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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198400441
Report Date: 03/17/2023
Date Signed: 03/17/2023 01:13:51 PM

Document Has Been Signed on 03/17/2023 01:13 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:CORNEJO FAMILY CHILD CAREFACILITY NUMBER:
198400441
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 5DATE:
03/17/2023
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
10:40 AM
MET WITH:Martiza Cornejo, LicenseeTIME COMPLETED:
01:30 PM
NARRATIVE
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Licensing Program Analyst (LPA) Denise Gibbs conducted an unannounced case management inspection to the above facility on 3/17/23 on 11:35 AM. LPA met with Maritza Cornejo, Licensee. LPA toured the facility. The purpose of this inspection is due to licensee’s request for a capacity increase.

There were five children and one adult present upon arrival. This facility is a small family child care home, licensed for eight children. Licensee wishes to increase capacity to a large family child care home, with a capacity of 14 children.

Hours of operation will remain the same, Monday to Friday Mon-Fri 7:30 AM - 5:45PM. A current children’s roster was available for review. Individuals residing in the home have been discussed and noted. All adults present in the home have obtained a criminal record clearance or exemption.

This is a two-story home that consists of four bedrooms and two bathrooms upstairs and living room, dining room, foyer, kitchen, laundry area, break room, one bathroom, front yard (not fenced), backyard (fenced), and detached garage downstairs. Main care areas include living room, dining room and back yard. Off limit areas include, four bedrooms and two bathrooms upstairs made inaccessible with child safety gates at the bottom and top of stairs and detached garage in the backyard (locked).

LPA observed all requires posting in the main entrance (foyer). Facility implements a daily schedule and curriculum. Guardians sign children and out. Children have cubbies for their belonging. Fire extinguisher was last serviced on 11/2022. Dual carbon and smoke detector located in kitchen was tested and is operable.

Facility has two main care areas, the living room and dinning room. LPA observed age appropriate toys, equipment and material for children to play with. Child safety gates block access to stairs in the living and the ----------------PAGE 1
SUPERVISORS NAME: Karen Chambers
LICENSING EVALUATOR NAME: Denise Gibbs
LICENSING EVALUATOR SIGNATURE: DATE: 03/17/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/17/2023
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 04/14/2023 11:30 AM - It Cannot Be Edited

Document is an Amendment of Original Document on 03/17/2023 01:30 PM


Created By: Denise Gibbs On 03/17/2023 at 12:37 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
MONTEREY PARK S WEST, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME: CORNEJO FAMILY CHILD CARE
FACILITY NUMBER: 198400441

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/17/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
04/17/2023
Section Cited
CCR
102417(g)

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102417(g) Operation of a Family Child Care Home (g) The home shall be free from defects or conditions which might endanger a child.

This requirement is not met as evidenced by:
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AMENDED TO ADD PLAN OF CORRECTION

Per licensee, she will have someone make repairs to the wooden gate and send picture to LPA by POC date 4/17/23
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Based on observation, the licensee did not comply with the section cited above. LPA observed wood fence leaned and wood plank on fence loose, which poses a potential health and safety rick to 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:Karen Chambers
LICENSING EVALUATOR NAME:Denise Gibbs
LICENSING EVALUATOR SIGNATURE:
DATE: 03/17/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/17/2023


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: CORNEJO FAMILY CHILD CARE
FACILITY NUMBER: 198400441
VISIT DATE: 03/17/2023
NARRATIVE
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kitchen. LPA observed a faux fire place in the living room. Detergents, cleaning compounds and medication are stored in kitchen under the sink with child locks and on a high shelf in the laundry room above the washer and dryer, inaccessible to children. LPA observed a door that can be closed blocking access to the kitchen from the main care area if needed.

Children nap on cots in the main care area. LPA observed two play yards for younger infants in the main care area, free of hazards. Licensee is aware of safe sleep regulation and has implemented LIC9227, Infant Sleep Plan and 15-minute sleep log.


Children's bathroom is located towards the back of the home through the laundry area. Half bathroom includes a sink and toilet. Restroom was observed to be safe and sanitary with operable sink and toilet. LPA observed a changing table for children with diapers in the main care area. Licensee sanitizes changing table after each use.

Children will use the backyard yard for outdoor play, back yard is fenced. There are two areas in the outdoor space available for children; the larger main yard and the smaller garden area that is gated. Both areas have age appropriate toys, equipment and material for children. LPA observed a detached garage in the play area that is locked. To the left of the yard there is a long driveway from the front of the home to the end of the back yard. LPA advised licensee make the area with the dumpster and the area with the car and trash cans inaccessible to children. LPA observed a possible blind spot for children past the car and the trash cans. In the garden area LPA observe part of the wooden fence leaning and a wood plank loose from the fence, which is a potential hazard to children in care. The Licensee states that there are no firearms, weapons or bodies of water on the premises. LPA did not observe fire arms, weapons, or bodies of water.

Licensee currently has two assistants, one was present during inspection. Licensee has completed required Pediatric First Aid and CPR which training which expires on, 5/2023. Licensee and assistant have completed Mandated Reporter Training, expiring 5/2023. Licensee and assistant also have required immunization records on file. There are first aid supplies available. Children's files were reviewed and are complete.

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.

SUPERVISORS NAME: Karen Chambers
LICENSING EVALUATOR NAME: Denise Gibbs
LICENSING EVALUATOR SIGNATURE:

DATE: 03/17/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/17/2023
LIC809 (FAS) - (06/04)
Page: 3 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: CORNEJO FAMILY CHILD CARE
FACILITY NUMBER: 198400441
VISIT DATE: 03/17/2023
NARRATIVE
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Licensee is seeking to provide care for 14 children 0-8 years old. A fire clearance has been granted as of 2/28/23. Based on today’s observation, corrections need to made before large family child care is approved.

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

Exit interview was conducted with Martiza Cornejo, Licensee. Appeal Rights provided.

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SUPERVISORS NAME: Karen Chambers
LICENSING EVALUATOR NAME: Denise Gibbs
LICENSING EVALUATOR SIGNATURE:

DATE: 03/17/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/17/2023
LIC809 (FAS) - (06/04)
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