198017475-2-27-2025-54-CC-PBIP-DEAS5B-20250227123404

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 198017475
Report Date: 02/27/2025
Date Signed: 02/27/2025 12:34:12 PM

Document Has Been Signed on 02/27/2025 12:34 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:	CORNEJO FAMILY CHILD CARE		FACILITY NUMBER:	198017475
ADMINISTRATOR/ DIRECTOR:	CORNEJO, DILCIA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(323) 365-0420
CITY:	SOUTH GATE	STATE: CA	ZIP CODE:	90280
CAPACITY: 14	TOTAL ENROLLED CHILDREN: 10	CENSUS: 3	DATE:	02/27/2025
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	09:40 AM
MET WITH:	Dilcia Cornejo		TIME VISIT/ INSPECTION COMPLETED:	12:50 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) P Bishop arrived at the above facility for the purpose of an Unannounced Annual Inspection at 9:40 AM. Upon arrival, LPA announced the purpose of the visit and was granted entry into the facility by Licensee Dilcia Cornejo who provided tour of facility. LPA provided the inspection Entrance Checklist, LIC 126. LPA inspected rooms/areas on the facility sketch in which child-care services are provided and to which children have access. Per licensee, the current hours of care provided are Monday – Friday 6:00 am -- 6:00 pm at the time of inspection overnight care is being provided. Licensee Cornejo states that she does have 2 children that are enrolled 5:30 PM – 11:30 PM. There were 3 child present during today's inspection. Licensee states that there is a total of 10 children enrolled. Licensee stated that there are 5 people that live in the home, which include herself. All of whom have a background clearance on file. LPA observed the facility license, Publication (PUB) 394- Notification of Parent Rights and Licensing Form (LIC) 9148- Earthquake Preparedness forms. Licensee was advised to post the required documents on the parent board. At 10:00 AM LPA Bishop was given a tour of the facility. This is single - family home consists of three bedrooms, two bathrooms, kitchen, living/dining area and backyard. Per licensee, the areas used by children include: Living Room, Bathroom 1, kitchen area rear outside play area. Outside play area was accessible. Areas that are used by children were inspected for safety, comfort, cleanliness, telephone service, ventilation, and heating. Off limit areas are all bedrooms, bathroom 2. Licensee states that the living room will be used as a Isolation area for sick children waiting to be picked up by a parent. Rooms that are off-limits need to be made inaccessible during operating hours. The licensee does understand that licensing staff may have access to off-limit areas during inspection visit, if necessary. 1 of 4

SUPERVISORS NAME: Karen Chambers
LICENSING EVALUATOR NAME: Peter Bishop
LICENSING EVALUATOR SIGNATURE:	DATE: 02/27/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/27/2025

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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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: CORNEJO FAMILY CHILD CARE	FACILITY NUMBER: 198017475
	VISIT DATE: 02/27/2025

NARRATIVE

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At 10:15 AM, life-saving devices were inspected throughout the home. The smoke detector is located in the living room as you enter the home and the carbon monoxide detector is located right next to the smoke detector. All devices were tested and operable. The 2A 10 BC Fire extinguisher is located in the kitchen and indicates fully charged and was serviced on 05/2024. Licensee was reminded that fire extinguisher needs to be serviced yearly. The home maintains telephone service via cell phone/LAN line.

At 10:30 AM Living room (Main care area) was observed to be clean and orderly. There are toys and other age-appropriate materials for the children. LPA observed the living room to have three playpens, a diaper changing stations and two tables and chairs for activities. There were colorful storage boxes, and individual cubbies for toys.

At 10:40 AM, LPA observed the kitchen. Licensee stated that the baby gate is broken. Licensee stated that she will get the new gate installed today and Licensee showed LPA P Bishop the gate to be installed. LPA stated that as best practice Licensee should get baby gate installed immediately. Licensee stated that cleaning supplies are made inaccessible to children in care with lock on cabinets. Licensee states that there are no poisons stored in the home and understands that all poisons must be lock, not only inaccessible to children.

At 10:50 AM, LPA observed that the bathroom the children use is clean and free of floor hazards. There was toilet paper, hand-washing soap, and towels for the children. LPA did not observe chemicals stored under the sink.

Per Licensee there are no firearms or weapons stored in the home. LPA did not observe any firearms or weapons in the home. Licensee states that there are no body of water present. LPA did not observe any bodies of water on the premises.

At 11:00 AM., LPA Bishop observed the back yard for outdoor play. The outdoor play area was observed to be completely fenced. At the time of the inspection there was one slide and other age appropriate toys. There was also a shaded area for the children as well. Licensee stated that they do have one dog at the time of inspection. The dogs are kept away from children, and they are locked on the side of the house during operating hours.
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SUPERVISORS NAME: Karen Chambers
LICENSING EVALUATOR NAME: Peter Bishop
LICENSING EVALUATOR SIGNATURE:	DATE: 02/27/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/27/2025

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 SW RO, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME: CORNEJO FAMILY CHILD CARE	FACILITY NUMBER: 198017475
	VISIT DATE: 02/27/2025

NARRATIVE

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At 11:15 AM, Staff records were reviewed for approved Pediatric First Aid and CPR certification. Valid CPR/First Aide was available at the time of inspection Licensee Dilcia Cornejo is valid through 04/29/2025 and Assistant through 10/26/2026. LIC-501: Personnel Record, LIC 9052- Employee Rights, Proof of immunizations against measles, pertussis and influenza or influenza declination, TB clearance or risk assessment available at the time of the visits. LIC 9108- Statement Acknowledging Requirement to Report Child Abuse is available and current Mandated Reporter Training Certificate was available and is in compliance for both Licensee and Assistant with expiration dates of 11/14/2026 and 8/15/2026. LPA advised Licensee that it is due for renewal every 2 years.

Children’s records were reviewed LIC 700 Identification and Emergency Information, LIC 627 Consent for Emergency Medical Treatment, LIC 995A Notification of Parents rights and Immunizations were all current and up to date. LIC 9227 was on file and the Infant Sleep Chart had been completed for all three infants in care.
The following information was discussed:
LPA discussed the safe sleep regulations with Licensee Cornejo and discussed the Child Care Licensing Safe Sleep. Also, webpage resources provided at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPA P Bishop also informed Licensee Cornejo 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.

IF A FACILITY IS CURRENTLY PROVIDING IMS, USE AS FOLLOWS:
This facility does not provide Incidental Medical Services – IMS. 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 Center and the ADA, available at: http://www.ada.gov/childqanda.htm
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SUPERVISORS NAME: Karen Chambers
LICENSING EVALUATOR NAME: Peter Bishop
LICENSING EVALUATOR SIGNATURE:	DATE: 02/27/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/27/2025

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 SW RO, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME: CORNEJO FAMILY CHILD CARE	FACILITY NUMBER: 198017475
	VISIT DATE: 02/27/2025

NARRATIVE

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Criminal Record Clearance - Family Child Care Homes - Licensee Cornejo 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.

Licensee Cornejo 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.

Based on the LPA's observations, record review, and interviews, there will be no deficiencies cited today in accordance with California Title 22 Regulations.
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During the exit interview, the licensee, confirmed that there are no Registered Sex Offenders (RSO) living in the facility and LPA completed the RSO search in Megan’s Law Website. A notice of site visit was given and must remain posted for 30 days. Failure to post will result in a $100 civil penalty. Exit interview was conducted and report was reviewed with Licensee Cornejo. A copy of the report and appeal rights was given to Licensee Cornejo.

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SUPERVISORS NAME: Karen Chambers
LICENSING EVALUATOR NAME: Peter Bishop
LICENSING EVALUATOR SIGNATURE:	DATE: 02/27/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/27/2025

LIC809 (FAS) - (06/04)

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