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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198400298
Report Date: 06/13/2024
Date Signed: 06/13/2024 11:18:21 AM

Document Has Been Signed on 06/13/2024 11:18 AM - 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:JIMENEZ FAMILY CHILD CAREFACILITY NUMBER:
198400298
ADMINISTRATOR/
DIRECTOR:		ANTONIA JIMENEZFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(310) 740-6168
CITY:COMPTONSTATE: CAZIP CODE:
90220
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 6DATE:
06/13/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:30 AM
MET WITH:Antonia Jimenez, LicenseeTIME VISIT/
INSPECTION COMPLETED:
11:30 AM
NARRATIVE
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Licensing Program Analysts (LPAs) ALicia Mooberry and Portia Bowden conducted an unannounced case management inspection to the above facility. LPAs met with Liliana Rivas, Assistant and informed of the reason for the visit. LPAs inspected the home, there were six (6) children present including one napping infant, Child #1 age 9 months was observed sleeping in a stroller in the outdoor play area, posing a potential risk to the health and safety of children in care.

Also present during this inspection was Armando Jimenez, Licensee's adult son. The licensee arrived at 10:05am.

The licensee reported on 6/7/24 that an above ground pool will be installed in the backyard in area that is inaccessible to children in care. LPAs observed an above ground pool with no water in it (Bestway Pool Set 18 ft x 48 in.). LPAs observed that the pool in not barricaded and the back emergency exit door leads to the backyard. LPA Mooberry discussed the requirements to having a pool on the premises. The licensee agrees not to fill the pool until the family has installed the required barriers or if the pool will be removed. LPAs will conduct a follow up visit to ensure the health and safety of children in care and to ensure that Licensee is in compliance.

LPA discussed Safe Sleep Regulation and referenced PIN 20-24-CCP, and provided a copy of LIC 9227. LPA reviewed with Licensee items prohibited in FCCH, no baby bouncers, no infant walkers, No Johnny jumpers, no saucer chairs, and any other item that falls into that category are not permitted in the facility.

LPA Mooberry provided technical assistance on required documentation for staff and children files.



The facility is cited one (1) type B deficiency per California Code of Regulation Title 22.

The Notice of Site Visit (LIC 9213) – must remain posted for 30 days during the hours of operation after each site visit made by a licensing representative.

Exit interview was conducted with Antonia Jimenez, Licensee, including, but not limited to Appeal Procedures, Site Visit and Initial Appeal Rights.

SUPERVISORS NAME: Valarie Cook
LICENSING EVALUATOR NAME: Alicia Mooberry
LICENSING EVALUATOR SIGNATURE: DATE: 06/13/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/13/2024
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 06/13/2024 11:18 AM - It Cannot Be Edited


Created By: Alicia Mooberry On 06/13/2024 at 10:54 AM
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: JIMENEZ FAMILY CHILD CARE
FACILITY NUMBER: 198400298

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/13/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
06/13/2024
Section Cited
CCR
102425(i)

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(i) If an infant falls asleep before being placed in a crib or play yard, the provider shall move the infant to a crib or play yard as soon as possible.

This requirement is not met as evidenced by:
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The licensee removed child #1 from the stroller. LPA observed child being held by Assistant. Per licensee, they will review Safe sleep requirements and ensure infants sleep in play yard or crib.
The defeciency was corrected during the visit.
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LPAs observed Child #, 9 month old infant sleeping in stoller in outdoor playarea supervised by Assistant,
This poses a potential risk to the health and safety of children 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: 06/13/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/13/2024


LIC809 (FAS) - (06/04)
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