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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198017607
Report Date: 10/01/2021
Date Signed: 10/01/2021 04:07:50 PM

Document Has Been Signed on 10/01/2021 04:07 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
CCLD Regional Office, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME:FLORES FAMILY CHILD CAREFACILITY NUMBER:
198017607
ADMINISTRATOR:FLORES, CELESTEFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(323) 812-3660
CITY:LOS ANGELESSTATE: CAZIP CODE:
90002
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 7DATE:
10/01/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:49 PM
MET WITH:Josefina Hernandez, Licensee's AssistantTIME COMPLETED:
04:15 PM
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Licensing Program Analyst (LPA)Katrina Chicote and Licensing Program Manager (LPM) Trevino Cochran conducted an Unannounced Required Annual inspection to the above facility on 10/01/2021 at 12:50 PM. LPA Chicote attempted to conduct a COVID-19 Screening Call prior to entering facility, LPA conducted COVID-19 screening call at entrance of facility prior to entering home. Upon arrival, LPA disclosed the purpose of the inspection and met with Licensee's Assistant, Josefina Hernandez, who guided the LPA on a tour of the facility. Licensee's Assistant stated that Licensee was not home at this time due to an emergency. Also present was Licensee's other Assistant, and both have criminal record clearance. There is an adult that does not have criminal record clearance at time of inspection. There were seven day care children (one infant) present during today’s inspection that were settling down for nap time. LPA observed blue cots laid out and a Cosco play yard for infant sleep. Licensee's Assistant states that there are currently fifteen children enrolled. The children's roster was reviewed and is current. Per Licensee's Assistant, the facility’s hours of operation are 6:30 AM to 7:30 PM, Monday thru Friday. Emergency Disaster Plan, License, and Parents’ Rights were posted at the time of inspection. At 1:06 PM, LPA observed disaster drill log and last disaster drill conducted on 10/2/2020.

This is a single-story home which consists of three bedrooms and two bathrooms, kitchen/dining room combination, and living room. At 1:04 PM, LPA observed that there is a wall heater in the hallway leading up to backyard area that is barricaded by a open netting that touches wall heater at time of inspection. Areas used by the children include the living room used for napping, back patio for eating, and detached converted garage used for daycare activities. Licensee's Assistant understands that detached converted garage can only be used for daycare activities and not for eating and sleeping. Per Licensee's Assistant, areas off limits to children and parents include all three bedrooms and Bathroom 1, located inside the house. Licensee's Assistant states these doors remain closed during operating hours and that parents utilize outside side entrance to enter home. LPA observed side yard entrance that Licensee's Assistant states parents use as primary entrance to enter facility.
Report continues- Page 1 of 4
SUPERVISORS NAME: Trevino Cochran
LICENSING EVALUATOR NAME: Katrina Chicote
LICENSING EVALUATOR SIGNATURE: DATE: 10/01/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/01/2021
This report must be available at Child Care and Group Home facilities for public review for 3 years.

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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
CCLD Regional Office, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME: FLORES FAMILY CHILD CARE
FACILITY NUMBER: 198017607
VISIT DATE: 10/01/2021
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All areas identified on the facility sketch as accessible to children were inspected to ensure that they are clean and orderly with ventilation and heating for the safety of the children. There is a working telephone maintained in the home. At 1:05 PM, LPA observed detached converted garage to have child size table and chairs, bookshelf, play carpets, shelves filled with puzzles, building toys, and other age appropriate toys, free of loose and sharp parts available for children at time of inspection. At 1:08 PM, LPA observed Bathroom 2, that children will use, to be located through a door to the right of day care activity space to have adequate hand washing supplies, operable sink and toilet, and diaper changing table with cubby space for diaper changing supplies LPA observed electrical cover outlets all through the home. Per Licensee's Assistant, there are no pets and LPA did not observe any pets. Detergents, cleaning compounds, medications, and other items which can pose a danger to children are inaccessible. At 1:00 PM, LPA observed cleaning compounds kept in under kitchen cabinet sink with operable child safety lock and knives to be kept in high cabinet in kitchen making these items inaccessible to children in care at time of inspection. The Licensee states that there are no poisons in the home and none observed.

Per Licensee's Assistant, the children will have access to back patio area for out door play. LPA observed backyard has turf grass and adequate perimeter fencing through out the yard. LPA observed children have access to outdoor play space through a door in daycare activity space. LPA observed plastic ride along toys, plastic play houses, plastic play structure with slide with cushioning to absorb fall, and artificial grass play area in the back with Soccer net, and other age appropriate toys free of loose and sharp parts available for the children in the backyard and all trees, shrubs, and plants are maintained at time of inspection. Licensee's Assistant states back patio area will also be used for eating and LPA observed high chairs in back patio at time of inspection.

The valve on the required 2A 10BC fire extinguisher indicates fully charged. At 1:27 PM, LPA observed smoke and carbon monoxide detectors are in operable condition at time of inspection. LPA observed First Aid kit is kept in the daycare activity space. The Licensee's Assistant has current Pediatric First Aid and CPR. Proof of immunization against influenza, pertussis, were readily available during today’s inspection but not for Measles. Licensee's Assistant states they do not have proof of Mandated Reporter training readily available at today's inspection.
—CPR Card valid until: 01/2023 for Licensee's Assistant
—Fire Extinguisher was last serviced on: 09/25/2021
Report continues- Page 2 of 3
SUPERVISORS NAME: Trevino Cochran
LICENSING EVALUATOR NAME: Katrina Chicote
LICENSING EVALUATOR SIGNATURE:

DATE: 10/01/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/01/2021
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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
CCLD Regional Office, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME: FLORES FAMILY CHILD CARE
FACILITY NUMBER: 198017607
VISIT DATE: 10/01/2021
NARRATIVE
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Per Licensee's Assistant, there are no weapons, firearms in the home and there are no bodies of water around the premises. LPA observation did not see any bodies of water around the premises and no firearms observed at time of inspection. Per Licensee's Assistant, they provide food for children in care.

The following were discussed:
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 Centers and the ADA, available at: http://www.ada.gov/childqanda.htm

Licensee (or facility representative) 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.

Rooms that are off-limits need to be made inaccessible during operating hours. NO smoking, NO infant walkers, NO Johnny jumpers, NO saucer chairs, NO incline sleepers and any other item that falls into that category are permitted in the facility. Effective January 1, 2010, licensees of family child care homes are required to ensure that at least one staff member with current training in pediatric first aid and pediatric CPR is on site at all times when children are present.



The Licensee was advised that inaccessibility of hazards must be constantly reassessed depending on the children in care. Sudden Infant Death Syndrome (SIDS) and Never-Shake-a-Baby were discussed. A hard copy of PIN 20-24-CCP Safe Sleep Regulations, PIN 21-25-CCP, and LIC 9227 was provided at time of inspection.

Licensee's Assistant was made aware that it is his/her responsibility to know the regulations as well as anyone who assists in providing care.
Report Continues - Page 3 of 4
SUPERVISORS NAME: Trevino Cochran
LICENSING EVALUATOR NAME: Katrina Chicote
LICENSING EVALUATOR SIGNATURE:

DATE: 10/01/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/01/2021
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
CCLD Regional Office, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME: FLORES FAMILY CHILD CARE
FACILITY NUMBER: 198017607
VISIT DATE: 10/01/2021
NARRATIVE
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AB 1207: Beginning on January 1, 2018, this law requires all licensed providers, applicants, directors and employees to complete training as specified on their mandated reporter duties and to renew their training every two years. Volunteers are encouraged but not required to take the training. Website: http://www.mandatedreporterca.com/

Senate Bill 792: this bill, commencing September 1, 2016, prohibits a person from being employed or volunteering at a child care facility or family day care if he or she has not been immunized against influenza, pertussis and measles. LPA discussed the influenza waiver during the visit.

Upon receipt of this report, the Licensee shall post the Notice of Site Visit and any Licensing report documenting a type “A” deficiency. The report and the Notice of Site Visit shall be posted for 30 consecutive days. Failure to maintain posting as required, will result in an immediate $100 civil penalty. A copy of this report shall be provided to the parent/guardian of children currently enrolled by the next business day or immediately upon return. A copy of this report shall also be provided to the parent/guardian of any newly enrolled children for the next 12 months (1 year). The Acknowledgement of Receipt (LIC 9224 form must be maintained in each child’s file immediately upon receipt from parent. Licensee was provided with a copy of the Acknowledgement of Receipt of Licensing Reports (LIC 9224) Form during this visit.

A violation regarding criminal record clearance was given on this date and civil penalty assessed of $500 is assessed, see LIC421BG.

Exit interview was conducted and report was reviewed with the Licensee (or facility representative), Josefina Hernandez.


Report Ends - Page 4 of 4
SUPERVISORS NAME: Trevino Cochran
LICENSING EVALUATOR NAME: Katrina Chicote
LICENSING EVALUATOR SIGNATURE:

DATE: 10/01/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/01/2021
LIC809 (FAS) - (06/04)
Page: 3 of 8
Document Has Been Signed on 10/01/2021 04:07 PM - It Cannot Be Edited


Created By: Katrina Chicote On 10/01/2021 at 03:05 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: FLORES FAMILY CHILD CARE
FACILITY NUMBER: 198017607

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/01/2021

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102417(g)(1)
Operation of A Family Child Care Home
(g) The home shall be free from defects or conditions which might endanger a child. Safety precautions shall include but not limited to: (1) Fireplaces and open face heaters shall be screened to prevent access by children. The home shall contain a fire extinguisher and smoke detector device which meet standards established by the State Fire Marshall.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Nased on LPA observation at 1:01 PM, LPA observed wall heater in hallway leading to back patio which children will use for outdoor play to have open netting that touches wall heater, still making it accessible to children in care which poses a potential health, safety, and personal rights risk to children in care.
POC Due Date: 11/01/2021
Plan of Correction
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Licensee's Assistant states that they will provide photo proof of new barrier to LPA by POC date via text.
Type B
Section Cited
CCR
102417(g)(9)(A)
Operation of A Family Child Care Home
(g) The home shall be free from defects or conditions which might endanger a child. Safety precautions shall include but not limited to: (9) Each family child care home shall have a written disaster plan of action prepared on a form approved by the Department. All children, age and ability permitting, and the provider, the assistant provider, and other members of the household, shall be instructed in their duties under the disaster plan. As their age and ability permit, newly enrolled children shall be informed promptly of their duties as required in the plan. (A) Each family child care home shall conduct fire drills and disaster drills at least once every six months.

This requirement is not met as evidenced by:
Deficient Practice Statement
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At 1:06 PM, LPA observed disaster drill log posted in main day care activity space last dated on 10/02/2020, Licensee's Assistant states that is the only log they haev at this time. This a potential health, safety, and personal rights risk to children in care.
POC Due Date: 11/01/2021
Plan of Correction
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Licensee's Assistant states they will provide updated photo proof of a disaster drill conducted within the last 6 months via text.
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:Trevino Cochran
LICENSING EVALUATOR NAME:Katrina Chicote
LICENSING EVALUATOR SIGNATURE:
DATE: 10/01/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/01/2021


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Document Has Been Signed on 10/01/2021 04:07 PM - It Cannot Be Edited


Created By: Katrina Chicote On 10/01/2021 at 03:05 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: FLORES FAMILY CHILD CARE
FACILITY NUMBER: 198017607

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/01/2021

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
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Based on LPA record review and interviews LPA did not see proof of mandated reporter training readily available during inspection. Licensee's Assistant states they believe they took training but did not have proof available at this time. This poses a potential health, safety, and personal rights risk to children in care.
POC Due Date: 11/01/2021
Plan of Correction
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Licensee's Asisstant states they will provide photo proof of completion by POC date via text.
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
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Based on LPA record review of immunization records for staff and proof of immunizations for measles were not readily available during today's inspection. This poses a potential health, safety, and personal rights risk to children in care.
POC Due Date: 11/01/2021
Plan of Correction
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Licensee states they will provide photo proof of immunization for measles by POC date via text.
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:Trevino Cochran
LICENSING EVALUATOR NAME:Katrina Chicote
LICENSING EVALUATOR SIGNATURE:
DATE: 10/01/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/01/2021


LIC809 (FAS) - (06/04)
Page: 2 of 8
Document Has Been Signed on 10/01/2021 04:07 PM - It Cannot Be Edited


Created By: Katrina Chicote On 10/01/2021 at 03:05 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: FLORES FAMILY CHILD CARE
FACILITY NUMBER: 198017607

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/01/2021

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102425(c)
Infant Safe Sleep
An Individual Infant Sleeping Plan [LIC 9227 (3/20)] shall be completed for each infant up to 12 months of age the provider has in care and included in the infant's file at the facility.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on LPA record review and interview, Child 1 (D.O.B 03/04/2021), did not have LIC 9227 in file. Licensee's Assistant states she was unaware of new safe sleep regulations. This poses a potential health, safety, and personal rights risk to children in care.
POC Due Date: 11/01/2021
Plan of Correction
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Licensee's Assistant states that she will provide photo proof of filled out form by POC date via text.
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:Trevino Cochran
LICENSING EVALUATOR NAME:Katrina Chicote
LICENSING EVALUATOR SIGNATURE:
DATE: 10/01/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/01/2021


LIC809 (FAS) - (06/04)
Page: 8 of 8
Document Has Been Signed on 10/01/2021 04:07 PM - It Cannot Be Edited


Created By: Katrina Chicote On 10/01/2021 at 03:38 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: FLORES FAMILY CHILD CARE
FACILITY NUMBER: 198017607

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/01/2021

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
102416(d)
102416(d) Personnel Requirements
Prior to employment or initial presence in the child care home, all employee...shall: (1)
Obtain a California clearance or a criminal record exemption as required by law or
Department regulations....

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on LPA observation, Licensee's son arrived at the home while children were still present. LPA reviewed personnel report and observed Licensee is not listed. Licensee's Assistant states that Licensee's son does not have criminal record clearance and lives at the home. This poses an immediate health, safety, personal rights risk to children in care.
POC Due Date: 10/04/2021
Plan of Correction
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Licensee's Assistant states that she will provide proof that criminal record clearance was obtained by POC date via text.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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4
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:Trevino Cochran
LICENSING EVALUATOR NAME:Katrina Chicote
LICENSING EVALUATOR SIGNATURE:
DATE: 10/01/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/01/2021


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