

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.

Exit interview was conducted and report was reviewed with the Licensee (or facility representative), Christopher Villalobos.

Report Ends - Page 4 of 4

SUPERVISORS NAME: Trevino Cochran
LICENSING EVALUATOR NAME: Katrina Chicote
LICENSING EVALUATOR SIGNATURE:	DATE: 03/09/2022

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/09/2022

LIC809 (FAS) - (06/04)

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