334810456-3-11-2026-09-CC-SBRR-DS3TRZ-20260311145823

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 334810456
Report Date: 03/11/2026
Date Signed: 03/11/2026 02:59:19 PM

Document Has Been Signed on 03/11/2026 02:59 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
RIVERSIDE CC RO, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501

FACILITY NAME:	VELASCO FAMILY CHILD CARE		FACILITY NUMBER:	334810456
ADMINISTRATOR/ DIRECTOR:	JUANA VELASCO		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(951) 361-3146
CITY:	JURUPA VALLEY	STATE: CA	ZIP CODE:	92509
CAPACITY: 14	TOTAL ENROLLED CHILDREN: 17	CENSUS: 12	DATE:	03/11/2026
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	08:35 AM
MET WITH:	Juana Velasco, Licensee		TIME VISIT/ INSPECTION COMPLETED:	03:15 PM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	On date and time listed above, Licensing Program Analyst (LPA) Susan Brewer arrived at the facility to conduct an annual inspection and was granted entry by Licensee Juana Velaso. LPA toured the facility, reviewed records, and observed and/or discussed the following: Present were the Licensee, 1 resident adult, one assistant. The licensee's spouse was available to assist with the inspection for interpretation. The licensee updated the LIC999A Home Sketch for off-limit areas and designated daycare areas. The licensee agrees to submit a new LIC999A outdoor facility sketch to reflect upgrades to the back yard, including accurate locations of the pool, the pool house, side yards and patio areas. The Licensee agrees to update the LIC279 Application form for reported changes. Days and hours of operation: Monday - Friday, 6:00 AM to 6:00 PM OFF-LIMIT AREAS INCLUDE: Master Bedroom/Bath 1, Bedroom 2, Garage, Pool house, Pool, Garage. The inspection consisted of reviews of the CARE tool domains. The inspection found the facility to be in compliance except as noted on the LIC809D. Deficiencies were cited this visit. The Licensee is present and operating within the licensed capacity with approved supervision and ratio. The LPA took a census of 12 children with 2 assistants. A working telephone is verified. A fully charged fire extinguisher (2A:10BC) was observed and tagged by the fire department and needle in the green. A smoke detector and carbon monoxide detector were present and tested by the licensee during this inspection on 03/11/2026.

NAME OF LICENSING PROGRAM MANAGER: Ana Noble
NAME OF LICENSING PROGRAM ANALYST: Susan Brewer
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 03/11/2026

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/11/2026

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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California Health & Human Services Agency

California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:

Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.

Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)

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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
RIVERSIDE CC RO, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501

FACILITY NAME: VELASCO FAMILY CHILD CARE	FACILITY NUMBER: 334810456
	VISIT DATE: 03/11/2026

NARRATIVE

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All hazardous items are NOT inaccessible to children. Storage of poisons and toxins are NOT locked. The LPA observed air fresheners, a Bic lighter wand, sharp kitchen tools, vitamin supplements, unopened wine bottles and medications in the refrigerator, household cleaning items accessible to daycare children in the kitchen and dining room. The licensee also has a lower-level mini beverage refrigerator with unopened wine bottles. The LPA observed hygiene products accessible in a lower restroom cabinets, medicine cabinet and hallway cabinet. No children were observed in the kitchen, dining room, or restroom at the time of the observations. The licensee removed most of the items to make inaccessible in the presence of the LPA, however additional corrections are pending for future storage.

A fireplace is properly screened on today’s date.
This is a single story home.
Facility is clean, orderly and has adequate heating and ventilation.
Facility has safe, age-appropriate toys for indoor and outdoor activities.
Outdoor play area is fenced.
Verification of control of property on file. The licensee owns their own home and deed of trust on file.
The following postings are visible: License, Emergency Disaster Plan (LIC610) and Earthquake Preparedness Checklist (LIC9148); Parent’s Rights Poster (PUB393); Personal Rights; Child Car Seat Law and facility sketch.
Pediatric CPR and First Aid Card expires on: 02/15/2027
Health & Safety Certificate - completed on 08/21/2001
Mandated reporter: Child Care Expired: 09/12/2025.
Fire clearance: 11/02/2009; Documentation of fire & earthquake drills completed on 02/06/2026 at 9:00 AM with 5 children in care and 3:00 PM with 10 children in care
Children/Infant records are NOT complete: 2 infants present did not have sleep logs; 1 infant missing all required documentation to include immunization records, 2 children were missing immunization, the licensee provided proof of immunization records for two children prior to the LPA closing the inspection.
Employee records are NOT complete: Missing proof of TB screening, Immunization records, and Mandated Reporter Training.
Guns or weapons are present as stated by the Licensee Juana Velasco. The Licensee understands all guns, weapons and ammunition must be locked key separately and made inaccessible per Title 22 regulations. The LPA verified the weapons and ammunition were key locked separately and made inaccessible to daycare children.

NAME OF LICENSING PROGRAM MANAGER: Ana Noble
NAME OF LICENSING PROGRAM ANALYST: Susan Brewer
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 03/11/2026

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/11/2026

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
RIVERSIDE CC RO, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501

FACILITY NAME: VELASCO FAMILY CHILD CARE	FACILITY NUMBER: 334810456
	VISIT DATE: 03/11/2026

NARRATIVE

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There are bodies of water during this visit Licensee understands all bodies of water must be properly covered or fenced per Title 22 regulations. The Department must be notified before and after installation of the above types of water bodies. Licensee has not implemented required pool safety in accordance with PIN 25-01-CCP. The pool was observed to be surrounded by mesh fencing with metal posts. The mesh panels were observed to be stable and without damage. During the inspection the equipment was tested and observed to be faulty. The LPA pool entry gate was not able to shut and self-latch. The licensee’s spouse placed oil in the device. The device was retested and the gated was observed to self-latch. The licensee was missing the daily pool inspection log, a pool alarm, pole with hook, and a life ring.

Additionally, the following was reviewed with Licensee.
- AB 1207 – Mandated Child Abuse Reporting: Child Day Care Personnel Training, beginning January 1, 2018 – Requires all licensed providers, applicants, directors and employees to complete training as specified on their mandated reporter duties and to renew their training every two years.
-AB2960 – This bill requires the State Superintendent of Public Instruction (SSPI), within the California Department of Education (CDE), to develop and post on CDE's website a comprehensive childcare and development services online portal for families and providers by June 30, 2022.
- Effective January 1, 2017 – Children under 2 years of age shall ride in a rear-facing car seat unless the child weighs 40 or more pounds OR is 40 or more inches tall. For additional information regarding car seat laws see www.chp.ca.gov

-Unusual Incident Reporting email: UnusualIncidentReportsDO09@dss.ca.gov
-Duty Officer availability: Mon. – Fri. at 1-844-LET-US-NO (1-844-538-8766)
-Access to forms & Regulations online at www.ccld.ca.gov
-Licensee is responsible to know the regulations for anyone providing care
-Failure to meet the posting requirements shall result in an immediate civil penalty
-To receive important licensed -related information to licensed facilities, visit the CCLD Important Information website at https://www.cdss.ca.gov/inforesources/community-care-licensing/subscribe and select the Child Care option to receive email communication
Licensee Juana Velasco as 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.

NAME OF LICENSING PROGRAM MANAGER: Ana Noble
NAME OF LICENSING PROGRAM ANALYST: Susan Brewer
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 03/11/2026

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/11/2026

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
RIVERSIDE CC RO, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501

FACILITY NAME: VELASCO FAMILY CHILD CARE	FACILITY NUMBER: 334810456
	VISIT DATE: 03/11/2026

NARRATIVE

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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 Juana Velasco 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 Susan Brewer discussed the safe sleep regulations with licensee Juana Velasco 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.

LPA also informed licensee Juana Velasco of the importance of checking for and removing any 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.

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.

NAME OF LICENSING PROGRAM MANAGER: Ana Noble
NAME OF LICENSING PROGRAM ANALYST: Susan Brewer
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 03/11/2026

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/11/2026

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
RIVERSIDE CC RO, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501

FACILITY NAME: VELASCO FAMILY CHILD CARE	FACILITY NUMBER: 334810456
	VISIT DATE: 03/11/2026

NARRATIVE

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During the exit interview, the Licensee Juana Velasco, confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS.

Type B deficiencies were issued on today’s date.

No civil penalties were issued on today’s date.

A notice of site visit was given and must remain posted for 30 days.

Exit interview conducted and report was reviewed with the licensee Juana Velasco.

NAME OF LICENSING PROGRAM MANAGER: Ana Noble
NAME OF LICENSING PROGRAM ANALYST: Susan Brewer
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 03/11/2026

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/11/2026

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 03/11/2026 02:59 PM - It Cannot Be Edited

Created By: Susan Brewer On 03/11/2026 at 01:26 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
, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501

FACILITY NAME: VELASCO FAMILY CHILD CARE	FACILITY NUMBER: 334810456
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 03/11/2026

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

102417(g)(4)

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 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. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on (observation) (interview), the licensee did not comply with the section cited above in the LPA observed air fresheners, a Bic lighter wand, sharp kitchen tools, vitamin supplements, unopened wine bottles, medications in kitchen refrigerator, household cleaning items in the kitchen & dining room; hygiene products accessible in a lower restroom cabinets & hallway cabinet; which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 04/10/2026
	Plan of Correction
1 2 3 4	The licensee agrees to ensure the facility is free from defects or conditions which might endanger a child. Safety precautions shall include but not 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 and submit proof of items made inaccessible to daycare children.

Type B

Section Cited

CCR

102425(b)

Infant Safe Sleep

(b) Cribs or play yards shall be free from all loose articles and objects. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on (observation) (interview) (record review), the licensee did not comply with the section cited above in on today's date the licensee placed an infant to sleep in a crib with a pillow and blanket, which poses a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 03/11/2026
	Plan of Correction
1 2 3 4	The licensee agrees to ensure cribs or play yards shall be free from all loose articles and objects, and agrees to submit a written statement of understanding the Infant Safe Sleep Standards to the department by fax, mail or email.

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

	Ana Noble
NAME OF LICENSING PROGRAM MANAGER:

	Susan Brewer
NAME OF LICENSING PROGRAM ANALYST:

LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 03/11/2026

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/11/2026

LIC809 (FAS) - (06/04)

Page: 7 of 17

Document Has Been Signed on 03/11/2026 02:59 PM - It Cannot Be Edited

Created By: Susan Brewer On 03/11/2026 at 01:26 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
, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501

FACILITY NAME: VELASCO FAMILY CHILD CARE	FACILITY NUMBER: 334810456
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 03/11/2026

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

HSC

1596.814(a)(1)(B)(ii)(I)

Pool Safety

(ii) (I) An alarm that, when placed in a swimming pool, will sound upon detecting an entrance into the water. The alarm shall be turned on and be in working condition during a facility’s operating hours while the swimming pool is not in use. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on (observation) (interview) (record review), the licensee did not comply with the section cited above in the licensee failed to ensure a working pool alarm is placed in the swimming pool during operating hours, which poses a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 04/10/2026
	Plan of Correction
1 2 3 4	The licensee agrees to ensure an alarm is placed in the swimming pool, and will sound upon detecting an entrance into the water. In addition, the licensee agrees to ensure the alarm shall be turned on and be in working condition during a facility’s operating hours while the swimming pool is not in use; and submit proof of a working pool alarm to the department by video.

Type B

Section Cited

HSC

1596.814(a)(2)(A)

Pool Safety

(a) A licensed family daycare home operated at a private single-family dwelling with an in-ground swimming pool on the premises shall comply with all of the following requirements: (2) The licensee shall have the following safety equipment visible from the swimming pool and readily available for immediate use: (A) A life ring with a minimum exterior diameter of 17 inches and labeled as approved by the United States Coast Guard. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on (observation) (interview), the licensee did not comply with the section cited above in the licensee was unable to provide proof of a life ring in compliance with HSC 1596.814(a)(2)(A)which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 04/10/2026
	Plan of Correction
1 2 3 4	The licensee agrees to ensure a family daycare home operated at a private single-family dwelling with an in-ground swimming pool on the premises...(2) The licensee shall have the following safety equipment visible from the swimming pool and readily available for immediate use: (A) A life ring with a minimum exterior diameter of 17 inches & labeled as approved by the United States Coast Guard; and submit proof equipment to the department by fax, mail or e-mail.

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

	Ana Noble
NAME OF LICENSING PROGRAM MANAGER:

	Susan Brewer
NAME OF LICENSING PROGRAM ANALYST:

LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 03/11/2026

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/11/2026

LIC809 (FAS) - (06/04)

Page: 8 of 17

Document Has Been Signed on 03/11/2026 02:59 PM - It Cannot Be Edited

Created By: Susan Brewer On 03/11/2026 at 01:26 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
, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501

FACILITY NAME: VELASCO FAMILY CHILD CARE	FACILITY NUMBER: 334810456
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 03/11/2026

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

HSC

1596.814(a)(2)(B)

Pool Safety

(a) A licensed family daycare home operated at a private single-family dwelling with an in-ground swimming pool on the premises shall comply with all of the following requirements: (2) The licensee shall have the following safety equipment visible from the swimming pool and readily available for immediate use: (B) A rescue pole with a body hook and a minimum fixed length of 12 feet. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on (observation) (interview), the licensee did not comply with the section cited above in the licensee did not ensure a rescue pole with a body hook and a minimum fixed length of 12 feet, which poses a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 04/10/2026
	Plan of Correction
1 2 3 4	The licensee agrees to ensure a rescue pole with a body hook and a minimum fixed length of 12 feet, and the safety equipment is visible from the swimming pool and readily available for immediate use. The licensee also agrees to ensure they submit proof of equipment obtained and placed in the visable location by fax, mail or email.

Type B

Section Cited

HSC

1596.814(a)(3)

Pool Safety

(a) A licensed family daycare home operated at a private single-family dwelling with an in-ground swimming pool on the premises shall comply with all of the following requirements: (3) A licensee shall perform a daily inspection of the drowning prevention safety features and safety equipment before opening the facility and maintain a log of the inspections to be provided to the department upon request. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on [(observation) (interview) (record review)], the licensee did not comply with the section cited above in the licensee was unable to provide proof that a daily inspection of the drowning prevention safety features and safety equipment is performed before opening the facility and a log of the inspections is maintained, to be provided to the department upon request. which poses a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 04/10/2026
	Plan of Correction
1 2 3 4	The licensee agrees to ensure a daily inspection is perfomed of the drowning prevention safety features and safety equipment before opening the facility and maintain a log of the inspections to be provided to the department upon request and submit proof of the daily inspection log for the pool, by fax, mail or email.

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

	Ana Noble
NAME OF LICENSING PROGRAM MANAGER:

	Susan Brewer
NAME OF LICENSING PROGRAM ANALYST:

LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 03/11/2026

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/11/2026

LIC809 (FAS) - (06/04)

Page: 9 of 17

Document Has Been Signed on 03/11/2026 02:59 PM - It Cannot Be Edited

Created By: Susan Brewer On 03/11/2026 at 01:26 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
, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501

FACILITY NAME: VELASCO FAMILY CHILD CARE	FACILITY NUMBER: 334810456
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 03/11/2026

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

HSC

1596.8662(b)(1)

Administration of Child Day Care Licensing

(1) On or before March 30, 2018, a person who, on January 1, 2018, is a licensed child day care provider, administrator, or employee of a licensed child day care facility shall complete the mandated reporter training provided pursuant to paragraphs (2) and (3) of subdivision (a), and shall complete renewal mandated reporter training every two years following the date on which he or she completed the initial mandated reporter training. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on [(observation) (interview) (record review)], the licensee did not comply with the section cited above in the licensee did not complete a renewal of the mandated reporter training after 09/12/2025, a was unable to provide proof of mandated reporter training completed by employees present which poses a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 04/10/2026
	Plan of Correction
1 2 3 4	The licensee agrees to ensure a licensed child day care provider, administrator, or employee of a licensed child day care facility shall complete the mandated reporter training provided pursuant to paragraphs (2) and (3) of subdivision (a), and shall complete renewal mandated reporter training every two years following the date on which he or she completed the initial mandated reporter training, and submit proof of training by fax, mail or email.

Type B

Section Cited

CCR

102416.1(d)

Personnel Records

(d) All personnel records shall be maintained at the child care home and shall be available to the licensing agency for review. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on [(observation) (interview) (record review)], the licensee did not comply with the section cited above in the licensee was unable to provide proof of records for an assistant present and caring for children which poses a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 04/10/2026
	Plan of Correction
1 2 3 4	The licensee agrees to ensure personnel records shall be maintained at the child care home and shall be available to the licensing agency for review and submit proof of employee records by fax, mail and e-mail.

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

	Ana Noble
NAME OF LICENSING PROGRAM MANAGER:

	Susan Brewer
NAME OF LICENSING PROGRAM ANALYST:

LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 03/11/2026

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/11/2026

LIC809 (FAS) - (06/04)

Page: 10 of 17

Document Has Been Signed on 03/11/2026 02:59 PM - It Cannot Be Edited

Created By: Susan Brewer On 03/11/2026 at 01:26 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
, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501

FACILITY NAME: VELASCO FAMILY CHILD CARE	FACILITY NUMBER: 334810456
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 03/11/2026

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

HSC

1597.622(a)(1)

General Provisions and Definitions

(1) Commencing September 1, 2016, a person shall not be employed or volunteer at a family day care home if he or she has not been immunized against influenza, pertussis, and measles. Each employee and volunteer shall receive an influenza vaccination between August 1 and December 1 of each year. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on [(observation) (interview) (record review)], the licensee did not comply with the section cited above in the licensee was unable to provide proof of immunization for an employee present and supervising children which poses a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 04/10/2026
	Plan of Correction
1 2 3 4	The licensee agrees to ensure a person shall not be employed or volunteer at a family day care home if he or she has not been immunized against influenza, pertussis, and measles. Each employee and volunteer shall receive an influenza vaccination between August 1 and December 1 of each year; and submit proof of immunizations for employees by fax, mail or email.

Type B

Section Cited

CCR

102418(g)

Immunizations

(g) The licensee shall document each child's immunizations as required by the California Code of Regulations, Title 17, Section 6070, and shall maintain such documentation for as long as the child is enrolled. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on [(observation) (interview) (record review)], the licensee did not comply with the section cited above in 3 children present and in care were missing proof of immunization records, which poses a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 04/10/2026
	Plan of Correction
1 2 3 4	The licensee agrees to ensure each child's immunizations are documented as required by the California Code of Regulations, Title 17, Section 6070, and shall maintain such documentation for as long as the child is enrolled; and agrees to submit proof of immunizations for a subject child by fax, mail or email.

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

	Ana Noble
NAME OF LICENSING PROGRAM MANAGER:

	Susan Brewer
NAME OF LICENSING PROGRAM ANALYST:

LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 03/11/2026

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/11/2026

LIC809 (FAS) - (06/04)

Page: 11 of 17

Document Has Been Signed on 03/11/2026 02:59 PM - It Cannot Be Edited

Created By: Susan Brewer On 03/11/2026 at 01:26 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
, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501

FACILITY NAME: VELASCO FAMILY CHILD CARE	FACILITY NUMBER: 334810456
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 03/11/2026

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

102417(g)(7)

Operation of A Family Child Care Home

(7) An emergency information card shall be maintained for each child and shall include the child's full name, telephone number and location of a parent or other responsible adult to be contacted in an emergency, the name and telephone number of the child's physician and the parent's authorization for the licensee or registrant to consent to emergency medical care. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on [(observation) (interview) (record review)], the licensee did not comply with the section cited above in the licensee was unable to provide proof of the LIC700 Emergency Information record and the LIC627 medical consent record for a subject child in care, which poses a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 03/16/2026
	Plan of Correction
1 2 3 4	The licensee agrees to ensure an emergency information card shall be maintained for each child and shall include the child's full name, telephone number and location of a parent or other responsible adult to be contacted in an emergency, the name and telephone number of the child's physician and the parent's authorization for the licensee or registrant to consent to emergency medical care; and submit proof of records to the department by fax, mail or e-mail.

Section Cited


	Deficient Practice Statement
1 2 3 4
	POC Due Date:
	Plan of Correction
1 2 3 4

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

	Ana Noble
NAME OF LICENSING PROGRAM MANAGER:

	Susan Brewer
NAME OF LICENSING PROGRAM ANALYST:

LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 03/11/2026

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/11/2026

LIC809 (FAS) - (06/04)

Page: 12 of 17

Document Has Been Signed on 03/11/2026 02:59 PM - It Cannot Be Edited

Created By: Susan Brewer On 03/11/2026 at 01:26 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
, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501

FACILITY NAME: VELASCO FAMILY CHILD CARE	FACILITY NUMBER: 334810456
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 03/11/2026

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

102419(d)(1)

Admission Procedures and Authorized Representatives Rights

(d) At the time of acceptance of each child into care, the licensee shall provide the child's parent or authorized representative with a copy of the notice Family Child Care Home Notification of Parent's Rights, LIC 995A (8/06), the Caregiver Background Check Process, LIC 995E (6/05), and the Family child Care Consumer Awareness Information, LIC 9212 (10/05). (1) The licensee shall request the child's parent or authorized representative to sign and date the bottom portion of the notice form LIC 995A (8/06), which acknowledges that the parent or authorized representative has received and read the LIC 995A. The bottom portion of this form must be kept in the child’s file as proof that the parent or authorized representative has been notified of his or her rights and received a copy of the Caregiver background Check Process, LIC 995E (6/05), and the Family Child Care Consumer Awareness Information, LIC 9212 (10/05). This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on [(observation) (interview) (record review)], the licensee did not comply with the section cited above in the licensee was unable to provide proof of the LIC995A Parents Rights Notification form for a subject child which poses a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 03/16/2026
	Plan of Correction
1 2 3 4	The licensee agrees to ensure the above regulatio is met and a copy of the bottom portion of this 995A form is kept in the child’s file as proof that the parent or authorized representative has been notified of his or her rights and received a copy of the Caregiver background Check Process, LIC995E (6/05), and the Family Child Care Consumer Awareness Information, LIC 9212 (10/05). The licensee agrees to submit proof of the signed receipt by fax, mail or email.

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

	Ana Noble
NAME OF LICENSING PROGRAM MANAGER:

	Susan Brewer
NAME OF LICENSING PROGRAM ANALYST:

LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 03/11/2026

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/11/2026

LIC809 (FAS) - (06/04)

Page: 13 of 17

Document Has Been Signed on 03/11/2026 02:59 PM - It Cannot Be Edited

Created By: Susan Brewer On 03/11/2026 at 01:26 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
, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501

FACILITY NAME: VELASCO FAMILY CHILD CARE	FACILITY NUMBER: 334810456
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 03/11/2026

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

102425(c)

Infant Safe Sleep

An Individual Infant Sleeping Plan [LIC 9227 (3/20)] shall be completed for each infant up to 12 months of age the provider has in care and included in the infant's file at the facility. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on [(observation) (interview) (record review)], the licensee did not comply with the section cited above in the licensee was unable to provide proof of a LIC9227 Safe Sleep Plan for an infant under 12 months of age, while in care and during a review of records, which poses a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 03/16/2026
	Plan of Correction
1 2 3 4	The licensee agrees to ensure an Individual Infant Sleeping Plan [LIC 9227 (3/20)] shall be completed for each infant up to 12 months of age the provider has in care and included in the infant's file at the facility; and submit proof of a completed plan with the authorized representative, to the department by fax, mail or e-mail.

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
1 2 3 4	Based on [(observation) (interview) (record review)], the licensee did not comply with the section cited above inthe licensee was unable to provide proof of 15 minute sleep logs for 2 infants in care which poses a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 03/16/2026
	Plan of Correction
1 2 3 4	The licensee agrees to ensure a 15-minute check log is completed for each infant under 24 months of age and is maintained in the infant’s file... Documentation shall include the following: maintained in the infant’s file and be available to the Department for review and shall include the following: the child's name, the date, the time of each 15-minute check, the physical status of the child's skin, position, temperature and breathing. The licensee also agrees to submit proof of the sleep log by fax, mail or e-mail.

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

	Ana Noble
NAME OF LICENSING PROGRAM MANAGER:

	Susan Brewer
NAME OF LICENSING PROGRAM ANALYST:

LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 03/11/2026

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/11/2026

LIC809 (FAS) - (06/04)

Page: 14 of 17