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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198400529
Report Date: 02/08/2023
Date Signed: 02/08/2023 02:51:27 PM

Document Has Been Signed on 02/08/2023 02:51 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:ROSALES VILLAGRANA FAMILY CHILD CAREFACILITY NUMBER:
198400529
ADMINISTRATOR:ROSALES VILLAGRANA, MARTHAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(408) 348-9090
CITY:LONG BEACHSTATE: CAZIP CODE:
90810
CAPACITY: 14TOTAL ENROLLED CHILDREN: 10CENSUS: 4DATE:
02/08/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:45 AM
MET WITH:Martha Rosales Villagrana, LicenseeTIME COMPLETED:
03:11 PM
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 THIS INSPECTION WAS CONDUCTED IN SPANISH

Licensing Program Analysts (LPA) Susann Sanchez conducted an unannounced annual required inspection at the above facility on 2/08/2023 at 12:45PM. LPA met with Martha Rosales Villagrana, Licensee who guided analysts on a tour of the facility. There was 2 children and 2 infants present with the licensee and licensee assistant/daughter when LPA arrived. Facility capacity is in compliance for a Large Family Child Care Home. Food is provided by Licensee. Per Licensee, hours of operation Monday through Friday, 6:00 am to 6:00 pm and does not to exceed 24 hour care at one time. Licensee states that she will care for children Infants -13 years of age. Entrance Checklist was provided.

This is a one-story home which consists of 3 bedrooms, 2 bathrooms, kitchen w/ dining area, living room, front yard and backyard (fenced & divided) and garage. On limit areas are: living room, kitchen, bathroom, 1 bedroom and part of the backyard. Per Licensee's, areas off limits to children and parents include: 2 bedrooms, one bathroom, part of the backyard, and the garage and front yard. All off limit rooms are were observed to be locked or blocked off by a gate were gated off.

During inspection, Licensee stated that she want to use bedroom #3 (master bedroom). LPA toured the room. Licensee updated sketch during inspection. Licensee emailed LPA the updated sketch during inspection.

Consult was given regarding construction and remodeling. LPA printed a blank facility sketch so In the future Licensee also wants to convert garage into a studio. LPA advised Licensee to check with the City of Long Beach first and the department needs permits. LPA explained process.

Individuals residing in the home have been discussed and noted. All adults present in the home have obtained a criminal record clearance or exemption.
SUPERVISORS NAME: Valarie Cook
LICENSING EVALUATOR NAME: Susann Sanchez
LICENSING EVALUATOR SIGNATURE: DATE: 02/08/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/08/2023
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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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: ROSALES VILLAGRANA FAMILY CHILD CARE
FACILITY NUMBER: 198400529
VISIT DATE: 02/08/2023
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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 Licensing Form (LIC) 9148- Earthquake Preparedness form. Facility records were reviewed for LIC 9040- Facility Roster, LIC 610- Facility Disaster Plan and Disaster drill log, last drill conducted on 2/06/2023

The valve on the required 2A 10BC fire extinguisher indicates fully charged and was serviced on 08/29/2022, as indicated on service tag. Per State Fire Marshall standards, fire extinguishers shall be serviced annually. The home maintains telephone service via landline and cell phone. The home is observed to be clean and orderly. There are toys and other age appropriate material available for children. LPA observed that detergents, cleaning compounds and medication are locked and inaccessible to children. Licensee states that there are no poisons stored in the home and understands that all poisons must be lock, not only inaccessible to children. Isolation area for sick children waiting to be picked up is in bedroom, away from the other children. Per Licensee there are no firearms or weapons stored in the home.

Infant Care: Currently licensee has 2 infants enrolled. LPA observed 1 infant sleeping in a crib and the other infant sleeping in a playpen. 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 cribs/play yards. Licensee uses the Safe sleep regulations, including LIC 9227 Infant Sleep Plan for infants under 12 months, 15-minute sleep check documentation for infants 0-24 months, and provided PIN 20-24-CCP. Licensee states the following plan for infants: Infant sleeping in the living room.

Usually, children are using the side yard for outdoor play. Per Licensee, children are fully supervised when outside. LPA observed that the outdoor yard has toys and other materials for children to play with. LPA did not observe any objects that could be hazardous to children in care. However, this week children are not playing outside due to street construction. LPA also observe city employees working on the side walk. There are no pools or spas, or other bodies of water.



Children’s records were reviewed for (LIC) 282- Affidavit Regarding Liability Insurance, Immunizations 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)
SUPERVISORS NAME: Valarie Cook
LICENSING EVALUATOR NAME: Susann Sanchez
LICENSING EVALUATOR SIGNATURE:

DATE: 02/08/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/08/2023
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
CCLD Regional Office, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME: ROSALES VILLAGRANA FAMILY CHILD CARE
FACILITY NUMBER: 198400529
VISIT DATE: 02/08/2023
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Staff records were reviewed for approved Pediatric First Aid and CPR certification (expires 02/21/24), LIC-501: Personnel Record, LIC 508-Criminal Record Statement, LIC 9052- Employee Rights, Proof of immunizations against measles, pertussis and influenza or influenza declination, TB clearance or risk assessment, LIC 9108- Statement of Child and Mandated Reporter Training Certificate (expires 12/16/23).

During inspection all children were observed to be treated with dignity and respect, they were observed to be receiving safe, healthful and comfortable accommodations, furnishings and equipment, and free from corporal and/or unusual punishment.

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 Center 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 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 at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource.

SUPERVISORS NAME: Valarie Cook
LICENSING EVALUATOR NAME: Susann Sanchez
LICENSING EVALUATOR SIGNATURE:

DATE: 02/08/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/08/2023
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
CCLD Regional Office, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME: ROSALES VILLAGRANA FAMILY CHILD CARE
FACILITY NUMBER: 198400529
VISIT DATE: 02/08/2023
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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.

LPA was unable to test smoke detectors and carbon monoxide detector due to children sleeping. Licensee will test smoke and carbon detectors via Facetime with LPA on 02/09/2023.

Based on the LPA's observations and records review no deficiencies will be cited today 2/08/23.

A notice of site visit was given and must remain posted for 30 days. Exit interview conducted and report was reviewed with the Licensee Rosales Villagrana. Appeal Right were given and explained.

SUPERVISORS NAME: Valarie Cook
LICENSING EVALUATOR NAME: Susann Sanchez
LICENSING EVALUATOR SIGNATURE:

DATE: 02/08/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/08/2023
LIC809 (FAS) - (06/04)
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