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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198014584
Report Date: 10/04/2024
Date Signed: 10/04/2024 04:45:11 PM

Document Has Been Signed on 10/04/2024 04:45 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 SW RO, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME:CELIS FAMILY CHILD CAREFACILITY NUMBER:
198014584
ADMINISTRATOR/
DIRECTOR:		CELIS, KELLYFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(562) 429-9646
CITY:LAKEWOODSTATE: CAZIP CODE:
90712
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 7DATE:
10/04/2024
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:38 AM
MET WITH:Licensee, Kelly CelisTIME VISIT/
INSPECTION COMPLETED:
04:50 PM
NARRATIVE
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On October 4, 2024 at 10:38, Licensing Program Analyst (LPA) Jonnisha Culbert conducted an unannounced inspection at the facility noted above and met with Assistant 1, who informed LPA that licensee is not at the facility and will return in ten minutes. LPA waited and at approximately 10:54am licensee Kelly Celis arrived at the facility. LPA met with licensee. The purpose of the inspection was to conduct annual/random. The operating hours of the facility is Monday through Friday from 7:00 AM to 5:00 PM. Entrance Checklist (LIC 126) was provided to the Licensee upon arrival. Individuals residing in the home were discussed and noted. At the time of the inspection, one (1) dog, Licensee, two (2) assistants, and seven (7) children were present.

All areas accessible to children was inspected. This facility is a single-family home that consists of four (4) bedrooms, 2 bathrooms, living room, dining room, kitchen, playroom, detached garage (converted to day care room), and fenced backyard.

Areas that are accessible to children include: 3 bedrooms, one (1) bathroom, living room, dining room, kitchen, playroom, detached garage (converted to day care room), and fenced backyard. Per Licensee, the children utilize the fenced backyard for outdoor activity. Per Licensee, the detached garage that was converted to a day care room is only used for play and not for napping. Licensee also stated that the bedrooms are used only for napping.
Areas off-limits to children include: 1 bathroom and 1 bedroom. Licensee was advised that off-limit areas must be made inaccessible during operating hours or while children in care are present.

The following documents were posted in a prominent, publicly accessible area: Facility License, Notification of Parents' Rights (PUB 394), Earthquake Preparedness (LIC 9148), and Emergency Disaster Plan (LIC 610A). Licensee has a current Facility Roster (LIC 9040). Licensee also has verification of disaster and fire drills. The last drill was conducted on 07/01/2024.


SUPERVISORS NAME: Valarie Cook
LICENSING EVALUATOR NAME: Jonnisha Culbert
LICENSING EVALUATOR SIGNATURE: DATE: 10/04/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/04/2024
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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Document Has Been Signed on 10/04/2024 04:45 PM - It Cannot Be Edited


Created By: Jonnisha Culbert On 10/04/2024 at 02:28 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: CELIS FAMILY CHILD CARE
FACILITY NUMBER: 198014584

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/04/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
102417(g)(4)
The home shall be free from defects or conditions which might endanger a child. Safety precautions shall include but not be limited to:

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation and interview, the licensee did not comply with the section cited above. At 11:16am, LPA observed water with cleaning solution in mop bucket in area accessible to children. Per licensee, bucket was brought for cleaning purposes after lunch.Licensee stated that they normally put mop bucket back in closet and use it throughout the day. This poses an immediate health and safety risk to persons in care.
POC Due Date: 10/04/2024
Plan of Correction
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Assistant 1 immediately poured water out of bucket. Per licensee, they are going to add a saftey latch to kitchen closet and keep the bucket in the close when water is inside of it.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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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:Jonnisha Culbert
LICENSING EVALUATOR SIGNATURE:
DATE: 10/04/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/04/2024


LIC809 (FAS) - (06/04)
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Document Has Been Signed on 10/04/2024 04:45 PM - It Cannot Be Edited


Created By: Jonnisha Culbert On 10/04/2024 at 03:08 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: CELIS FAMILY CHILD CARE
FACILITY NUMBER: 198014584

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/04/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102425(a)(3)
Infant Safe Sleep
(a) There shall be one crib or play yard for each infant who is unable to climb out of the crib or play yard. (3) Mattresses shall be firm and covered with a fitted sheet that is appropriate to the mattress size, fits tightly on the mattress, and overlaps the underside of the mattress so it cannot be dislodged.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation and interview, the licensee did not comply with the section cited above in 1 out of 4 infants did not have a firm mattress in play yard. LPA observed soft cushion mattress in play yard. Per licensee, parent provided memory foam mattress to place in child 1's play yard to help them sleep. This poses a potential health and safety risk to persons in care.
POC Due Date: 10/04/2024
Plan of Correction
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Licensee immediate removed mattress from play yard
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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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:Jonnisha Culbert
LICENSING EVALUATOR SIGNATURE:
DATE: 10/04/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/04/2024


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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
MONTEREY PARK SW RO, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME: CELIS FAMILY CHILD CARE
FACILITY NUMBER: 198014584
VISIT DATE: 10/04/2024
NARRATIVE
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At approximately 11am LPA observed cushioned mattress inside of play yard. Per licensee, parent provided memory foam mattress to place in child 1's play yard to help them sleep. LPA advised licensee This poses a potential health and safety risk to persons in care.

At approximately 11:16am LPA observed a mop bucket with water and cleaning solution inside of it. Per Licensee, the bucket was left out from mopping the floor earlier that morning. Per licensee, the mop bucket is usually placed back inside of kitchen closet after each use, and the water is reused throughout the day. This poses an immediate health and safety risk to the individuals in care. LPA advised licensee to empty bucket. Assistant 1 immediately emptied water out of mop bucket.

LPA observed the required fire extinguisher (2-A:10-B:C) that is fully charged and was last serviced on September 7, 2023. Per Licensee, they are scheduled get their fire extinguisher serviced on 09/07/2024. They did not realize it was already expired. Licensee was reminded to have the fire extinguisher serviced yearly. Smoke detectors and carbon monoxide detectors were tested and are operable. First Aid kit and emergency supplies are available and kept in the kitchen. Licensee was reminded that food that is brought from the child's home shall be labeled with the child’s name and properly stored or refrigerated.

LPA conducted a record review of seven (7) children's records, Licensee's record, and 2 personnel records. Based on the record reviews 4 out of 7 children files needed updated immunization record. LPA advised licensee to keep children immunization records updated. Licensee immediately contacted parents to request records and three files were updated during visit.

Licensee and assistants have proof of immunization against pertussis, influenza, and a TB clearance. Licensee and assistant 2 has a valid Pediatric First Aid and CPR certification. Licensee completed the required Preventative Health and Safety Practices on August 23, 2008 and all personnel have valid Mandated Reporter Training. Licensee was advised that the Mandated Reporter training (AB 1207) must be completed every 2 years and is available at www.mandatedreporterca.com.
SUPERVISORS NAME: Valarie Cook
LICENSING EVALUATOR NAME: Jonnisha Culbert
LICENSING EVALUATOR SIGNATURE:

DATE: 10/04/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/04/2024
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
MONTEREY PARK SW RO, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME: CELIS FAMILY CHILD CARE
FACILITY NUMBER: 198014584
VISIT DATE: 10/04/2024
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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 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.

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.

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

SUPERVISORS NAME: Valarie Cook
LICENSING EVALUATOR NAME: Jonnisha Culbert
LICENSING EVALUATOR SIGNATURE:

DATE: 10/04/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/04/2024
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
MONTEREY PARK SW RO, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME: CELIS FAMILY CHILD CARE
FACILITY NUMBER: 198014584
VISIT DATE: 10/04/2024
NARRATIVE
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One type A and one type B violation are being cited based observation and interview in accordance with the California Code of Regulations, Title 22, see LIC 809D. A Violation regarding Operation of a Family Child Care Home and two B violation regarding Infant Safe Sleep. Civil penalty in the amount of $500 was assess. Please refer to LIC421IM. Appeal rights were given to licensee.

During the exit interview, Kelly Celis, confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS.

A notice of site visit was given and must remain posted for 30 days.

Exit interview conducted and report was reviewed with the licensee, Kelly Celis.

SUPERVISORS NAME: Valarie Cook
LICENSING EVALUATOR NAME: Jonnisha Culbert
LICENSING EVALUATOR SIGNATURE:

DATE: 10/04/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/04/2024
LIC809 (FAS) - (06/04)
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