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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198017183
Report Date: 09/14/2023
Date Signed: 09/14/2023 11:21:43 AM

Document Has Been Signed on 09/14/2023 11:21 AM - 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:CHALCO FAMILY CHILD CAREFACILITY NUMBER:
198017183
ADMINISTRATOR:CHALCO,DIOCELINA&FORTUNATOFACILITY TYPE:
810
ADDRESS:TELEPHONE:
5622911338
CITY:DOWNEYSTATE: CAZIP CODE:
90241
CAPACITY: 14TOTAL ENROLLED CHILDREN: 8CENSUS: 6DATE:
09/14/2023
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
10:40 AM
MET WITH:Dioselina De ChalcoTIME COMPLETED:
11:30 AM
NARRATIVE
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While conducting an investigation for a complaint, Licensing Program Analyst (LPA), T. Tran observed the following deficiencies:

During record reviews, licensee failed to obtain immunization record children # 3, 4, 5, & 6 and licensee and her husband does not have current mandated reporter online training for child abuse which poses a potential health and safety risk to children in care.

Facility was cited a type B deficiencies. See Facility Evaluation Report LIC 809D for deficiency cited.

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


Exit interview conducted and report was reviewed with the facility representative, Dioselina De Chalco.
SUPERVISORS NAME: Denise Gibbs
LICENSING EVALUATOR NAME: Tiffanie Tran
LICENSING EVALUATOR SIGNATURE: DATE: 09/14/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/14/2023
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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Document Has Been Signed on 09/14/2023 11:21 AM - It Cannot Be Edited


Created By: Tiffanie Tran On 09/14/2023 at 11:00 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: CHALCO FAMILY CHILD CARE
FACILITY NUMBER: 198017183

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/14/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
10/06/2023
Section Cited
CCR
1596.8662

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Mandated reporter training.
This requirement is not met as evidenced by based on record review licensee and licensee's husband failed to complete the mandated reporter online training which poses a potential health and safety risk to children in care.
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Licensee and her husband agrees to complete Mandated Reporter training then submit to LPA by or before 10/06/23 in order to clear this citation.
Type B
10/06/2023
Section Cited
CCR
102418(a)

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Immunizations
This requirement is not met as evidenced by based on record review facility failed to obtain immunization record for children # 3, 4,5,& 6 which poses a potential health and safety risk to children in care.

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Licensee agrees to request immunization record for children # 3, 4, 5, & 6 then submit to LPA by or before 10/06/23 in order to clear this citation.

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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:Denise Gibbs
LICENSING EVALUATOR NAME:Tiffanie Tran
LICENSING EVALUATOR SIGNATURE:
DATE: 09/14/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/14/2023


LIC809 (FAS) - (06/04)
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