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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198019404
Report Date: 10/17/2024
Date Signed: 10/17/2024 05:05:28 PM

Document Has Been Signed on 10/17/2024 05:05 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
MONTEREY PARK SW RO, 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: 10CENSUS: 10DATE:
10/17/2024
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
03:40 PM
MET WITH:Lissette Virgen / LicenseeTIME VISIT/
INSPECTION COMPLETED:
05:15 PM
NARRATIVE
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 Licensing Program Analyst (LPA) Ashley Calderon arrived at the above licensed facility for the purpose of the inspection to conduct a complaint inspection. Due to LPAs observations, interviews and record review LPA conducted a Case Management inspection.

LPA met with Staff Michelle Sanchez who granted LPA entrance to the facility. LPA disclosed purpose of today's visit with staff present, Michelle Sanchez and Janelle Munoz. LPA via telephonically informed License Lissette Virgen the purpose of LPA's visit. At approximately 1:31pm, licensee arrived at the facility.

The following was deficiencies were cited:
  • LPA Calderon conducted a file review on Guardian and on LIS for adults living in the home; Individual #1 was not listed on roster. LPA Calderon called On Duty Analyst on 10/17/24, to conduct a individual search, per LPA Jeanette Estrada individual did not appear on system. Per Licensee interview, informed LPA Calderon Individual stated Individual turned in live scan. LPA requested clearance for individual #1, and Licensee was unable to provide clearance documentation's. Therefore, Individual #1 is an non- cleared fingerprinted adult living in the front of the day care home.
  • It was observed by LPA Calderon during 10/17/24, Staff #1 was alone with (9) children from 1:15pm and 1:30pm, Staff #1 per interview informed LPA Staff #2 went to do pick up and provide transportation for after-school child and informed Licensee is temporarily out of the facility. Staff #2 and Licensee returned at approximately 1:30pm. Staff #2 returned with (1) chid making census 10.

The following deficiencies listed are on an attached LIC 809-D (deficiency page) and Civil Penalty (LIC421BG) was given, the following is being cited in accordance with California Code of Regulations Title 22,Section CCR & H&S.

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). (continuation...)
SUPERVISORS NAME: Valarie Cook
LICENSING EVALUATOR NAME: Ashley Calderon
LICENSING EVALUATOR SIGNATURE: DATE: 10/17/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/17/2024
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 10/17/2024 05:05 PM - It Cannot Be Edited


Created By: Ashley Calderon On 10/17/2024 at 04:17 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: 10/17/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
10/18/2024
Section Cited
CCR
102370(k)

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The licensee shall maintain documentation of criminal record clearances or criminal record exemptions of employees, volunteers that require fingerprinting and non-client adults residing in the facility. This requirement is not met as evidenced by:
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Licensee will follow up with Guardian and individual #1. LPA provided Guardian information to Licensee. Licensee will update LPA by 11/17/24, on individual #1 clearance status.
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Licensee unable to provide clearance documentation's of individual #1 and LPA Calderon did a record review on Individual #1 was not listed in Guardian or on LIS search. OD LPA J.Estrada, did a Individual search for individual and adult was did not appear on system,
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Type A
10/18/2024
Section Cited
CCR102416.5(e)

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10216.5(e) If no assistant provider is present at a Large Family Child Care Home, then the licensee shall comply with the capacity requirements for a Small Family Child Care Home as specified in subsections (b) and (c).
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Licensee and Staff #2 arrived at approx 1:30pm to the facility. Licensee will review regulation on Staffing Ratio and Capacity. LPA providing Capacity/ Ratio form.
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This requirement was not met as evidence by: LPA observed Staff #1 alone with (9) children from 1:15pm and 1:30pm, Staff #1 per interview informed LPA Staff #2 went to pick up/ provide transportation for after-school child and informed LPA Licensee is temporarily out of the facility.
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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:Ashley Calderon
LICENSING EVALUATOR SIGNATURE:
DATE: 10/17/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/17/2024


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 SW RO, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME: VIRGEN FAMILY CHILD CARE
FACILITY NUMBER: 198019404
VISIT DATE: 10/17/2024
NARRATIVE
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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 during this visit.

Appeal Rights and Notice of Site visit was given and must remain posted for 30 days. An exit interview was conducted with Licensee Lissette Virgen.
SUPERVISORS NAME: Valarie Cook
LICENSING EVALUATOR NAME: Ashley Calderon
LICENSING EVALUATOR SIGNATURE:

DATE: 10/17/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/17/2024
LIC809 (FAS) - (06/04)
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