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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198400529
Report Date: 02/26/2025
Date Signed: 02/26/2025 04:08:57 PM

Document Has Been Signed on 02/26/2025 04:08 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 SW RO, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME:ROSALES VILLAGRANA FAMILY CHILD CAREFACILITY NUMBER:
198400529
ADMINISTRATOR/
DIRECTOR:		ROSALES VILLAGRANA, MARTHAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(408) 348-9090
CITY:LONG BEACHSTATE: CAZIP CODE:
90810
CAPACITY: 14TOTAL ENROLLED CHILDREN: 7CENSUS: 5DATE:
02/26/2025
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
11:40 AM
MET WITH:Licenssee, Martha Rosales VillagranaTIME VISIT/
INSPECTION COMPLETED:
04:20 PM
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On 02/26/2025 at 11:40 am, Licensing Program Analyst (LPA) Jonnisha Culbert conducted an unannounced annual/random inspection at the facility noted above and met with Licensee, Martha Rosales Villagrana. LPA stated the purpose of the visit was to conduct an annual/random inspection. The operating hours of the facility are Monday through Friday from 6:00 AM to 10 PM. Per licensee, they do not have any children currently enrolled that stays pass 6pm. Entrance Checklist (LIC 126) was provided to the Licensee upon arrival. Individuals residing in the home were discussed and noted. At the time of the inspection licensee, assistant, and 5 children were present.

This is a single-family home that consists of three (3) bedrooms, two (2) bathrooms, living room, dining area, kitchen, detached converted garage (with living room, kitchen, one (1) bedroom, and one (1) bathroom), driveway, and backyard.

Areas that are accessible to children include: living room, dining room, one (1) bathroom, driveway, kitchen, and detached garage. Per Licensee, utilize detached garage for activities and they eat and sleep in the home. LPA reminded licensee that garage cannot be used for eating or napping.

Areas off-limits to children include: 3 bedrooms, one (1) bathroom, and backyard Per Licensee, they keep the gate to the backyard locked and the dog is kept back there at all times.

The following documents were posted: Facility License, Notification of Parents' Rights (PUB 394), and Emergency Disaster Plan (LIC 610A). Licensee has a Facility Roster (LIC 9040) that is not updated. This is a potential safety risk for persons in care. LPA observed Disaster and Fire Drill log with no drills logged. LPA reminded licensee to perform, and log drill every 6 months.
SUPERVISORS NAME: Karen Chambers
LICENSING EVALUATOR NAME: Jonnisha Culbert
LICENSING EVALUATOR SIGNATURE: DATE: 02/26/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/26/2025
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 8
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MONTEREY PARK SW RO, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME: ROSALES VILLAGRANA FAMILY CHILD CARE
FACILITY NUMBER: 198400529
VISIT DATE: 02/26/2025
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Areas used by children were inspected for safety, comfort, heating, cleanliness, and telephone service.
Per Licensee, the home is equipped with a unit that produces air and heating. LPA observed air conditioning/heating unit attached to wall in living room. Per licensee, there are no fireplaces or gas wall heaters. Knives and sharp objects were made inaccessible to children. Per Licensee, there is no medication in the home and poisons are kept in a locked shed located in off limits backyard. LPA reminded licensee that poisons are to remain in areas that are locked and inaccessible to children. LPA did observe outlet covers. Per licensee, the wall sockets were recently replaced with outlets that remain locked until someone unlock them. LPA observed age-appropriate toys, play yards, and cots for children to use for napping. Per licensee, there are no pools or firearms on the premises.

LPA observed the required fire extinguisher (2-A:10-B:C) that is fully charged and last serviced on 08/14/2024. Licensee was reminded to have the fire extinguisher serviced yearly. Smoke and carbon monoxide detectors were observed and are operable.

Per licensee, they provide breakfast, am snack, lunch, pm snack, and dinner. Licensee was reminded that food that is brought from the children's home shall be labeled with the child’s name and properly stored or refrigerated.

LPA conducted a record review of two (2) children's records and 2 personnel records. Based on the children's record review, Child 1 and Child 2 are missing sleep logs. This poses a potential safety risk to children in care. LPA reminded Licensee to review Provider Information Notice (PIN 20-24-CCP Safe Sleep) for safe sleep.

Based on the personnel records, Licensees and assistant have records of current Pediatric First Aid and CPR (expires 08/10/2025) and Mandated Reporter Certificates. LPA reminded licensee that mandated reporter training must be completed every 2 years. Mandated reporter training is available at www.mandatedreprterca.com.
During record review, LPA did not observe licensee’s proof of immunization against measles, pertussis, tuberculosis, and flu. This poses a potential health and safety risk to persons in care.
SUPERVISORS NAME: Karen Chambers
LICENSING EVALUATOR NAME: Jonnisha Culbert
LICENSING EVALUATOR SIGNATURE:

DATE: 02/26/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/26/2025
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 SW RO, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME: ROSALES VILLAGRANA FAMILY CHILD CARE
FACILITY NUMBER: 198400529
VISIT DATE: 02/26/2025
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To improve the quality and value of the new inspection process, a survey may 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 CARE tools, please send email inquiries 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/inspection-process.

Licensee was reminded that all adults 18 and over living or working in the home, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, 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 for a maximum of 5 days or, if the penalty is for a repeat violation, for a maximum of 30 days 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-andresources/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.

Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02- CCP. 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: https://www.ada.gov/resources/child-care-centers/.

Licensee was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain childcare by connecting them to childcare providers and Resource and Referral Agencies (R&Rs) throughout California.During the exit interview, Martha Rosales Villagrana, confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS.

B citations were cited during today's visit in accordance with Title 22, California Code of Regulations. Appeal rights were provided to licensee. Please see attached LIC 809D.Exit interview conducted and report was reviewed with the licensee, Martha Rosales Villagrana.

SUPERVISORS NAME: Karen Chambers
LICENSING EVALUATOR NAME: Jonnisha Culbert
LICENSING EVALUATOR SIGNATURE:

DATE: 02/26/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/26/2025
LIC809 (FAS) - (06/04)
Page: 3 of 8
Document Has Been Signed on 02/26/2025 04:08 PM - It Cannot Be Edited


Created By: Jonnisha Culbert On 02/26/2025 at 02:02 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: ROSALES VILLAGRANA FAMILY CHILD CARE
FACILITY NUMBER: 198400529

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/26/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
HSC
1597.622(c)
Administration of Child Day Care Licensing
(c) The family day care home shall maintain documentation of the required immunizations or exemptions from immunization, as set forth in this section, in the person's personnel record that is maintained by the family day care home.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, the licensee did not comply with the section cited above in 1 out of 2 persons did not maintain documentation of the required immunizations or exemptions from immunization in the person's personnel record which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 03/12/2025
Plan of Correction
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Per licensee, they will email LPA J. Culbert a copy of licensee's immunization records by plan of correction date.
Type B
Section Cited
CCR
102417(g)(8)
Operation of A Family Child Care Home
(8) Each family child care home shall have a current roster of children as specified in Health and Safety Code Section 1596.841.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, the licensee did not comply with the section cited above and licensee did not have a current facility roster. 4 out of 7 children information was missing from roster which poses a potential safety risk to persons in care.
POC Due Date: 03/12/2025
Plan of Correction
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Per licensee, they will update facility roster with all children currently enrolled and email a copy of roster to LPA J. Culbert by plan of correction date.
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:Jonnisha Culbert
LICENSING EVALUATOR SIGNATURE:
DATE: 02/26/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/26/2025


LIC809 (FAS) - (06/04)
Page: 4 of 8
Document Has Been Signed on 02/26/2025 04:08 PM - It Cannot Be Edited


Created By: Jonnisha Culbert On 02/26/2025 at 02:02 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: ROSALES VILLAGRANA FAMILY CHILD CARE
FACILITY NUMBER: 198400529

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/26/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102425(j)(2)(D)(c)
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: Time of each 15-minute check

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, the licensee did not comply with the section cited above in 2 out of 2 persons record reviewed were missing time of each 15 minute check which poses a potential safety risk to persons in care.
POC Due Date: 03/12/2025
Plan of Correction
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Per licensee, they log infant sleep on an app and as soon as they can they will email LPA J. Culbert proof of logs for the month of 01/2025 and 02/2025. Per licensee, they will email documentation by plan of correction date.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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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:Jonnisha Culbert
LICENSING EVALUATOR SIGNATURE:
DATE: 02/26/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/26/2025


LIC809 (FAS) - (06/04)
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