198016231-6-29-2023-54-CC-RDEO-CT9QF4-20230629120718

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 198016231
Report Date: 06/29/2023
Date Signed: 06/29/2023 12:07:45 PM

Document Has Been Signed on 06/29/2023 12:07 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 S WEST, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME:	ARREOLA SIERRA FAMILY CHILD CARE		FACILITY NUMBER:	198016231
ADMINISTRATOR:	ARREOLA SIERRA, ROSA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(323) 264-8346
CITY:	LOS ANGELES	STATE: CA	ZIP CODE:	90023
CAPACITY: 14	TOTAL ENROLLED CHILDREN: 14	CENSUS: 10	DATE:	06/29/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	09:10 AM
MET WITH:	Licensee - Rosa Arreola Sierra		TIME COMPLETED:	12:20 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 1 year inspection to the above facility on 06/29/23. LPA arrived at the facility at 9:10 AM and met with licensee, Rosa Arreola Sierra, who guided analyst on a tour of the facility. Also present during this inspection were 2 assistants and 2 adult residents. Per Licensee, there are 14 children that are currently enrolled. There were 10 children present upon arrival. This is a one-story home which consists of 3 bedrooms, 1 bathroom, kitchen, dining room, living room, front yard (fenced) and backyard. LPA observed an additional dwelling unit located in the backyard. Per licensee, one additional bedroom and bathroom is located in the unit. Licensee also states that area and the backyard are off limits. Additional off limit areas include 2 bedrooms and kitchen area. The main care area is located in the living room. LPA observed a wooden storage locker for children's belongings, child sized couches, child sized chairs, age appropriate toys, children's art supplies, and an infant play yard. Emergency Disaster Plan, Parent’s Rights Poster and the Facility License were observed to be posted in the main care area. A fire place was observed in the living room to be screened and locked. Bedroom 2 was observed with 3 wooden Graco cribs, 2 sleeping cots, a wall mounted diaper changing table, and a wooden shelf with infant diapering supplies. The bathroom was observed to be sanitary with an operable sink, toilet and faucet. Licensee states that she provides food for children in care. A tension baby gate was observed to be mounted in the entrance of the kitchen area making it inaccessible to children in care. Per licensee, cleaning supplies are kept in the off limits kitchen area and in the off limits unit in the backyard. The outdoor play area is located in the front yard. LPA observed perimeter fencing, and an awning to provide shade. Additional toys and outdoor play equipment was observed in the front yard play area. Per licensee, isolation area for children showing signs of illness will be located in the bedroom or in the front yard, depending on the situation. Per licensee, children showing signs of illness will await parent pick (page 1 of 3)

SUPERVISORS NAME: Karen Chambers
LICENSING EVALUATOR NAME: Randy Derraco
LICENSING EVALUATOR SIGNATURE:	DATE: 06/29/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/29/2023

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 12

Document Has Been Signed on 06/29/2023 12:07 PM - It Cannot Be Edited

Created By: Randy Derraco On 06/29/2023 at 11:40 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: ARREOLA SIERRA FAMILY CHILD CARE	FACILITY NUMBER: 198016231
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 06/29/2023

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 observation, interview and record review, the licensee's employee did not renew mandated reporter training which poses a potential Health, safety and/or personal rights risk to persons in care.
	POC Due Date: 07/08/2023
	Plan of Correction
1 2 3 4	Licensee states she will have assistant complete Mandated Reporter Training AB1207 compliant and email LPA the completion certificate

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 and record review, the licensee did not maintain documentation of the required immunizations which poses a potential Health, safety and/or personal rights risk to persons in care.
	POC Due Date: 07/08/2023
	Plan of Correction
1 2 3 4	Licensee states she will obtain immunzation records for herself and staff and email copies 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:

Karen Chambers

LICENSING EVALUATOR NAME:

Randy Derraco

LICENSING EVALUATOR SIGNATURE:

DATE: 06/29/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/29/2023

LIC809 (FAS) - (06/04)

Page: 2 of 12

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MONTEREY PARK S WEST, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME: ARREOLA SIERRA FAMILY CHILD CARE	FACILITY NUMBER: 198016231
	VISIT DATE: 06/29/2023

NARRATIVE

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up. LPA did not observe the following items during the inspection: Infant Walkers, Johnny Jumpers, Saucer Chairs. Smoking is prohibited in a licensed Family Child Care Home. Per Licensee, no one smokes in the home. No bodies of water were observed in the back yard play area. There are no pets on the premises.

Individuals who reside in the home were noted and discussed. 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.

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 land line. The licensee understands that storage areas for poisons must be locked using an age appropriate lock, not just inaccessible. Licensee states that there are no firearms stored in the home. The valve on the required 2A 10BC fire extinguisher indicates fully charged and was serviced on 07/22/23, as indicated on service tag. Smoke and carbon monoxide detectors were tested and are operable.

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.

The licensee and other personnel have completed training on preventive health practices including Pediatric First Aid and CPR. The licensee's Pediatric First Aid and CPR expires on 12/2023. LPA observed that S3 did not have proof of the Mandated Reporter AB 1207 compliant Child Care Training Certificate on file. LPA advised license that a citation under Health and Safety Code (HSC) Section 1596.8662(b)(1) will be issued. (page 2 of 3)

SUPERVISORS NAME: Karen Chambers
LICENSING EVALUATOR NAME: Randy Derraco
LICENSING EVALUATOR SIGNATURE:	DATE: 06/29/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/29/2023

LIC809 (FAS) - (06/04)

Page: 11 of 12

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MONTEREY PARK S WEST, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME: ARREOLA SIERRA FAMILY CHILD CARE	FACILITY NUMBER: 198016231
	VISIT DATE: 06/29/2023

NARRATIVE

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Licensee was also unable to provide immunization records for herself and her staff. LPA advised that a citation under HSC section 1597.622(c) will be issued. Children’s records were reviewed, including emergency information and were observed to be complete. A current children’s roster was available for review.

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.cdss.ca.gov LPA also discussed and provide LIC 9227 - Individual Infant Sleep Plan and Infant Sleep Chart. LPA advised that the Infant Sleep Chart is not a resource and cannot be found on the CDSS website.

The following deficiencies listed on the attached LIC 809 (deficiency page) are being cited in accordance with California Code of Regulations Title 22 and Heath 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, appeal rights provided, and report was reviewed with the licensee Rosa Arreola Sierra.

(page 3 of 3)

SUPERVISORS NAME: Karen Chambers
LICENSING EVALUATOR NAME: Randy Derraco
LICENSING EVALUATOR SIGNATURE:	DATE: 06/29/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/29/2023

LIC809 (FAS) - (06/04)

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