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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 334843195
Report Date: 09/06/2023
Date Signed: 09/06/2023 03:52:10 PM

Document Has Been Signed on 09/06/2023 03:52 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, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501
FACILITY NAME:ANGULO FAMILY CHILD CAREFACILITY NUMBER:
334843195
ADMINISTRATOR:JULIE ANGULOFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(760) 343-0944
CITY:THOUSAND PALMSSTATE: CAZIP CODE:
92276
CAPACITY: 14TOTAL ENROLLED CHILDREN: 20CENSUS: 18DATE:
09/06/2023
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
02:25 PM
MET WITH:Licensee Julie AnguloTIME COMPLETED:
04:05 PM
NARRATIVE
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On 9/6/2023 Licensing Program Analyst (LPA) Samuel Lopez conducted an inspection to address an incident that took place at the facility that should have been reported.

LPA Lopez was informed that three children were playing in the playroom and while the licensee’s assistant walked over to another area of the facility, two of those three children were pantsed. This incident was reported to the parents/legal guardians of the children involved and children placed in separate areas of the facility as a result. Although the licensee informed the parents/legal guardians and addressed it with the children involved, the licensee failed to report the incident to the Department. The licensee disclosed the incident only after LPA Lopez made contact on August 8, 2023. The regulations, in Title 22, require licensees to report such incidents to the Department, verbally within 24 hours of its occurrence or knowledge, and in writing within 7 days (via LIC 624B).

See LIC 809-D for cited deficiency

A notice of site visit was given and must remain posted on, or immediately adjacent to, the interior side of the main door for 30 days.



Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

Exit interview conducted and report was reviewed with the licensee Julie Angulo.
SUPERVISORS NAME: Aaron Ross
LICENSING EVALUATOR NAME: Samuel Lopez
LICENSING EVALUATOR SIGNATURE: DATE: 09/06/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/06/2023
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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Document Has Been Signed on 09/06/2023 03:52 PM - It Cannot Be Edited


Created By: Samuel Lopez On 09/06/2023 at 03:27 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: ANGULO FAMILY CHILD CARE
FACILITY NUMBER: 334843195

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/06/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
09/15/2023
Section Cited
CCR
102416.2(b)

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Reporting Requirement: The licensee shall report to the Department any of the events as specified in Health and Safety Code Sections 1597.467(b)(1)(A) through (b)(3)(C) that occur during the operation of the family childcare home.
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Licensee provided a completed LIC 624B regarding the incident. Licensee is to provide a written statement regarding the understanding of Reporting Requirements and a copy of the facility’s discipline policy.
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This requirement was not being met as evidenced by the licensee’s failure to report verbally and in writing, via the Unusual Incident Report form (LIC624B), the incident the pantsing of children in care. This poses a potential Health, Safety or Personal Rights risk to the children in care.
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Documents to be submitted to the Riverside Child Care Regional Office by 9/15/2023

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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:Aaron Ross
LICENSING EVALUATOR NAME:Samuel Lopez
LICENSING EVALUATOR SIGNATURE:
DATE: 09/06/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/06/2023


LIC809 (FAS) - (06/04)
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