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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 304312679
Report Date: 06/01/2022
Date Signed: 06/01/2022 10:12:11 AM

Document Has Been Signed on 06/01/2022 10:12 AM - 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, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME:VILLASENOR, LOURDESFACILITY NUMBER:
304312679
ADMINISTRATOR:VILLASENOR, LOURDESFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(562) 587-4267
CITY:LA HABRASTATE: CAZIP CODE:
90631
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 4DATE:
06/01/2022
TYPE OF VISIT:Case Management - Annual ContinuationUNANNOUNCEDTIME BEGAN:
07:50 AM
MET WITH:Lourdes Villasenor, LicenseeTIME COMPLETED:
10:30 AM
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Licensing Program Analyst (LPA) P Rivas conducted an unannounced case management visit to continue the annual inspection that was commenced on 05/25/22.. LPA was assisted by Licensee Lourdes Villasenor; present during visit were 2 Preschool age children 2 infants and one assistant. Licensee was operating within the licensed capacity as specified on license. A review of the Facility Personnel Report Summary on this date indicates all facility residents, staff, or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions. 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. Currently there are 3 adults including the licensee residing in the facility. Facility Day care hours are 745am-430pm, Monday through Friday.
During today's inspection conducted a walk through and took census. LPA noted carbon monoxide and smoke detectors were operational. LPA also reviewed two staff files and four children files and conducted staff interview (while licensee was also caring for children)
Provided consultation on Safe Sleep Regulations and Requirements. LPA discussed the safe sleep regulations with licensee Lourdes Villasenor 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.
NO Deficiencies noted During today's inspection. Technical advisory for mandated Reporter Training given.
Notice of Site VisitA notice of site visit was given and must remain posted for 30 days.Posting RequirementsFailure to comply with posting requirements shall result in an immediate civil penalty of $100.
Appeal Rights were explained. The Licensee was provided a copy of appeal rights (LIC 9058 01/16) and their signature on this form acknowledges receipt of these rights. All appeals must be in writing and received by the Regional Office within 15 business days. First level appeals should be sent to the regional manager to the address listed above. Exit interview conducted and report was reviewed with the licensee
SUPERVISORS NAME: Rina Lopez
LICENSING EVALUATOR NAME: Pat Rivas
LICENSING EVALUATOR SIGNATURE: DATE: 06/01/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/01/2022
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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