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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 304313621
Report Date: 08/22/2024
Date Signed: 08/22/2024 02:30:55 PM

Document Has Been Signed on 08/22/2024 02:30 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, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME:GUILLEN, BLANCA ESTEPHANIAFACILITY NUMBER:
304313621
ADMINISTRATOR/
DIRECTOR:		FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 12CENSUS: 2DATE:
08/22/2024
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
05:59 AM
MET WITH:Blanca Estephania GuillenTIME VISIT/
INSPECTION COMPLETED:
03:00 PM
NARRATIVE
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On 8/22/2024, Licensing Program Analysts (LPA’s) Thompson and Duron conducted a case management deficiency report in conjunction with another inspection at the facility. LPA’s arrived at 5:59 AM and positioned the vehicles across the street from the family childcare home to have visual observation of the family childcare home. At the time of arrival, there were no vehicles parked on the driveway at the family childcare home. At 6:24 AM, LPA’s observed one adult male leave the family childcare home and enter into a vehicle parked directly across from family childcare home. At 7:22 AM, LPA’s observed a white SUV enter the driveway and one adult female exited then entered the home. At 7:22 AM, LPA’s observed one infant and one preschool age child being dropped off at the family childcare home.

LPA’s arrived at the front door of the family child care home at 7:38 AM and met with assistant #1 (A1) Victoria Rivera Velarde. LPA’s identified themselves by names, presented A1 with proper identification issued by the department. Victoria introduced herself as the mother of licensee Blanca Estephania Guillen and stated the licensee was not home. A1 stated licensee left at 6:00 AM to take day care children and the licensee daughter to school. LPA’s informed A1 the reason for today’s visit and asked to enter the home. A1 asked LPA’s if they can come back later or wait outside until the licensee arrives. LPA’s informed A1 of regulation 102391 Inspection Authority of the Department. A1 stated she would be back and proceeded to close the door while LPA’s waited outside. A1 allowed LPA’s to enter the home at 7:44 AM.

While touring the inside of the family childcare home, LPA’s observed two children inside the family room of the home. At 7:45 AM, LPA asked A1 if there were any other adults present. A1 replied “yes there are two families inside two different bedrooms. LPA asked to tour the bedrooms and was told no because the families were asleep and asked for the LPA’s to wait for the licensee to arrive. LPA asked A1 for the names of the adults and A1 stated the names Carlos, Rodrigo, Jose, and Oscar. A1 then stated two were male nephews inside bedroom #1 and two were male cousins inside bedroom #3.

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SUPERVISORS NAME: Thuy Ho
LICENSING EVALUATOR NAME: Patricia Duron
LICENSING EVALUATOR SIGNATURE: DATE: 08/22/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/22/2024
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, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME: GUILLEN, BLANCA ESTEPHANIA
FACILITY NUMBER: 304313621
VISIT DATE: 08/22/2024
NARRATIVE
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Licensee Blanca Estephania Guillen arrived in a black SUV at the family childcare home at approximately 7:50 AM and parked in the driveway. When licensee entered the home, LPA’s identified themselves by names, presented licensee with proper identification issued by the department, and stated the reason for the visit. Licensee stated she left the family childcare home at 7:30 AM to take her daughter to school. LPA asked if children enrolled in the childcare were dropped off as well, licensee stated “no just her daughter.” LPA informed licensee, LPA’s were present across from the home since 5:59 AM and didn’t observe licensee leave the home at 7:30 AM. Licensee replied “oh.” LPA asked licensee if LPA’s can tour bedroom #1 and bedroom #3. Licensee stated not right now because her nephews and cousins were asleep. LPA asked licensee for the names of her nephews and cousins and licensee stated the names were Jose, Cristan, Juan, and Alberto. LPA then asked licensee the name of the additional male that was observed leaving the home at 6:24 AM. Licensee replied she didn’t know. LPA asked about Rodrigo and Carlos that was previously mentioned by A1. Licensee stated the name is Jose Rodrigo Carlos. At approximately 8:10 AM, licensee stated nephew names were Jandry Rojas and Cristan Rojas. Licensee stated the cousins were Jose Rodrigo Valdez and Juan Alberto Valdez. Licensee then stated the male that left at 6:24 AM was Jose Rodrigo Valdez. Title 22, Division 12, Chapter 1 regulation 102402(a)(3) Revocation or Suspension of a License or Registration will be cited on LIC 809D.

While touring the children’s restroom at 8:17 AM, LPA’s observed an unlocked cabinet. Inside the unlocked cabinet, LPA observed Ajax with Bleach, and Raid that reads “keep out of reach of children.” Title 22, Division 12, Chapter 1 regulation 102417(g)(4) Operation of a Family Child Care Home will be cited on LIC 809D.

While reviewing children files, LPA observed child #1 (C1) did not have LIC 9227 Individual Infant Sleeping Plan and sleep logs available for review. Licensee stated the documents were misplaced. Title 22, Division 12, Chapter 1 regulation 102425(c) Infant Safe Sleep and regulation 102425(D) Infant Safe Sleep will be cited on LIC 809D.

Continue to page 3.
SUPERVISORS NAME: Thuy Ho
LICENSING EVALUATOR NAME: Patricia Duron
LICENSING EVALUATOR SIGNATURE:

DATE: 08/22/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/22/2024
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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, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME: GUILLEN, BLANCA ESTEPHANIA
FACILITY NUMBER: 304313621
VISIT DATE: 08/22/2024
NARRATIVE
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In the areas that were evaluated, three type A and two type B deficiencies were observed of the California Code of Regulations, Title 22, Division 12 at the time of the visit.

LPA Duron informed licensee Blanca Estephania Guillen that this report dated 8/22/2024 document(s) three Type A citation(s) which shall be posted for 30 consecutive days as there is/are immediate risk(s) to the health, safety, or personal rights of children in care.

Also, LPA Duron informed the licensee Blanca Estephania Guillen to provide a copy of this licensing report dated 8/22/2024, that documents any Type A citation(s) to parents/guardians of all children currently enrolled by the next business day or the next day the children are in care, and to any newly enrolled parents/guardians for 12 months from the date of this report. A signed Acknowledgement of Receipt of Licensing Report (LIC 9224), or other written statement, must be placed in the child's file for verification.

Exit interview conducted and report was reviewed with the licensee Blanca Estephania Guillen. 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.



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.
SUPERVISORS NAME: Thuy Ho
LICENSING EVALUATOR NAME: Patricia Duron
LICENSING EVALUATOR SIGNATURE:

DATE: 08/22/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/22/2024
LIC809 (FAS) - (06/04)
Page: 3 of 6
Document Has Been Signed on 08/22/2024 02:30 PM - It Cannot Be Edited


Created By: Patricia Duron On 08/22/2024 at 12:29 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
, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868

FACILITY NAME: GUILLEN, BLANCA ESTEPHANIA
FACILITY NUMBER: 304313621

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/22/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
08/22/2024
Section Cited
CCR
102402(a)(3)

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102402 Revocation or Suspension of a License or Registration (a) The Department shall have the authority to suspend or revoke any license for the following reasons:(3) Conduct in the operation or maintenance of a family day care home which is inimical to the health, morals, welfare, or safety of either an individual in or receiving services from the facility or the people of the State of California.

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Licensee stated she will submit an appeal.
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Licensee and assistant providing misinformation for four adults Jandry Rojas, Cristan Rojas, Jose Rodrigo Valdez, and Juan Alberto Valdez that were not associated to the facility and living in the home. Also. licensee stating she left the facility at 7:30 am when LPA's observed licensee was not present during that time.
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Type A
08/22/2024
Section Cited
CCR102417(g)(4)

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102417 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 be limited to: (4) Poisons, detergents, cleaning compounds, medicines, firearms and other items which could pose a danger if readily available to children shall be stored where they are inaccessible to children.

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LPA's observed cabinet locked before leaving the facility.
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While touring the children’s restroom at 8:17 AM, LPA’s observed an unlocked cabinet. Inside the unlocked cabinet, LPA observed Ajax with Bleach, and Raid that reads “keep out of reach of children.
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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:Thuy Ho
LICENSING EVALUATOR NAME:Patricia Duron
LICENSING EVALUATOR SIGNATURE:
DATE: 08/22/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/22/2024


LIC809 (FAS) - (06/04)
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Document Has Been Signed on 08/22/2024 02:30 PM - It Cannot Be Edited


Created By: Patricia Duron On 08/22/2024 at 12:36 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
, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868

FACILITY NAME: GUILLEN, BLANCA ESTEPHANIA
FACILITY NUMBER: 304313621

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/22/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
08/22/2024
Section Cited
CCR
102391(a)

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102391 Inspection Authority of the Department (a) Any duly authorized officer, employee, or agent of the Department shall, upon presentation of proper identification, enter and inspect any place providing personal care, supervision, and services at any time, with or without advance notice, to secure compliance with, or to prevent a violation of, the regulations adopted by the Department governing family child care homes, and in accordance with Section 102396.
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Licensee stated she will speak to her mother about the departments regulation.
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LPA’s arrived at the front door of the family child care home at 7:38 AM and met with assistant #1 (A1) Victoria Rivera Velarde. LPA’s identified themselves by names, presented A1 with proper identification issued by the department and A1 not allowing LPA's to enter the home for six minutes.
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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:Thuy Ho
LICENSING EVALUATOR NAME:Patricia Duron
LICENSING EVALUATOR SIGNATURE:
DATE: 08/22/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/22/2024


LIC809 (FAS) - (06/04)
Page: 5 of 6
Document Has Been Signed on 08/22/2024 02:30 PM - It Cannot Be Edited


Created By: Patricia Duron On 08/22/2024 at 12:39 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
, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868

FACILITY NAME: GUILLEN, BLANCA ESTEPHANIA
FACILITY NUMBER: 304313621

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/22/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
09/29/2024
Section Cited
CCR
102425(c)

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102425 Infant Safe Sleep (c) An Individual Infant Sleeping Plan [LIC 9227 (3/20)] shall be completed for each infant up to 12 month of age the provider has in care and maintained at the facility in the infant’s file.

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Licensee stated she will submit the documentation to LPA by POC due date.
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While reviewing children files, LPA observed child #1 (C1) did not have LIC 9227 Individual Infant Sleeping Plan. Licensee stated the documents were misplaced.
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Type B
08/29/2024
Section Cited
CCR102425(D)

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102425 Infant Safe Sleep (D) Documentation shall be maintained in the infant’s file and be available to the Department for review. Documentation shall include the following:

a. Date.
b. Infant’s name.
c. Time of each 15-minute c

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Licensee stated she will submit the documentation to LPA by POC due date.
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While reviewing children files, LPA observed child #1 (C1) did not have sleep logs available for review. Licensee stated the documents were misplaced.
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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:Thuy Ho
LICENSING EVALUATOR NAME:Patricia Duron
LICENSING EVALUATOR SIGNATURE:
DATE: 08/22/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/22/2024


LIC809 (FAS) - (06/04)
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