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

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198009945
Report Date: 01/05/2022
Date Signed: 01/05/2022 05:12:12 PM

Document Has Been Signed on 01/05/2022 05:12 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:ROBLEDO FAMILY CHILD CAREFACILITY NUMBER:
198009945
ADMINISTRATOR:ROBLEDO, CONSUELOFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(562) 423-5081
CITY:LONG BEACHSTATE: CAZIP CODE:
90805
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 6DATE:
01/05/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
02:00 PM
MET WITH:Licensee - Consuelo RobledoTIME COMPLETED:
05:30 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) R. Derraco conducted an unannounced required one year inspection to the above facility on 01/05/22. LPA arrived at the facility at 2:00 PM and met with Licensee Consuelo Robledo, who guided analyst on a tour of the facility. Also present during this inspection was the licensee's daughter Yesenia Robledo. Per Licensee, there are 14 children that are currently enrolled. There were 6 children present upon arrival. LPA observed 4 children being dropped off for care at 2:43 PM AM. Licensee's daughter continued the tour of the facility with LPA at 2:50 PM

This is a one-story home which consists of three bedrooms, two bathrooms, kitchen/dining room, living room, a detached garage, front yard and backyard (fenced). The off limit areas include three bedrooms, one bathroom, front yard, and detached garage.

The main care area is located in the living room. LPA observed a wall mounted television, age appropriate toys and materials, two couches and a covered heating appliance. The dining area was observed to have a dining table, a wall mounted air conditioning unit, a water dispenser and a pull down fire alarm. LPA observed the kitchen area to have a locked cabinet that contains cleaning detergents beneath the sink. Knives and other sharp objects were observed to be kept on a shelf above the counter making the items inaccessible to children in care. A dining table with chairs was also observed in the kitchen area where children can take meals. A side door was observed in the kitchen leading to the side of the home and into the backyard play area. LPA observed additional age appropriate toys and materials, a detached garage, a patio table and chairs. LPA observed the off limits garage door to be open where laundry appliances, detergents and additional storage items for the home is kept. Per licensee, the garage door stays closed when children are playing outside. LPA did not observe any children playing outside during time of inspection. A wooden gate was observed to be locked and lead to the off-limits side of the garage. A separate entrance leading to an off-limits bedroom was observed in the back yard play area. Per licensee, children in care enter the back (page 1 of 4)
SUPERVISORS NAME: Trevino Cochran
LICENSING EVALUATOR NAME: Randy Derraco
LICENSING EVALUATOR SIGNATURE: DATE: 01/05/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/05/2022
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 11
Document Has Been Signed on 01/05/2022 05:12 PM - It Cannot Be Edited


Created By: Randy Derraco On 01/05/2022 at 04:47 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
, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME: ROBLEDO FAMILY CHILD CARE
FACILITY NUMBER: 198009945

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/05/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102417(g)(1)
Operation of A Family Child Care Home
(g) The home shall be free from defects or conditions which might endanger a child. Safety precautions shall include but not limited to: (1) Fireplaces and open face heaters shall be screened to prevent access by children. The home shall contain a fire extinguisher and smoke detector device which meet standards established by the State Fire Marshall.

This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on [(observation) (interview) (record review)], the licensee did not comply with the section cited above in [count] out of [total count] [(objects) (persons)] [identifiers] which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 01/26/2022
Plan of Correction
1
2
3
4
Licensee will email a copy of service tag or receipt of fire extinguisher
Type B
Section Cited
CCR
102417(g)(4)
Operation of A Family Child Care Home
(g) The home shall be free from defects or conditions which might endanger a child. Safety precautions shall include but not limited to: (4) Poisons, detergents, cleaning compounds, medicines, firearms and other items which could pose a danger if readily available to children shall be stored where they are inaccessible to children.

This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on [(observation) (interview) (record review)], the licensee did not comply with the section cited above in [count] out of [total count] [(objects) (persons)] [identifiers] which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 01/26/2022
Plan of Correction
1
2
3
4
Licensee will email a picture of shampoos and body wash made inaccessible in the bathtub to LPA
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:Trevino Cochran
LICENSING EVALUATOR NAME:Randy Derraco
LICENSING EVALUATOR SIGNATURE:
DATE: 01/05/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/05/2022


LIC809 (FAS) - (06/04)
Page: 2 of 11
Document Has Been Signed on 01/05/2022 05:12 PM - It Cannot Be Edited


Created By: Randy Derraco On 01/05/2022 at 04:47 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
, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME: ROBLEDO FAMILY CHILD CARE
FACILITY NUMBER: 198009945

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/05/2022

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 [(observation) (interview) (record review)], the licensee did not comply with the section cited above in [count] out of [total count] [(objects) (persons)] [identifiers] which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 01/26/2022
Plan of Correction
1
2
3
4
Licensee will submit proof of completion of mandated reporter training by email or postal mail.
Type B
Section Cited
HSC
1597.622(c)
Administration of Child Day Care Licensing
(c) The family day care home shall maintain documentation of the required immunizations or exemptions from immunization, as set forth in this section, in the person's personnel record that is maintained by the family day care home.

This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on [(observation) (interview) (record review)], the licensee did not comply with the section cited above in [count] out of [total count] [(objects) (persons)] [identifiers] which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 01/26/2022
Plan of Correction
1
2
3
4
Licensee will submit proof of immunization records kept at the home to LPA by email.
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:Trevino Cochran
LICENSING EVALUATOR NAME:Randy Derraco
LICENSING EVALUATOR SIGNATURE:
DATE: 01/05/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/05/2022


LIC809 (FAS) - (06/04)
Page: 3 of 11
Document Has Been Signed on 01/05/2022 05:12 PM - It Cannot Be Edited


Created By: Randy Derraco On 01/05/2022 at 04:47 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
, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME: ROBLEDO FAMILY CHILD CARE
FACILITY NUMBER: 198009945

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/05/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102416(c)
Personnel Requirements
(c) The licensee and other personnel as specified shall complete training on preventive health practices, including pediatric cardiopulmonary resuscitation and pediatric first aid, pursuant to Health and Safety Code Section 1596.866.

This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on [(observation) (interview) (record review)], the licensee did not comply with the section cited above in [count] out of [total count] [(objects) (persons)] [identifiers] which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 01/26/2022
Plan of Correction
1
2
3
4
Licensee will submit proof of completion of pediatric CPR and First aid training to LPA by 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:Trevino Cochran
LICENSING EVALUATOR NAME:Randy Derraco
LICENSING EVALUATOR SIGNATURE:
DATE: 01/05/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/05/2022


LIC809 (FAS) - (06/04)
Page: 4 of 11
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: ROBLEDO FAMILY CHILD CARE
FACILITY NUMBER: 198009945
VISIT DATE: 01/05/2022
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
yard play area through the side of the home. LPA observed a working smoke alarm / carbon monoxide detector located in the hallway. A door leading to the bathroom designated for children in care was observed to be clean and free of defects. LPA observed a locked cabinet below the bathroom sink making contents inaccessible. A medicine cabinet was observed above the toilet making contents inaccessible. LPA observed shampoo and liquid body wash to be accessible in the corner of the bathroom tub. LPA advised licensee that a citation will be issued under California Code of Regulation (CCR) section 102417(g)(4). LPA observed the valve on the 3A-40BC fire extinguisher stored in the kitchen/dining area to be fully charged. A service tag or purchase receipt was not available for review. Licensee states that the fire extinguisher was purchase about a year and a half ago. LPA advised that a citation will be issued under CCR section 102417(g)(1).

Individuals who reside in the home were noted and discussed. All adults present in the home have obtained a criminal record clearance or exemption prior to working, residing or volunteering in the licensed childcare home. 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. Licensee states that there are no firearms stored in the home

All areas identified on the facility sketch that are accessible for children to use were inspected for safety,


comfort, and cleanliness. There is telephone service via a landline. LPAs observed a wall heater to be barricaded in the hallway.

LPA discussed the safe sleep regulations with licensee 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 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.
LPAs did not observe the following items during the inspection: Infant Walkers, Johnny Jumpers, Saucer Chairs.
(page 2 of 4)
SUPERVISORS NAME: Trevino Cochran
LICENSING EVALUATOR NAME: Randy Derraco
LICENSING EVALUATOR SIGNATURE:

DATE: 01/05/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/05/2022
LIC809 (FAS) - (06/04)
Page: 11 of 11
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: ROBLEDO FAMILY CHILD CARE
FACILITY NUMBER: 198009945
VISIT DATE: 01/05/2022
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
No bodies of water were observed in the back yard play area. A pet dog was observed on the premises.

The licensee and other personnel have not renewed their training on preventive health practices including Pediatric First Aid and CPR. LPA advised licensee that a citation will be issued under CCR section 102416 (c). LPA observed that the Licensee and assistant do not have proof of the Mandated Reporter AB 1207 compliant Child Care Training Certificate on file. LPA advised licensee that a citation under Health and Safety Code (HSC) section 1596.8662(b)(1) will be issued. File review was observed to not have proper mandated immunization records. Licensee was advised that a citation will be issued under HSC section 1597.622(c) will be issued. Children’s records were reviewed, including emergency information and were observed to be complete.



Emergency Disaster Plan, Parent’s Rights Poster and the Facility License were observed to be posted.

Smoking is prohibited in a licensed Family Child Care Home. Per Licensee, no one smokes in the home.

Incidental Medical Services (IMS):
IMS was discussed with licensee. Per licensee, there are no children enrolled that require IMS at this time. 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.

LPA advised the licensee to access forms, regulations and quarterly updates online at: www.ccld.ca.gov. LPA also discussed and provided the Provider Information Notices (PINS) on Recently Approved Safe Sleep Regulations in Effect: PIN 20-24-CCP, Licensee's, Assistant's and Children's File Checklist, Infant sleep Chart, Facility Roster LIC 9040. LPA advised licensee that checklists and infant sleep chart are not resources and cannot be found on the CCLD website.

The following deficiencies listed on the attached LIC 809 (deficiency page) are being cited in accordance with
(page 3 of 4)
SUPERVISORS NAME: Trevino Cochran
LICENSING EVALUATOR NAME: Randy Derraco
LICENSING EVALUATOR SIGNATURE:

DATE: 01/05/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/05/2022
LIC809 (FAS) - (06/04)
Page: 9 of 11
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: ROBLEDO FAMILY CHILD CARE
FACILITY NUMBER: 198009945
VISIT DATE: 01/05/2022
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
California Code of Regulations Title 22 and the Health and Safety Code. Deficiencies that are being cited need to be cleared to protect the children’s health & safety.

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 and report was reviewed with the licensee's daughter Yesenia Robledo

(page 4 of 4)

SUPERVISORS NAME: Trevino Cochran
LICENSING EVALUATOR NAME: Randy Derraco
LICENSING EVALUATOR SIGNATURE:

DATE: 01/05/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/05/2022
LIC809 (FAS) - (06/04)
Page: 10 of 11