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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198019040
Report Date: 07/21/2023
Date Signed: 07/21/2023 04:08:07 PM

Document Has Been Signed on 07/21/2023 04:08 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:DOMINGUEZ FAMILY CHILD CAREFACILITY NUMBER:
198019040
ADMINISTRATOR:DOMINGUEZ, MICHELLEFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(310) 213-7077
CITY:DOWNEYSTATE: CAZIP CODE:
90242
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 8DATE:
07/21/2023
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
02:40 PM
MET WITH:Michelle DominguezTIME COMPLETED:
04:15 PM
NARRATIVE
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Licensing Program Analysts (LPA) Elka Chavez conducted a Plan of Correction (POC) Inspection for the purpose of clearing citations from the Case Management Inspection on 07/21/2023. LPA reviewed and received documentation requested to clear citations.

Licensee has corrected the following deficiencies:

• Section 102417(g)(5)(B) - All licensees shall ensure the inaccessibility of pools (in-ground and above-ground).

• 102417(g)(9)(A)1 - Each family child care home shall conduct fire drills and disaster drills at least once every six months.

LPA toured the facility and observed that a mesh fence was installed. LPA observed the fence is at least five feet high. The Licensee agrees on the LIC 809 report that the fencing will remain in place whenever licensed care is provided, and so long as the mesh fence makes the swimming pool inaccessible to children as determined by licensing staff.



During this inspection, LPA did not observe a signed Acknowledgement of Receipt of Licensing Report (LIC 9224), or other written statement placed in the child's file for verification for child #2, #3, #4, #7, #8 and #9.
At 2:45 PM LPA observed child #7, #8 and #9 laying down in cots inside the detached garage. Per Licensee children were just resting.

Based on the LPA’s records review, 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.

Exit interview was conducted with Michelle Dominguez, Licensee.
SUPERVISORS NAME: Karen Chambers
LICENSING EVALUATOR NAME: Elka Chavez
LICENSING EVALUATOR SIGNATURE: DATE: 07/21/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/21/2023
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 2
Document Has Been Signed on 07/21/2023 04:08 PM - It Cannot Be Edited


Created By: Elka Chavez On 07/21/2023 at 03:12 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: DOMINGUEZ FAMILY CHILD CARE
FACILITY NUMBER: 198019040

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/21/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
07/21/2023
Section Cited
HSC
1596.8595

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1596.8595 Posting licensing report by child care facility or home; duration of posting; civil penalty for failure to comply; reports to be provided to parents or guardian of ...
This requirement was not met as evidenced by:
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Licensee stated that she was waiting for the appeal to be reviewed. Licensee wil provide parents with copies of the report along LIC9224.
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Based on records review, child #2, #3, #4, #7,#8 and #9 did not have a copy of LIC 9224 form on file. LPA observed LIC 9224 form on file for child #7. This poses a potential health and safety risk to children in care.
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Type B
07/21/2023
Section Cited
CCR102423(a)(2)

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102423(a)(2) Operation of a Family Child Care Home Each child receiving services from a family child care home shall have certain rights..
This requirement was not met as evidenced by:
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Licensee statet that children will not rest in the detached garage.
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LPA observed child #7, child #8 and child #9 in the detached garage were laying in cots. This poses a potential health and safety risk to children in care.
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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:Karen Chambers
LICENSING EVALUATOR NAME:Elka Chavez
LICENSING EVALUATOR SIGNATURE:
DATE: 07/21/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/21/2023


LIC809 (FAS) - (06/04)
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