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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198014215
Report Date: 01/09/2024
Date Signed: 01/09/2024 03:04:16 PM

Document Has Been Signed on 01/09/2024 03:04 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
MONTEREY PARK CC RO, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME:RUBALCABA FAMILY CHILD CAREFACILITY NUMBER:
198014215
ADMINISTRATOR:RUBALCABA, GRACIELAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(323) 604-9050
CITY:LOS ANGELESSTATE: CAZIP CODE:
90063
CAPACITY: 12TOTAL ENROLLED CHILDREN: 12CENSUS: 7DATE:
01/09/2024
TYPE OF VISIT:Required - 3 YearUNANNOUNCEDTIME BEGAN:
01:05 PM
MET WITH:Licensee Graciela RubalcabaTIME COMPLETED:
03:15 PM
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This inspection was conducted in Spanish.

Licensing Program Analyst (LPA) Veronica Martinez Garza conducted an unannounced Required 3-year inspection at the above facility on 01/09/24 at 01:05 p.m. LPA met with Graciela Rubalcaba, licensee who guided analyst on a tour of the facility. Licensee’s husband was also present during this inspection. There were 07 napping children present during this inspection. Per licensee, 12 children are enrolled.

Operation hours are Monday through Friday 07:30 a.m. – 05:30 p.m.

This is a one-story home which consists of 3 bedrooms, 1 bathroom, living room, dining room, kitchen, and laundry room. Children use living room, dining room, kitchen, and 1 bedroom. Per licensee, areas off limits to children and parents include: 2 bedrooms and laundry room. Per licensee, family members residing in the home are 2 adults and 0 minors. Licensee stated there are no pets on the premises. All individuals present in the home have obtained a criminal record clearance or exemption prior to working, residing, or volunteering in a licensed home. Individuals living in the home are identified on the attached LIC811.

LPA toured all areas identified on the facility sketch used by children during this visit and were inspected for safety, comfort, and cleanliness. LPA toured the living room, dining room, kitchen, 1 bedroom and bathroom. LPA observed that the living room has a barricaded chimney. LPA observed toys and other age-appropriate materials available for children. LPA observed that the door leading to the hallway and bedrooms was closed. LPA also observed that the bedroom children were napping was closed. LPA advised licensee that the doors must always remain open during nap time. Appropriate napping equipment (crib, play yards, and cots) were observed in the living room and bedroom. LPA observed that the crib, play yards, and cots do not hinder the entrance or exit to and from the space they are sleeping in. The crib and play yards do not have anything hanging on the sides or on top. LPA did not observe any hazardous materials throughout this inspection; exposed outlets were observed to have covers. There’s also a first aid kit readily available. LPA observed the bathroom children use to be safe and in sanitary conditions. LPA did not observe any hazardous materials. All areas that are off-limits to children were observed inaccessible.

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SUPERVISORS NAME: Ana Chico
LICENSING EVALUATOR NAME: Veronica Martinez-Garza
LICENSING EVALUATOR SIGNATURE: DATE: 01/09/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/09/2024
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 4
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MONTEREY PARK CC RO, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME: RUBALCABA FAMILY CHILD CARE
FACILITY NUMBER: 198014215
VISIT DATE: 01/09/2024
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LPA observed the following required posted documentation in the living room of the facility: Facility License, Publication (PUB) 394- Notification of Parent Rights and Licensing Form (LIC) 9148- Earthquake Preparedness form. LPA reviewed facility records LIC 610- Emergency Disaster Plan and Disaster drill log. Children’s roster was available during this inspection and was observed to be current.

All homes shall conduct fire and disaster drills at least once every six months and document the date and time of each drill. Last drill documented was 01/04/24.

Licensee does understand that licensing staff may have access to off-limit areas during inspection visit if necessary.

**Rooms that are off-limits need to be made inaccessible during operating hours**

Per licensee, food is provided to all children in care. The home maintains telephone service via a landline. There is ventilation via wall units and child proof heaters.

Detergents, cleaning compounds, medications, and other items which could pose a danger to children were observed to be inaccessible to children. The licensee states that there are no poisons in the home and understands that storage areas for poisons must be locked with a key or combination lock.

Per licensee, there are no firearms or weapons stored in the home.

At 2:21 p.m. smoke and carbon monoxide detectors were tested and are operable. The valve on the required 2: A10 BC fire extinguisher indicates fully charged and was purchased on 07/26/23, as indicated on the attached receipt. Per State Fire Marshall standards, fire extinguishers shall be serviced annually.

Isolation area for sick children waiting to be picked up is in the hallway with supervision.

Licensee does not have an area for outdoor play. Per Licensee, children are taken at a near park.

LPA did not observe any pools, spas, hot tubs, fishponds, or similar bodies of water during the inspection.

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

Children’s records were reviewed for (LIC) 282- Affidavit Regarding Liability Insurance, Immunization's Records, LIC 700- Identification and Emergency Information, LIC 627- Consent for Medical Treatment, LIC 995A Notification of Parents’ Rights, LIC 9227- Infant sleep form (0-12 months, and documentation of 15-minute Infant Sleep Check (0-24 months). LPA observed all children’s files were complete.

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SUPERVISORS NAME: Ana Chico
LICENSING EVALUATOR NAME: Veronica Martinez-Garza
LICENSING EVALUATOR SIGNATURE:

DATE: 01/09/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/09/2024
LIC809 (FAS) - (06/04)
Page: 2 of 4
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MONTEREY PARK CC RO, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME: RUBALCABA FAMILY CHILD CARE
FACILITY NUMBER: 198014215
VISIT DATE: 01/09/2024
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Licensee and husband’s records were reviewed for approved Proof of immunizations against measles, pertussis and influenza or influenza declination, TB clearance or risk assessment, LIC 9108- Statement Acknowledging Requirement to Report Child Abuse and current Mandated Reporter Training Certificate. Licensee’s Mandated Reporter Training expires 07/26/24. Licensee’s Pediatric CPR/FA expires on 04/08/25.

AB1207 Mandated Child Abuse Reporting – On or before March 30, 2018, any person who works in a child care facility shall complete the training and renew the training every 2 years. Website provided: https://www.mandatedreporterca.com/training/child-care-providers

The licensee is operating within proper capacity and ratios. LPA observed licensee to be present at the home and providing adequate care and supervision.

Licensee is caring for infants. 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-andresources/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. LPA provided PIN 20-24-CCP, and PUB 217 Never Shake a Baby Brochure.

No infant walkers, No baby bouncers, No Johnny jumpers, No exersaucers and any other item that falls into that category.

Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02- CCP. 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: https://www.ada.gov/resources/child-care-centers/.

Licensee was reminded that all adults 18 and over living or working in the home, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, 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 for a maximum of 5 days or, if the penalty is for a repeat violation, for a maximum of 30 days per person will be assessed if this regulation is violated.

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SUPERVISORS NAME: Ana Chico
LICENSING EVALUATOR NAME: Veronica Martinez-Garza
LICENSING EVALUATOR SIGNATURE:

DATE: 01/09/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/09/2024
LIC809 (FAS) - (06/04)
Page: 3 of 4
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MONTEREY PARK CC RO, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME: RUBALCABA FAMILY CHILD CARE
FACILITY NUMBER: 198014215
VISIT DATE: 01/09/2024
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To improve the quality and value of the new inspection process, a survey may 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 CARE tools, please send email inquiries 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/inspection-process.

Licensee was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain child care by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.

Licensee Graciela Rubalcaba confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS.

At this time, the facility is in compliance with California Title 22 Regulations. Therefore, there are no deficiencies being issued today.


Exit interview conducted and report was reviewed with the Licensee Graciela Rubalcaba.

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SUPERVISORS NAME: Ana Chico
LICENSING EVALUATOR NAME: Veronica Martinez-Garza
LICENSING EVALUATOR SIGNATURE:

DATE: 01/09/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/09/2024
LIC809 (FAS) - (06/04)
Page: 4 of 4