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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198002693
Report Date: 04/06/2023
Date Signed: 04/06/2023 03:51:15 PM

Document Has Been Signed on 04/06/2023 03:51 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 CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME:PENA FAMILY DAY CAREFACILITY NUMBER:
198002693
ADMINISTRATOR:PENA, IDALIAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(626) 222-2416
CITY:LA PUENTESTATE: CAZIP CODE:
91744
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 10DATE:
04/06/2023
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
02:00 PM
MET WITH:Idalia PenaTIME COMPLETED:
04:00 PM
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Visit Conducted in Spanish

On 4/6/2023, Licensing Program Analysts (LPAs) Carolyn Tuba and Mary Silva conducted an unannounced POCs (Plan of Corrections) inspection to clear the type-A and three (3) type-B deficiencies that occurred during an annual visit on 3/28/2023 to ensure they had been corrected. Covid risk assessment was conducted upon entry. LPAs met with Licensee Idalia Pena, who guided LPAs on a tour of the facility. LPA observed 10 daycare children present, along with the Licensee’s assistant and an additional adult present at the time of visit. LPAs provided Licensee with letters of Deficiency Citations Cleared. LPAs discussed if Licensee would be interested in having Technical Support Program (TSP) and Licensee agreed to having TSP contact her and assist with children activities and classroom organization.

LPAs observed play yard with infant child sleeping, which did not have anything inside except for fitted sheet. During the visit LPAs provided Licensee with Safe Sleep Material for her reference.

LPAs observed the 15-minute sleep log that was last conducted on April 6, 2023.

Licensee purchased and installed a new smoke detector and LPAs observed that it was operable.

LPAs observed that LIC 9227 Individual Infant Sleeping Plan had been filled for infant children.

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 conducted, appeal rights given and a copy of the report was reviewed and given to Licensee, Idalia Pena.
SUPERVISORS NAME: Ana Chico
LICENSING EVALUATOR NAME: Carolyn Tuba
LICENSING EVALUATOR SIGNATURE: DATE: 04/06/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/06/2023
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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