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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198019404
Report Date: 05/29/2024
Date Signed: 05/29/2024 08:29:34 PM

Document Has Been Signed on 05/29/2024 08:29 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:VIRGEN FAMILY CHILD CAREFACILITY NUMBER:
198019404
ADMINISTRATOR/
DIRECTOR:		LISSETTE J. VIRGENFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(562) 209-2476
CITY:DOWNEYSTATE: CAZIP CODE:
90242
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 12DATE:
05/29/2024
TYPE OF VISIT:POCUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
02:00 PM
MET WITH:Lissette Virgen, LicenseeTIME VISIT/
INSPECTION COMPLETED:
04:00 PM
NARRATIVE
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Licensing Program Analyst (LPA) Alicia Mooberry conducted an unannounced Plan of Correction visit to follow up on a previous inspection and to ensure the health and Safety of children in care.
Upon arrival LPA met with Alijah Guzman, Assistant. The licensee arrived at 3:29pm.
There were 12 children present including five (5) infants, the facility is operating over the licensing capacity. Posing an immediate risk to the health and safety of children in care. This is a repeat violation, a civil penalty of $250 is assessed on this date. During this visit Child #1 (infant left the facility, bringing the facility into compliance.

During this visit LPA observed that Child #1, infant age 11 month was observed sleeping in a rocker with a blanket covering their head posing an immediate risk to the health and safety of children in care. On 5/14/24 the facility was cited for not having a play yard as is required for infants unable to climb out, this is a repeat violation, a civil penalty of $250 is assessed.

Due to time limitations, LPA will return at a later date to review facility documentation and address any other health and safety issues. LPA discussed Technical Support Program (TSP) and provided informational brochure.

Based on the LPA's observations, interview and records review the facility is cited two "A" deficiencies in accordance with California Title 22 Regulations, and Civil Penalty totalling $500 for repeat violations..

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 form must be maintained in each child’s file immediately upon receipt from parent. Licensee was provided with a copy of the parent Acknowledgement of Receipt of Licensing Reports Form LIC 9224 during this visit.

A notice of site visit was given and must remain posted for 30 days. Exit interview conducted and report was reviewed with Lissette Virgen, Licensee, Appeal Rights were discussed and a copy provided.

SUPERVISORS NAME: Valarie Cook
LICENSING EVALUATOR NAME: Alicia Mooberry
LICENSING EVALUATOR SIGNATURE: DATE: 05/29/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/29/2024
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 05/29/2024 08:29 PM - It Cannot Be Edited

Citations on this Visit Report are Under Appeal!


Created By: Alicia Mooberry On 05/29/2024 at 02:55 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: VIRGEN FAMILY CHILD CARE
FACILITY NUMBER: 198019404

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/29/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Under Appeal
Type A
05/29/2024
Section Cited
CCR
102416.5

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102416.5 Staffing Ratio and Capacity
(a) The capacity specified on the license shall be the maximum number of children for whom care may be provided at any one time.

This requirement is not met as evidenced by:
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Per licensee the child #5 will be disenrolled. An updated roster will be provided to LPA by 6/5/24.
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Based on observation, interview and record review, the licensee did not comply with the section cited above in that there were 12 children including 5 infants present which poses an immediate health, safety or personal rights risk to persons in care.
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Under Appeal
Type A
05/29/2024
Section Cited
CCR102425(a)

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(a) There shall be one crib or play yard for each infant who is unable to climb out of the crib or play yard.

This requirement is not met as evidenced by:
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During this visit, the Licensee provided a play yard for Child #1 to use.
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Based on observation the licensee did not comply with the section cited above in that The facility did not have a crib or play yard for 11 month old Infant in care which posed a potential health, safety or personal rights risk to persons 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:Valarie Cook
LICENSING EVALUATOR NAME:Alicia Mooberry
LICENSING EVALUATOR SIGNATURE:
DATE: 05/29/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/29/2024


LIC809 (FAS) - (06/04)
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