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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198400397
Report Date: 11/03/2022
Date Signed: 11/03/2022 05:31:52 PM

Document Has Been Signed on 11/03/2022 05:31 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:ARCEO FAMILY CHILD CAREFACILITY NUMBER:
198400397
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 9CENSUS: 5DATE:
11/03/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
02:15 PM
MET WITH:Alma ArceoTIME COMPLETED:
05:45 PM
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Licensing Program Analyst (LPA) Elka Chavez conducted an unannounced 1-year required inspection to the above facility on 11/03/2022. LPA arrived at the facility at 2:15 PM and met with Facility Representative, MaGuadalupe Andrade. Licensee, Alma Arceo arrived 25 minutes later and guided analyst on a tour of the facility. Entrance Checklist for Family Child Care Homes was provided to the licensee upon entry. There were 5 children present upon arrival. Hours of operation are Monday through Friday from 7:00 AM to 5:00PM.

This facility is a two-story home that consists of 5 bedrooms, 4 bathrooms, living room ("hall"), family room, dining room, kitchen, laundry room, game room, detached garage, and backyard (fenced). Areas accessible to children are: 1 bathroom (located downstairs), living room ("hall"), family room, and backyard (fenced). Areas off limits to children and parents are: 5 bedrooms, 3 bathrooms, dining room, kitchen, laundry room, game room, and detached garage. LPA observed the fence on the side of the detached garage had fallen and was on the floor. Licensee stated that the door needed to be replaced. All off-limit areas need to be made inaccessible to children in care. The licensee understands that licensing staff may have access to off-limit areas during inspection visit if necessary. Food is provided by Licensee. Licensee was reminded if children bring food from home it must be labeled with the child’s name and properly stored or refrigerated.

Individuals residing in the home have been discussed and noted. All adults present in the home have obtained a criminal record clearance or exemption. All areas identified on the facility sketch that are accessible for children to use were inspected for safety, comfort, and cleanliness. The following was observed and reviewed during this inspection:

LPA reviewed required posted documentation for Facility License, Publication (PUB) 394- Notification of Parent Rights and LIC 999A Facility Sketch or equivalent sketch. Facility records were reviewed for LIC 9040-
SUPERVISORS NAME: Karen Chambers
LICENSING EVALUATOR NAME: Elka Chavez
LICENSING EVALUATOR SIGNATURE: DATE: 11/03/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/03/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.

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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: ARCEO FAMILY CHILD CARE
FACILITY NUMBER: 198400397
VISIT DATE: 11/03/2022
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Facility Roster, LIC 610- Facility Disaster Plan and Disaster drill log. LPA did not observe a drill log. Licensee stated that she did not know a log had to be kept for drills conducted.

Smoke and carbon monoxide detectors were tested and are operable. Fire extinguisher indicated fully charged and was serviced in September 2021. The home maintains telephone service via cell phone. The home is observed to be clean and orderly. There are toys and other age appropriate material available for children. LPA observed stairs are screened to prevent access by children. LPA observed that detergents and cleaning compounds are inaccessible to children. LPA observed they are kept under the kitchen sink with a child safety latch. Licensee understands that all poisons must be locked. Isolation area for sick children waiting to be picked up is in the living room next to the door leading to the backyard, away from the other children. Per Licensee there are no firearms or weapons stored in the home. Licensee stated that there are no pets in the home.

Licensee cares for two infants. LPA observed play yard visible in the living room (“hall”). Napping equipment does not block entrances or exits. Infant mattresses were observed to be firm with tightly fitted sheets. LPA did not observe loose object, bumpers, objects hanging, or objects attached to the play yards. There are currently no infants with pacifiers. Each infant has their own play yard and bedding. Bedding is washed weekly or as needed by the Licensee. LPA informed Licensee of the new Safe sleep regulations, including LIC 9227 Infant Sleep Plan for infants under 12 months, and the 15-minute sleep check documentation for infants 0-24 months. At 3:45 PM LPA did not observe a sleep log for child #1.

Currently, children are using the backyard for outdoor play. Licensee stated that the children are also taken on walks. The outdoor play area was observed to be fenced. LPA observed a large portable storage unit in the backyard. Licensee stated that furniture is currently being stored in it by the landlord. Licensee stated that the landlord is in the process of building a ADU. There are no pools or spas, or other bodies of water. The licensee states that supervision is always provided. The licensee states that supervision is always provided.

Children’s records were reviewed for (LIC) 282- Affidavit Regarding Liability Insurance, Immunization Records, LIC 700- Identification and Emergency Information, LIC 627- Consent for Medical Treatment, LIC 995A Notification of Parents’ Rights, LIC 9227- Infant sleep form (0-12 months, and documentation of 15-minute Infant Sleep Check (0-24 months). LPA observed child #1 was missing sleep log, LIC 700 form was blank,
SUPERVISORS NAME: Karen Chambers
LICENSING EVALUATOR NAME: Elka Chavez
LICENSING EVALUATOR SIGNATURE:

DATE: 11/03/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/03/2022
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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: ARCEO FAMILY CHILD CARE
FACILITY NUMBER: 198400397
VISIT DATE: 11/03/2022
NARRATIVE
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files for children #1 through #5 were incomplete.

Staff records were reviewed for approved Pediatric First Aid and CPR certification, LIC 508- Criminal Record Statement, LIC 9052- Employee Rights, Proof of immunization against measles, pertussis and influenza or influenza declination, TB clearance or risk assessment, LIC 9108- Statement Acknowledging Requirement to Report Child Abuse and current Mandated Reporter Training Certificate. LPA observed staff #2 was along with children in care. Staff #2 Pediatric First Aid and CPR certification expired 8/2022. LPA observed staff #2 is scheduled to attend training 11/5/22. LPA did not observe Mandated Reporter Training Certificate for staff #2.

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

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.

Licensee Alma Arceo 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 Alma Arceo and discussed the Child Care Licensing Safe Sleep webpage at
SUPERVISORS NAME: Karen Chambers
LICENSING EVALUATOR NAME: Elka Chavez
LICENSING EVALUATOR SIGNATURE:

DATE: 11/03/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/03/2022
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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: ARCEO FAMILY CHILD CARE
FACILITY NUMBER: 198400397
VISIT DATE: 11/03/2022
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https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPA also informed licensee Alma Arceo 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.

Based on the LPA’s observations and records review, the following deficiencies listed on the attached LIC 809 (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 the licensee Alma Arceo.
SUPERVISORS NAME: Karen Chambers
LICENSING EVALUATOR NAME: Elka Chavez
LICENSING EVALUATOR SIGNATURE:

DATE: 11/03/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/03/2022
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Document Has Been Signed on 11/03/2022 05:31 PM - It Cannot Be Edited


Created By: Elka Chavez On 11/03/2022 at 04:58 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: ARCEO FAMILY CHILD CARE
FACILITY NUMBER: 198400397

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/03/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Request Denied
Type B
Section Cited
CCR
102417(g)(9)(A)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: (9) Each family child care home shall have a written disaster plan of action prepared on a form approved by the Department. All children, age and ability permitting, and the provider, the assistant provider, and other members of the household, shall be instructed in their duties under the disaster plan. As their age and ability permit, newly enrolled children shall be informed promptly of their duties as required in the plan. (A) Each family child care home shall conduct fire drills and disaster drills at least once every six months. 1. The licensee shall document the drills, including the date and time of each drill. This documentation shall kept at the family child care home.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review licensee did not have record of disaster drills conducted which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 11/07/2022
Plan of Correction
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Licensee stated that she will provide proof of correction to LPA by POC due date. Going forward licensee she will make sure to log them.

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:Elka Chavez
LICENSING EVALUATOR SIGNATURE:
DATE: 11/03/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/03/2022


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Document Has Been Signed on 11/03/2022 05:31 PM - It Cannot Be Edited


Created By: Elka Chavez On 11/03/2022 at 04:58 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: ARCEO FAMILY CHILD CARE
FACILITY NUMBER: 198400397

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/03/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Request Denied
Type B
Section Cited
HSC
1596.8662(b)(1)
Administration of Child Day Care Licensing
(1) On or before March 30, 2018, a person who, on January 1, 2018, is a licensed child day care provider, administrator, or employee of a licensed child day care facility shall complete the mandated reporter training provided pursuant to paragraphs (2) and (3) of subdivision (a), and shall complete renewal mandated reporter training every two years following the date on which he or she completed the initial mandated reporter training.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review staff #2 is missing proof of Mandate Reporter training which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 11/10/2022
Plan of Correction
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Licensee stated that she will prpvide proof to LPA by POC due date. Going forward licensee stated that she will make sure that the training is completed by all staff.
Request Denied
Type B
Section Cited
CCR
102416.1(a)(6)
Personnel Records
(a) Personnel records shall be maintained on each employee and shall contain the following information: (6) Documentation of completion of training on preventative health practices as required by Section 102416(c).

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review 3:40 PM staff #1 is missing preventative health training which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 12/02/2022
Plan of Correction
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Licensee stated that she will prpvide proof to LPA by POC due date. Going forward licensee stated that she will make sure that the training is completed by all staff.
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:Elka Chavez
LICENSING EVALUATOR SIGNATURE:
DATE: 11/03/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/03/2022


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Document Has Been Signed on 11/03/2022 05:31 PM - It Cannot Be Edited


Created By: Elka Chavez On 11/03/2022 at 04:58 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: ARCEO FAMILY CHILD CARE
FACILITY NUMBER: 198400397

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/03/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Request Denied
Type B
Section Cited
CCR
102417(g)(7)
Operation of A Family Child Care Home
(7) An emergency information card shall be maintained for each child and shall include the child's full name, telephone number and location of a parent or other responsible adult to be contacted in an emergency, the name and telephone number of the child's physician and the parent's authorization for the licensee or registrant to consent to emergency medical care.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review at 3:45 PM LPA observed child #1 LIC 700 form was blank, child #3 & #4 only had one file which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 11/04/2022
Plan of Correction
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Licensee stated that she will provide proof of correction to LPA by POC due date. Going forward licensee she will make sure to reference LIC 311D form to make sure all forms are on file.
Request Denied
Type B
Section Cited
CCR
102418(g)
Immunizations
(g) The licensee shall document each child's immunizations as required by the California Code of Regulations, Title 17, Section 6070, and shall maintain such documentation for as long as the child is enrolled.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review child #2 was missing proof of immunization which posesd a potential health, safety or personal rights risk to persons in care.
POC Due Date: 11/28/2022
Plan of Correction
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Licensee stated that she will provide proof of correction to LPA by POC due date. Going forward licensee she will make sure to reference LIC 311D form to make sure all forms are on file.
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:Elka Chavez
LICENSING EVALUATOR SIGNATURE:
DATE: 11/03/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/03/2022


LIC809 (FAS) - (06/04)
Page: 7 of 9
Document Has Been Signed on 11/03/2022 05:31 PM - It Cannot Be Edited


Created By: Elka Chavez On 11/03/2022 at 04:58 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: ARCEO FAMILY CHILD CARE
FACILITY NUMBER: 198400397

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/03/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Request Denied
Type B
Section Cited
CCR
102425(j)(2)(D)
Infant Safe Sleep
Documentation shall be maintained in the infant’s file and be available to the Department for review. Documentation shall include the following:

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review child #1 was missing sleep log which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 11/07/2022
Plan of Correction
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4
Licensee stated that she will provide log to LPA by POC due date. LIcensee stated that she will follow safe sleep regulation.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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4
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:Elka Chavez
LICENSING EVALUATOR SIGNATURE:
DATE: 11/03/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/03/2022


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