<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198019427
Report Date: 09/20/2023
Date Signed: 09/20/2023 03:55:30 PM

Document Has Been Signed on 09/20/2023 03:55 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 CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME:CARRILLO FAMILY CHILD CAREFACILITY NUMBER:
198019427
ADMINISTRATOR:BLANCA LIDIA CARRILLOFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(626) 374-1633
CITY:WHITTIERSTATE: CAZIP CODE:
90604
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 9DATE:
09/20/2023
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
01:45 PM
MET WITH:Assistant Angelina Rodriguez TIME COMPLETED:
04:20 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
Licensing Program Analyst (LPA) Roxana Lopez conducted a Case Management Deficiencies Inspection to address a deficiency observed during an inspection visit conducted on 09/20/23. A risk assessment was conducted upon entry. LPA met with Assistant Angelina Rodriguez, who guided analyst on a tour of the day care room. Licensee Blanca Carrillo, arrived around 1:05 pm and gave LPA a full tour of the home.

Upon arrival at 12:15 pm- LPA observed an infant in a play pen with a boppy pillow and a bottle. Infant was awake during observation. LPA did observed Assistant laying child on pillow and providing her with a bottle. LPA asked for baby to be held and items to be removed.

Per Assistant and Licensee- the pillow and bottle comes out of playpen when child falls asleep and pillow is used to assist child with sitting up during circle time.

During inspection LPA also observed 5 low feeding chairs and 4 playpens and a saucer chair.Per Licensee, they only have two infants enrolled and saucer chair is used for granddaughter. Licensee, stated that they don't have a garage to store extra items. LPA advised that saucer chair is not recommended to be in day care area. Saucer chair was removed during inspection.

The following deficiency on the attached LIC 809 deficiency page is being cited in accordance with CA code of Regulations Title 22. A notice of site visit was given and must remain posted for 30 days.
Exit interview conducted and report was reviewed with Licensee, Blanca Carrillo.
SUPERVISORS NAME: Brandi VanOosten
LICENSING EVALUATOR NAME: Roxana Lopez
LICENSING EVALUATOR SIGNATURE: DATE: 09/20/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/20/2023
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 09/20/2023 03:55 PM - It Cannot Be Edited


Created By: Roxana Lopez On 09/20/2023 at 02:35 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 CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME: CARRILLO FAMILY CHILD CARE
FACILITY NUMBER: 198019427

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/20/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
10/06/2023
Section Cited
CCR
102425(b)

1
2
3
4
5
6
7
102425 INFANT SAFE SLEEP (b)Cribs or play yards shall be free from all loose articles and objects. This requirement was not met as evidenced by:
1
2
3
4
5
6
7
Items were removed during inspection- Per Assistant and Licensee when child falls asleep all items are removed and boppy is only used to support child with sitting during circle time. Liceense and assistant will review sleep regulation and provide decleration with plan moving forward.
8
9
10
11
12
13
14
Based on observation and interview, the facility did not comply with the section cited above as LPA observed an infant in a playpen with a boppy pillow and bottle in it. Infant was observed to be awake.
8
9
10
11
12
13
14

1
2
3
4
5
6
7
1
2
3
4
5
6
7

1
2
3
4
5
6
7
1
2
3
4
5
6
7
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:Brandi VanOosten
LICENSING EVALUATOR NAME:Roxana Lopez
LICENSING EVALUATOR SIGNATURE:
DATE: 09/20/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/20/2023


LIC809 (FAS) - (06/04)
Page: 2 of 2