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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198017758
Report Date: 10/14/2021
Date Signed: 10/14/2021 02:26:50 PM

Document Has Been Signed on 10/14/2021 02:26 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:PLASCENCIA FAMILY CHILD CAREFACILITY NUMBER:
198017758
ADMINISTRATOR:PLASCENCIA, REYNALDAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(562) 529-7502
CITY:LONG BEACHSTATE: CAZIP CODE:
90805
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 6DATE:
10/14/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:30 PM
MET WITH:Licensee - Reynalda PlascenciaTIME COMPLETED:
02:45 PM
NARRATIVE
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Licensing Program Analysts (LPA) R. Derraco conducted an unannounced annual inspection to the above facility on 10/14/21. LPA arrived at the facility at 12:30 PM and met with licensee, Reynalda Plascencia, who guided analyst on a tour of the facility. Due to a language barrier, LPA used language link to provide translation services in Spanish. Per Licensee, there are 9 children that are currently enrolled. There were 6 children present upon arrival.

This is a one story home which consists of four bedroms, two bathrooms, kitchen, dining room, living room, a detached garage, front yard and backyard (fenced). The off limit areas include three bedrooms, one on suite bathroom, detached garage and front yard. Per licensee, children are currently not allowed to use the back yard as a play area due to incomplete yard work. LPA observed a pile of debris in the middle of the back yard play area. Licensee states that workers are scheduled to clean up the back yard today (10/14/21). The living room is being used as the main care area. LPA observed age appropriate toys and materials, two couches, a child sized table with chairs, a wall mounted television and a brown Baby Trend playpen. A fireplace was observed to not have a barrier making the fireplace accessible. Licensee confirmed she does not have a cover for the fire place other than the screen that is stored inside the fireplace. LPA advised licensee that a type B citation will be issued under California Code of Regulation (CCR) section 102417(g)(1). LPA observed Emergency Disaster Plan, Parent’s Rights Poster and the Facility License posted above the fireplace. One bedroom has been converted to be used for child care. The room was observed to have additional age appropriate toys and materials. The restroom that children use was observed to be clean a free of defects. Child locks were observed underneath the bathroom sink making contents inaccessible. Additional cleaning products are kept locked underneath the kitchen sink. During the inspection, LPA observed the licensee preparing food for the children in care. No sharp objects were observed to be accessible to children in care in the kitchen area. LPAs did not observe the following items during the inspection: Infant Walkers, Johnny Jumpers, Saucer Chairs. No bodies of water were observed in the back yard play area. There are no pets on (page 1 of 3)
SUPERVISORS NAME: Trevino Cochran
LICENSING EVALUATOR NAME: Randy Derraco
LICENSING EVALUATOR SIGNATURE: DATE: 10/14/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/14/2021
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 5
Document Has Been Signed on 10/14/2021 02:26 PM - It Cannot Be Edited


Created By: Randy Derraco On 10/14/2021 at 02:11 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: PLASCENCIA FAMILY CHILD CARE
FACILITY NUMBER: 198017758

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/14/2021

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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Based on [(observation) (interview) (record review)], the licensee did not comply with the section cited above in [count] out of [total count] [(objects) (persons)] [identifiers] which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 10/28/2021
Plan of Correction
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Licensee states she will put a screen to cover the fireplace and email LPA a photo.
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 [(observation) (interview) (record review)], the licensee did not comply with the section cited above in [count] out of [total count] [(objects) (persons)] [identifiers] which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 10/28/2021
Plan of Correction
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Licensee states she will complete mandated reporter and email LPA a copy of the completed certificate.

www.mandatedreporterca.com
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:Randy Derraco
LICENSING EVALUATOR SIGNATURE:
DATE: 10/14/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/14/2021


LIC809 (FAS) - (06/04)
Page: 2 of 5
Document Has Been Signed on 10/14/2021 02:26 PM - It Cannot Be Edited


Created By: Randy Derraco On 10/14/2021 at 02:11 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: PLASCENCIA FAMILY CHILD CARE
FACILITY NUMBER: 198017758

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/14/2021

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102419(d)
Admission Procedures and Parental and Authorized Representative's Rights
(d) At the time of acceptance of each child into care, the licensee shall provide the child's parent or authorized representative with a copy of the notice Family Child Care Home Notification of Parent's Rights, LIC 995A (8/06), the Caregiver Background Check Process, LIC 995E (6/05), and the Family child Care Consumer Awareness Information, LIC 9212 (10/05).

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on [(observation) (interview) (record review)], the licensee did not comply with the section cited above in [count] out of [total count] [(objects) (persons)] [identifiers] which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 10/28/2021
Plan of Correction
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Licensee states she will have completed children records and email LPA a picture of the completed chidlren files.
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:Randy Derraco
LICENSING EVALUATOR SIGNATURE:
DATE: 10/14/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/14/2021


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: PLASCENCIA FAMILY CHILD CARE
FACILITY NUMBER: 198017758
VISIT DATE: 10/14/2021
NARRATIVE
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the premises. Smoking is prohibited in a licensed Family Child Care Home. Per Licensee, no one smokes in the home.

Individuals who reside in the home were noted and discussed. All adults present in the home have obtained a criminal record clearance or exemption prior to working, residing or volunteering in the licensed childcare home. 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. Licensee states that there are no firearms stored in the home. There is telephone service via a land line. Per Licensee, the home is equipped with central heating and air conditioning. The licensee states that there are no poisons in the home and understands that storage areas for poisons must be locked, not just inaccessible. The valve on the required 2A 10BC fire extinguisher indicates fully charged and a purchase receipt was attached showing date 07/2021. Smoke and carbon monoxide detectors were tested and are operable.

LPA discussed the safe sleep regulations with licensee [or facility representative] 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 [facility representative] 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 have completed training on preventive health practices including Pediatric First Aid and CPR. The licensee's Pediatric First Aid and CPR expires on 12/2022. LPAs observed that the Licensee does not have proof of the Mandated Reporter AB 1207 compliant Child Care Training Certificate on file. LPA advised licensee that a citation will be issued under Health and Safety Code section 1596.8662(b)(1). File review was observed to have proper mandated immunization records. Children’s records were reviewed, including emergency information. Per licensee, three children in care do not have a facility records on file because the authorized representative has not brought them back. LPA advised licensee that a citation will be issued


(page 2 of 3)
SUPERVISORS NAME: Trevino Cochran
LICENSING EVALUATOR NAME: Randy Derraco
LICENSING EVALUATOR SIGNATURE:

DATE: 10/14/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/14/2021
LIC809 (FAS) - (06/04)
Page: 4 of 5
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: PLASCENCIA FAMILY CHILD CARE
FACILITY NUMBER: 198017758
VISIT DATE: 10/14/2021
NARRATIVE
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under CCR section 102419(d). 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.html

LPA advised the licensee to access forms, regulations and quarterly updates online at: www.ccld.ca.gov. LPA also discussed and provided the Provider Information Notices (PINS) on Recently Approved Safe Sleep Regulations in Effect: PIN 20-24-CCP, Infant Sleep Plan: LIC 9227, and infant sleep chart. LPA advised licensee that the infant sleep chart is not a resource and cannot be found on the CCLD website.

The following deficiencies listed on the attached LIC 809 (deficiency page) are being cited in accordance with California Code of Regulations Title 22. 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.

Exit interview conducted and report was reviewed with the licensee Reynalda Plascencia.

(page 3 of 3)

SUPERVISORS NAME: Trevino Cochran
LICENSING EVALUATOR NAME: Randy Derraco
LICENSING EVALUATOR SIGNATURE:

DATE: 10/14/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/14/2021
LIC809 (FAS) - (06/04)
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