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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198019571
Report Date: 10/13/2021
Date Signed: 10/13/2021 02:41:58 PM

Document Has Been Signed on 10/13/2021 02:41 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:VALENZUELA FAMILY CHILD CAREFACILITY NUMBER:
198019571
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 9DATE:
10/13/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:50 AM
MET WITH:Dolores ValenzuelaTIME COMPLETED:
03:00 PM
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Licensing Program Analyst (LPA) Warren Birks conducted an unannounced Required 1 Year inspection. LPA met with Licensee Dolores Valenzuela who guided LPA on a tour of the facility. LPA observed Licensee caring for nine children (eight preschool and one infant). LPA informed Licensee that she is over the capacity listed on her license and the enrollment is out of ratio as child #7 and #8 must be at least a kindergartner and a six year old. The facility is cited for Capacity and Ratio. Licensee Valenzuela indicated that one child was a drop off emergency for the day and she also misunderstood the terms of the license in regards to ratio. There are currently eight children enrolled (The ninth child is not enrolled). The roster and disaster drill is current.

This is a one story home which consists of three bedrooms, two restrooms, living room, kitchen, dining area, and back yard. The home has central air and heating. The children use the living room, dining room, two front bedrooms, one bathroom, and backyard. Licensee mentioned the backyard is off-limits at this time as they are rearranging storage. All other areas that are off limits to the children and parents.

Areas used by children were inspected to ensure areas are clean and orderly with ventilation and heating for the safety of the children. LPA observed an empty inclined sleeper and empty car seat in the living room and dining area. LPA informed Licensee that these items must be made inaccessible. Licensee removed items from the area. There is a working telephone maintained in the home. Licensee has a small dog that is inaccessible during daycare hours. LPA advised Licensee to provide extra care and supervision when animals are present. Detergents, cleaning compounds, medications, and other items which can pose a danger to children are inaccessible. LPA informed Licensee that poisons must be locked with a key or combination lock.
Per Licensee there are no firearms, weapons or bodies of water on the premises. The Emergency Disaster Plan, Parents Rights and License was posted. Children’s records were reviewed and contain the required documentation including Identification and Emergency, Immunization and Parents Rights. The required 2A 10BC fire extinguisher is fully charged however service or purchase date is missing.
SUPERVISORS NAME: Karen Chambers
LICENSING EVALUATOR NAME: Warren Birks
LICENSING EVALUATOR SIGNATURE: DATE: 10/13/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/13/2021
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME: VALENZUELA FAMILY CHILD CARE
FACILITY NUMBER: 198019571
VISIT DATE: 10/13/2021
NARRATIVE
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Proof of immunization against influenza, pertussis, and measles for the Licensee was readily available during today’s inspection.

The following was discussed: Individuals who are 18 years of age or older living in the home must obtain a criminal record clearance. Individuals within one month of their 18th birthday must be fingerprinted immediately. Failure to obtain a criminal record background check clearances prior to initial presence in the home will result in an immediate $100.00 dollar or more per day Civil Penalty.

LPA reminded Licensee that all rooms that are off-limits need to be remain inaccessible during operating hours. No smoking, No infant walkers, No Johnny jumpers, No saucer chairs, No trampolines and any other item that falls into that category are not permitted in the facility. Effective January 1, 2010, licensees of family child care homes are required to ensure that at least one staff member with current training in pediatric first aid and pediatric CPR is on site at all times when children are present.

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 informed Licensee of appropriate sleeping arrangements for infants. LPA advised the Licensee that infants shall be placed on their backs for sleeping and shall be supervised. Infants shall be checked on every 15 minutes and the time of each 15-minute check shall be documented with child’s name and date. The LIC 9227 Individual Infant Sleeping Plan shall be completed for each infant up to 12 months of age. An extra copy of the LIC 9227 will be emailed to Licensee. LPA explained form is available on CCLD website.

The Licensee was advised that inaccessibility of hazards must be constantly reassessed depending on the children in care. Sudden Infant Death Syndrome (SIDS) and Never-Shake-a-Baby were discussed.
SUPERVISORS NAME: Karen Chambers
LICENSING EVALUATOR NAME: Warren Birks
LICENSING EVALUATOR SIGNATURE:

DATE: 10/13/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/13/2021
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
CCLD Regional Office, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME: VALENZUELA FAMILY CHILD CARE
FACILITY NUMBER: 198019571
VISIT DATE: 10/13/2021
NARRATIVE
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LPA discussed LIC 311D - Forms/Records to Keep in Your Family Child Care Home. Mandatory Forms for the children’s files and staff files, requirements for fire drills, earthquake drills and documentation were discussed. Role and responsibilities of being a Mandated Reporter were reviewed. The Licensee was advised how to access forms and Regulations online at www.ccld.ca.gov. Licensee was made aware that it is his/her responsibility to know the regulations as well as anyone who assists in providing care.

LPA consulted and explained Child Abuse Reporting, Updated Parent’s Rights Poster with Complaint Hotline information, Never Shake a Baby, Sudden Infant Death Syndrome (SIDS), and Safe Sleeping practices which always Baby is sleeping on his/her back. Capacity Handout (Small & Large) was provided during this inspection. Any unusual incidents or injuries must be reported to the Department within 24 hours via telephone and within seven (7) days in writing (use LIC624B for written report). Mandated reporter training must be completed every 2 years. www.mandatedreporterca.com Licensee's Mandated Reporter Training expires August 2023 and must be renewed every two years.

LPA also discussed Covid Self Assessment and Covid safety according to the Los Angeles County Health Department.

Note: The Licensee indicated that she will provide documentation indicating that her enrollment is within the specifications on the License.

Exit interview was conducted with Licensee Valenzuela. The Notice of Site Visit (LIC 9213) – must remain posted for 30 days during the hours of operation after each site inspection by a licensing representative. Failure to maintain posting as required will result in a civil penalty of $100.00.
SUPERVISORS NAME: Karen Chambers
LICENSING EVALUATOR NAME: Warren Birks
LICENSING EVALUATOR SIGNATURE:

DATE: 10/13/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/13/2021
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 10/13/2021 02:41 PM - It Cannot Be Edited


Created By: Warren Birks On 10/13/2021 at 01:39 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: VALENZUELA FAMILY CHILD CARE
FACILITY NUMBER: 198019571

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/13/2021

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
102416.5(c)
Staffing Ratio and Capacity
(c) The total licensed capacity for a Small Family Child Care Home shall not exceed eight children.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, the licensee did not comply with the section cited above. LPA observed nine children in care (eight enrolled and one not enrolled). Overcapcity poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 10/14/2021
Plan of Correction
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Licensee indicated that she misunderstood the License terms and will go over roster to observe who must be disenrolled. Licensee will also provide forms indicating children are disenrolled.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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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:Warren Birks
LICENSING EVALUATOR SIGNATURE:
DATE: 10/13/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/13/2021


LIC809 (FAS) - (06/04)
Page: 4 of 5
Document Has Been Signed on 10/13/2021 02:41 PM - It Cannot Be Edited


Created By: Warren Birks On 10/13/2021 at 01:39 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: VALENZUELA FAMILY CHILD CARE
FACILITY NUMBER: 198019571

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/13/2021

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102417(g)(1)
Operation of A Family Child Care Home
(g) The home shall be free from defects or conditions which might endanger a child. Safety precautions shall include but not limited to: (1) Fireplaces and open face heaters shall be screened to prevent access by children. The home shall contain a fire extinguisher and smoke detector device which meet standards established by the State Fire Marshall.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, the licensee did not comply with the section cited above as the Licensee could not find the purchase receipt for the fire extinguisher. Thus LPA could not determine if the extinguisher needs annual service. This poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 10/20/2021
Plan of Correction
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Licensee indicated that she purchased the fire extinguisher this year and will submit the receipt when she can find it.
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 record review, the licensee did not comply with the section cited above as the Licensee indicated that she could not locate the renewal for current CPR records. This poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 10/20/2021
Plan of Correction
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Licensee will provide evidence of renewed CPR.
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:Warren Birks
LICENSING EVALUATOR SIGNATURE:
DATE: 10/13/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/13/2021


LIC809 (FAS) - (06/04)
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