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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198400324
Report Date: 01/12/2023
Date Signed: 01/13/2023 04:27:55 PM

Document Has Been Signed on 01/13/2023 04:27 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 S WEST, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME:DAVALOS FAMILY CHILD CAREFACILITY NUMBER:
198400324
ADMINISTRATOR:ANGELICA DAVALOSFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(323) 601-7190
CITY:SOUTH GATESTATE: CAZIP CODE:
90280
CAPACITY: 14TOTAL ENROLLED CHILDREN: 8CENSUS: 5DATE:
01/12/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
02:00 PM
MET WITH:Angelica DavalosTIME COMPLETED:
06:22 PM
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On 1/12/2023 at 2:00pm Licensing Program Analysts (LPAs) Patricia Medel and Raul Navarro conducted an announced annual inspection to the above facility. LPA arrived at the facility 1:45pm and met with Angela Davalos, Licensee who guided analyst on a tour of the facility. LPA provided Licensee with a copy of the Facility Entrance Checklist. Licensee guided LPA on a tour of the facility. Per Licensee, there are 8 children that are currently enrolled. A current children’s roster was available for review. There were 3 children present when LPA’s arrived. School age children 5 arrived in the afternoon. Infants left at 3:00pm. Licensee and her assistant (Staff #1) were present upon arrival. Licensee and two nephews under-age live at the home. Per the Licensee/Applicant, operating hours will be Monday to Sunday 6AM to 12AM and she will provide care for children ages 9 months to 12yrs old.

All areas identified on the facility sketch were inspected. This is a one-story home which consists of 4 bedrooms, two restrooms, kitchen, dining room, living room, front and backyard, pool and detached garage (with 4th bedroom). The home was inspected for safety, comfort, cleanliness, telephone service, heating and ventilation, inaccessibility to poisons, detergents, cleaning compounds, medicines, and hazardous items that can pose a danger to children. There are toys and other ageappropriate materials available for children to use.



Areas accessible to the children are the living room, Room #1, and the restroom in the kitchen area. Per Licensee, supervision will be provided when the children walk through the kitchen and dining room area. LPA observed a safety gate located between the kitchen and the dining room. The living room area has a fireplace that is made inaccessible.

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SUPERVISORS NAME: Karen Chambers
LICENSING EVALUATOR NAME: Patricia Medel
LICENSING EVALUATOR SIGNATURE: DATE: 01/12/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/12/2023
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
MONTEREY PARK S WEST, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME: DAVALOS FAMILY CHILD CARE
FACILITY NUMBER: 198400324
VISIT DATE: 01/12/2023
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There is a screen and the applicant has installed a safety gate nailed to the fireplace. Room #2 will be used for napping. Room #3 will be used as needed. Children will have the front yard accessible for outdoor play. LPA observed Yard is fenced with lock.
Off limit areas: Detached garage/Room #4, bathroom in between Room #1 and Room #2 and backyard with pool area which is fenced all the way around.

All required postings are visible, pub 394 notification of parent's rights, lic 9148 earthquake preparedness, and facility license. All children’s records reviewed are current with licensing forms.
Staff Files are current with licensing forms and CPR/First Aid and Mandated Reporter certificates. The fire drill and earthquake drill was not updated so provided a technical violation. Licensee will conduct a drill of each the following work day and send proof via email to LPA. The emergency disaster drill and the facility roster are present and up to date. The required (2A10BC) fire extinguisher is located in between the living room and dining room and indicates fully charged. Applicant demonstrated that the Smoke detectors and carbon monoxide detectors located in the living room are in operable condition. Per Licensee/Applicant there are no weapons or firearms in the facility. First Aid and emergency kit is available in tining room. The Licensee/applicant states she provide food and water for the children. Per the applicant there is no smoking in the home. There is a dog in the facility. Per the Licensee/Applicant, the dog is vaccinated and registered and will remain outside in the fenced area between the pool and the dining room during operating hours.

Incidental Medical Services (IMS): Incidental Medical Services (IMS) policy was discussed. Per Licensee, 1 child enrolled requires a medical device. Medical device is brought to the home by the child and taken back home at the end of the day. 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 Center and the ADA, available at: http://www.ada.gov/childqanda.htm

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SUPERVISORS NAME: Karen Chambers
LICENSING EVALUATOR NAME: Patricia Medel
LICENSING EVALUATOR SIGNATURE:

DATE: 01/12/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/12/2023
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 S WEST, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME: DAVALOS FAMILY CHILD CARE
FACILITY NUMBER: 198400324
VISIT DATE: 01/12/2023
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Licensee was reminded that all adults 18 and over living or working in the home, including employees and volunteers, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a licensed Family Child Care Home. A civil penalty of $100.00 minimum/day up to $500.00 maximum per day/per person will be assessed if this regulation is violated.
LPA discussed the safe sleep regulations with Licensee and discussed the Child Care Licensing Safe Sleep webpage athttps://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleephttps://www.cdss.ca.gov/inforesources/child-care-licensing/ public -information-and-resources/safe-sleep as an additional resource. LPA also informed licensee of the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at https://www.cpsc.gov/ and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment. To improve the quality and value of the new inspection process, a survey will be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or tools, please send them by email to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/process.

Exit interview conducted and report was reviewed with the Licensee, Angelica Davalos. A notice of site visit was given and must remain posted for 30 days.

Page 3 End of Report

SUPERVISORS NAME: Karen Chambers
LICENSING EVALUATOR NAME: Patricia Medel
LICENSING EVALUATOR SIGNATURE:

DATE: 01/12/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/12/2023
LIC809 (FAS) - (06/04)
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