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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198020341
Report Date: 03/16/2023
Date Signed: 03/16/2023 02:03:10 PM


Document Has Been Signed on 03/16/2023 02:03 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:CHINCHILLA FAMILY CHILD CAREFACILITY NUMBER:
198020341
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY:8CENSUS: 4DATE:
03/16/2023
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
11:15 AM
MET WITH:Licensee Gladys Chinchilla TIME COMPLETED:
02:15 PM
NARRATIVE
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At 11:15 am Licensing Program Analysts (LPA) Roxana Lopez conducted an unannounced poc (plan of correction) inspection to insured that the Technical Violations and Type B deficiencies cited on 2/15/2023 have been cleared. A risk assessment was conducted upon entry- appropriate PPE was used. Upon arrival LPA met with Assistant, Nora Chinchilla in the back yard with 4 children, 2 being infants. Per assistant, Licensee went to pick up a child. Assistant brought the four children inside the home to let LPA inside as they did not have the key to side gate. Assistant guided LPA to the table and went back outside with children.

The following was observed
- At 11:20 am LPA Lopez observed various cosmetic products (lotions, toner, moisturizer) and car cleaning wipes on the dining table which is located in an accessible area to children in care. Licensee, Gladys Chinchilla arrived at 11:40 am with 1 child. Licensee removed items during inspection and placed then in a inaccessible area for children.
- 4 out 8 children’s files reviewed on 2/15/2023 remain not completed.
- CPR for both Licensing and Assistant is not EMSA approved
- Licensing Fees have not been paid
- Assistant has current mandated reporter training AB1207 certificate on file
- Infant sleep chart is on file for both infants enrolled
- Drill Log is updated and available for review

LPA advised the licensee how to access forms, regulations and quarterly updates on the Child Care Licensing Website at: www.ccld.ca.gov.--------------------- pg. 1 of 2 ----------------------------------------------
SUPERVISOR'S NAME: Brandi VanOostenTELEPHONE: (323) 981-3365
LICENSING EVALUATOR NAME: Roxana LopezTELEPHONE: (323) 854-5073
LICENSING EVALUATOR SIGNATURE:
DATE: 03/16/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/16/2023
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 4


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 CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME: CHINCHILLA FAMILY CHILD CARE
FACILITY NUMBER: 198020341
VISIT DATE: 03/16/2023
NARRATIVE
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Based on the LPA’s observations and records review, the following deficiencies listed on the attached LIC 809D (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.

A notice of site visit was given and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

Exit interview conducted and report was reviewed with Licensee, Gladys Chinchilla.

-------------------------------------------------- pg. 2 of 2 --------------------------------------------------------------------------
SUPERVISOR'S NAME: Brandi VanOostenTELEPHONE: (323) 981-3365
LICENSING EVALUATOR NAME: Roxana LopezTELEPHONE: (323) 854-5073
LICENSING EVALUATOR SIGNATURE:

DATE: 03/16/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/16/2023
LIC809 (FAS) - (06/04)
Page: 2 of 4
Document Has Been Signed on 03/16/2023 02:03 PM - It Cannot Be Edited

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 CNTR DR. 200-B
MONTEREY PARK, CA 91754


FACILITY NAME: CHINCHILLA FAMILY CHILD CARE
FACILITY NUMBER: 198020341

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/16/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
04/06/2023
Section Cited

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101221(d)All children's records shall be available to the Department to inspect, audit, and copy upon demand during normal business hours. Records may be removed if necessary for copying...This requirement was not met as evidence by
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During inspection Licensee printed forms needed. Per Licensee, she will provide all parents a new packet with all documents needed. Licensee will place documents on file for the department to review.
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Based on observation and record review, the licensee did not comply with the section cited above in that 4 out 8 children files reviewed are not completed which poses/posed a potential health, safety or personal rights risk to persons in care.
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Type B
03/16/2023
Section Cited

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102417(g)(4)The home shall be free from defects or conditions which might endanger a child. Safety precautions shall include but not be limited to: Poisons... cleaning compounds...and other items which could pose a danger if readily available to children shall be stored
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During inspection Licensee, removed all items and placed them in an off limits room.
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 where they are inaccessible to children. This requirement is not met as evidenced by. Based on observation, the licensee did not comply with the section cited above in that LPA observed various cosmetic products and car cleaning wipes on the dining table which poses/posed
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 a potential health, safety or personal rights risk to persons in care.
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 VanOostenTELEPHONE: (323) 981-3365
LICENSING EVALUATOR NAME: Roxana LopezTELEPHONE: (323) 854-5073
LICENSING EVALUATOR SIGNATURE:
DATE: 03/16/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/16/2023
LIC809 (FAS) - (06/04)
Page: 3 of 4


Document Has Been Signed on 03/16/2023 02:03 PM - It Cannot Be Edited

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 CNTR DR. 200-B
MONTEREY PARK, CA 91754


FACILITY NAME: CHINCHILLA FAMILY CHILD CARE
FACILITY NUMBER: 198020341

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/16/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
04/06/2023
Section Cited

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1596.803 (e)(e) The failure of an applicant for licensure or a licensee to pay all applicable and accrued fees and civil penalties shall constitute grounds for denial or forfeiture of a license. This requirement is not met as evidenced by:
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Per Licensee, she will check her documents for recepit. If they don't find receipts they will pay the balance on the account. LPA provided Licensee with pin # to pay online.
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Based on observation and record review, the licensee did not comply with the section cited above in that there is a balance on their license which poses/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: Brandi VanOostenTELEPHONE: (323) 981-3365
LICENSING EVALUATOR NAME: Roxana LopezTELEPHONE: (323) 854-5073
LICENSING EVALUATOR SIGNATURE:
DATE: 03/16/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/16/2023
LIC809 (FAS) - (06/04)
Page: 4 of 4