197493699-6-20-2023-54-CC-JESA-CSYQ57-20230620115129

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 197493699
Report Date: 06/20/2023
Date Signed: 06/20/2023 11:51:40 AM

Document Has Been Signed on 06/20/2023 11:51 AM - 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: 9	CENSUS: 4	DATE:	06/20/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	09:40 AM
MET WITH:	Licensee Christopher Villalobos		TIME COMPLETED:	12:00 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 6/20/2023 Licensing Program Analyst (LPA) Jeanette Estrada conducted an unannounced required 1 year inspection at the above facility. LPA met with Licensee Christopher Villalobos. LPA informed Licensee of the purpose for the visit and provided Licensee with a copy of the facility entrance checklist (LIC 126). During this inspection, the facility was also evaluated for a large license. An approved fire clearance for a capacity of 14 was issued on 6/9/23. The facility provides care to children ages 0 to 12 years old. The operating hours of the facility are 24hours/7days a week. Licensee was advised care cannot be provided for a continuous 24 hours. There were four children and one additional staff (Staff 1)present during the inspection. All residents living in the home were discussed and noted. Licensee provided a tour of the facility. This is a one story, 3 bedroom, 1 bathroom home. Per Licensee areas on limits to children are: Living room, two rooms used for day care, kitchen for meals, hallway bathroom and fenced front yard. Per Licensee areas off limits to children are: one bedroom All areas that are accessible to children were inspected for safety, comfort, and cleanliness. The following was observed and reviewed during this inspection: LPA observed required posted documentation: Facility license, Publication (PUB) 394- Notification of Parent Rights, LIC 9148 Earthquake Preparedness checklist. LPA observed a current facility roster LIC 9040 and a current emergency drill log. The last documented drill was conducted on 5/18/23. Licensee was advised disaster drills shall be conducted every 6 months. LPA observed an operable smoke detector and an operable carbon monoxide detector in the facility. LPA observed a 2A10BC Fire Extinguisher next to the daycare room which indicated full and was last serviced in March 2023. There are toys and other age appropriate materials available for children in the day care areas. The home maintains telephone service (cell phone). Food is provided by Licensee. Licensee was reminded if children bring food from home it must be labeled with the child’s name and properly stored or refrigerated. Sharp objects, detergents and cleaning compounds are inaccessible. Knives are kept in a latched kitchen cabinet, cleaning products and detergents are kept in a latched cabinet under the sink.

SUPERVISORS NAME: Valarie Cook
LICENSING EVALUATOR NAME: Jeanette Estrada
LICENSING EVALUATOR SIGNATURE:	DATE: 06/20/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/20/2023

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: 06/20/2023

NARRATIVE

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Per Licensee, there are no personal medicines in the home and there are no children who require medication enrolled. Heating and ventilation was evaluated. The home has central air and heating. LPA did not observe any wall heaters.LPA did not observe any fireplaces in the home.
Per Licensee, children have meals in the kitchen and children nap in one of the day care rooms. Children use the bathroom in the hallway. LPA observed cleaning products in the bathroom in a latched cabinet under the sink. Per Licensee, children use the front yard for outdoor play. LPA observed the front yard is fully fenced and separated from the driveway. LPA observed age appropriate toys for children in the front yard. Per Licensee, Children are supervised while playing outside. Per Licensee, there are no poisons kept in the home. Licensee was advised that all poisons must be locked, not only inaccessible to children. Isolation area for sick children waiting to be picked up is in one of the day care rooms separated from other children. Per Licensee, there are no firearms or weapons in the home. There are no bodies of water in the home. LPA did not observe any bodies of water. Per Licensee there are no pets in the home.
Infant Care: Currently there are no infants enrolled. The facility is open for infants to enroll. LPA discussed the following with Licensee: Napping equipment shall not block the entrances or exits. Licensee was advised Infants shall not be swaddled in care. Car seats shall not be used for sleeping. LPA discussed the new Safe sleep regulation, including LIC 9227 Infant Sleep Plan for infants under 12 months, 15-minute sleep check documentation for infants 0-24 months.
Overnight Care: Per Licensee, no overnight care is provided at the moment. LPA discussed the following: Licensee is aware that they must remain awake while children are awake. If children sleep in separate area from licensee, the door must remain open. If licensee cannot hear children when they wake up, video or audio device can be used.
Children's records were reviewed. LPA verified that records contained: Immunization Records, LIC 700- Identification and Emergency Information, LIC 627- Consent for Medical Treatment. LPA did not observe LIC 995A Notification of Parents’ Rights. LPA provided information on required documents.
Staff records were reviewed: Licensee's Pediatric first aid/cpr certification issued by the American Red Cross expires February 2024. Staff 1's pediatric first aid/cpr certification issued by the American Red Cross expires October 2024. Licensee's current mandated reporter certificate expired 6/18/23. Licensee was advised to renew the mandated reporter training. Staff 1's mandated reporter training certificate expires 8/19/2024. Licensee and staff 1 had proof of required immunization to measles, pertussis and influenza. Licensee and staff 1 had proof of TB clearance.

SUPERVISORS NAME: Valarie Cook
LICENSING EVALUATOR NAME: Jeanette Estrada
LICENSING EVALUATOR SIGNATURE:	DATE: 06/20/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/20/2023

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

FACILITY NAME: VILLALOBOS FAMILY CHILD CARE	FACILITY NUMBER: 197493699
	VISIT DATE: 06/20/2023

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Incidental Medical Services (IMS): Incidental Medical Services (IMS) policy was discussed. Per Licensee, no children enrolled require medication. 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 Center and the ADA, available at: http://www.ada.gov/childqanda.htm
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 athttps://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep https://www.cdss.ca.gov/inforesources/child-care-licensing/ public -information-and-resources/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.
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. The deficiency listed on the following page was observed by the LPA and is being cited in accordance with California Code of Regulations Title 22. One type B deficiency is being issued today. Please see attached LIC 809-D for citation. Deficiencies that are being cited need to be cleared to protect the children’s health & safety . A large family child care license will be granted upon Department approval. Exit interview conducted and report was reviewed with Licensee Christopher Villalobos . A notice of site visit was given and must remain posted for 30 days.

SUPERVISORS NAME: Valarie Cook
LICENSING EVALUATOR NAME: Jeanette Estrada
LICENSING EVALUATOR SIGNATURE:	DATE: 06/20/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/20/2023

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 06/20/2023 11:51 AM - It Cannot Be Edited

Created By: Jeanette Estrada On 06/20/2023 at 11:08 AM

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: VILLALOBOS FAMILY CHILD CARE	FACILITY NUMBER: 197493699
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 06/20/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

HSC

1596.8662(b)(1)

Administration of Child Day Care Licensing

(1) On or before March 30, 2018, a person who, on January 1, 2018, is a licensed child day care provider, administrator, or employee of a licensed child day care facility shall complete the mandated reporter training provided pursuant to paragraphs (2) and (3) of subdivision (a), and shall complete renewal mandated reporter training every two years following the date on which he or she completed the initial mandated reporter training. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on record review, the licensee did not comply with the section cited above in one out of two staff records reviewed which did not contain a current certificate which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 06/26/2023
	Plan of Correction
1 2 3 4	Licensee will renew the mandated reporter for child care providers training and will submit the certificate to LPA via email.

Section Cited


	Deficient Practice Statement
1 2 3 4
	POC Due Date:
	Plan of Correction
1 2 3 4

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:

Valarie Cook

LICENSING EVALUATOR NAME:

Jeanette Estrada

LICENSING EVALUATOR SIGNATURE:

DATE: 06/20/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/20/2023

LIC809 (FAS) - (06/04)

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