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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198018639
Report Date: 05/12/2023
Date Signed: 05/12/2023 11:10:02 AM

Document Has Been Signed on 05/12/2023 11:10 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 S WEST, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME:TRUJILLO FAMILY CHILD CAREFACILITY NUMBER:
198018639
ADMINISTRATOR:TRUJILLO, MARIAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(323) 495-0148
CITY:LOS ANGELESSTATE: CAZIP CODE:
90023
CAPACITY: 14TOTAL ENROLLED CHILDREN: 5CENSUS: 1DATE:
05/12/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:25 AM
MET WITH:Assistant - Rosalinda OrtegaTIME COMPLETED:
11:30 AM
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Licensing Program Analyst (LPA) R. Derraco conducted an unannounced required 1 year inspection to the above facility on 05/12/23. LPA arrived at the facility at 9:25 AM and met with Assistant Rosalinda Ortega, who guided analyst on a tour of the facility. Also present during this inspection was S2 and S4. LPA observed licensee arriving to the home at 9:45 AM and continued the tour with LPA. S2 provided a translation for LPA and licensee. Per Licensee, there are 5 children that are currently enrolled. There was 1 child present upon arrival.

This is a one-story home which consists of 3 bedrooms, 1 bathroom, kitchen/dining room, living room, a detached garage, front yard (fenced). The off limit areas include 3 bedrooms and detached garage.

The main care area is located in the living room. LPA observed child sized table, child sized chairs, art supplies, childrens reading materials, a wall mounted television, and age appropriate toys. A wall heater was observed in the main care area. Per licensee, documentation was given to the LPA during pre-licensing inspection as part of her list of corrections. Licensee states that she does not have a copy of the document. LPA advised licensee to obtain a copy of the document indicating that the wall heater has been turned off and keep it at the facility. LPA advised that a technical advisory will be issued to document the conversation. Emergency Disaster Plan, Parent’s Rights Poster and the Facility License were observed to be posted at the entrance behind the door. The bathroom was observed with an operable sink, toilet, and faucet. A cabinet lock was observed beneath the bathroom sink to make contents inaccessible to children in care. The kitchen/dining area was observed to have a dining table and chairs. Per licensee, children take meals on the dining table. The licensee states that she provides snacks for children in care, and that children usually brings food from home. Licensee understands that food brought from home must be labeled and properly stored or refrigerated. Cleaning supplies were observed to be locked beneath the kitchen sink. Knives and other sharp or pointy objects were observed to be locked in a drawer next to the kitchen sink. The outdoor
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SUPERVISORS NAME: Karen Chambers
LICENSING EVALUATOR NAME: Randy Derraco
LICENSING EVALUATOR SIGNATURE: DATE: 05/12/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/12/2023
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 05/12/2023 11:10 AM - It Cannot Be Edited


Created By: Randy Derraco On 05/12/2023 at 10:44 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: TRUJILLO FAMILY CHILD CARE
FACILITY NUMBER: 198018639

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/12/2023

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
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Based on observation, interview and record review, the licensee did not renew mandater reporter training every two years which poses a potential Health, safety and/or personal rights risk to persons in care.
POC Due Date: 05/22/2023
Plan of Correction
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Licensee states she will complete the course and email LPA a copy of the completed training certificate
Type B
Section Cited
CCR
102416(c)
Personnel Requirements
(c) The licensee and other personnel as specified shall complete training on preventive health practices, including pediatric cardiopulmonary resuscitation and pediatric first aid, pursuant to Health and Safety Code Section 1596.866.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, interview and record review, the licensee did not complete trainig on pediatric CPR after the expiration date posted on the completion certificate which poses a potential Health, safety and/or personal rights risk to persons in care.
POC Due Date: 05/22/2023
Plan of Correction
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Licensee states she will register for training and complete the requirement. Licensee states she will contact LPA when she registers for the training and email LPA when she receives the completed training certficate.
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: 05/12/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/12/2023


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 S WEST, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME: TRUJILLO FAMILY CHILD CARE
FACILITY NUMBER: 198018639
VISIT DATE: 05/12/2023
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play area was observed with perimeter fencing and shade provided by a pop up tent. Additional age appropriate toys and outdoor play equipment were observed in the outdoor play area. LPA did not observe the following items during the inspection: Infant Walkers, Johnny Jumpers, Saucer Chair. Per licensee, isolation area for children showing signs of illness will be located in the main care area while they await parent pick up.

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. Licensee states that there are no firearms stored in the home.

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 cellphone that is used and the cellphone stays at the facility during operation hours. LPA observed a window mounted air conditioning unit and an electrical heater kept on a shelf where it is inaccessible to children in care. Day care area was observed with safe toys, play equipment and materials. The valve on the required 2A 10BC fire extinguisher indicates fully charged and was serviced on 08/10/22, as indicated on service tag. Smoke and carbon monoxide detectors were
tested and are operable. No bodies of water were observed in the back yard play area. There are no pets on the premises. Smoking is prohibited in a licensed Family Child Care Home. Per Licensee, no one smokes in the home.

Licensee states she does not care for infants, however 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
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SUPERVISORS NAME: Karen Chambers
LICENSING EVALUATOR NAME: Randy Derraco
LICENSING EVALUATOR SIGNATURE:

DATE: 05/12/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/12/2023
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 S WEST, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME: TRUJILLO FAMILY CHILD CARE
FACILITY NUMBER: 198018639
VISIT DATE: 05/12/2023
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First Aid and CPR. The licensee and assistants Pediatric CPR expired in 04/2023. LPA advised licensee that a citation under California Code of Regulation (CCR) section 102416(c) will be issued. LPA observed that the Licensee and assistants Mandated Reporter AB 1207 compliant Child Care Training Certificate on file has also expired on 02/2023. LPA advised licensee that a citation under Health and Safety Code (HSC) section 1596.8662(b)(1) will be issued. File review was observed to have proper mandated immunization records. 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.

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. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

Exit interview conducted and report was reviewed with the licensee Maria Trujillo.

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SUPERVISORS NAME: Karen Chambers
LICENSING EVALUATOR NAME: Randy Derraco
LICENSING EVALUATOR SIGNATURE:

DATE: 05/12/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/12/2023
LIC809 (FAS) - (06/04)
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