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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 336300474
Report Date: 03/13/2023
Date Signed: 03/13/2023 03:03:05 PM

Document Has Been Signed on 03/13/2023 03:03 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 STREET, STE 700
RIVERSIDE, CA 92501
FACILITY NAME:VICTOR FAMILY CHILD CAREFACILITY NUMBER:
336300474
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 4CENSUS: 2DATE:
03/13/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
01:30 PM
MET WITH:Consuelo VictorTIME COMPLETED:
03:15 PM
NARRATIVE
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On March 13th, 2023, Licensing Program Analyst (LPA), Sumayya Habeebulla arrived at the facility for another purpose. LPA met with Licensee Consuelo Victor and discussed the deficiencies observed during the visit.

LPA observed the stairs were not gated and there was a child under five years present during the visit. The child was upstairs in the Off Limits area. LPA reminded Licensee that childcare children cannot be in Off Limit areas. Licensee immediately brought the child downstairs to the childcare area.

During the tour of the facility, it was observed there was a walker present at the facility. The walker/exersaucers has been in use at the facility for some time as per Licensee. Licensee stated it belongs to one of the child in care and Licensee removed it from the child care when advised.

It was also observed there were cleaning supplies out on the counters in the Kitchen and Family Room area.

See LIC 809D for Deficiencies

An exit interview was conducted, and a copy of this report was provided to Licensee Consuelo Victor.

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

SUPERVISORS NAME: Carlos Martinez
LICENSING EVALUATOR NAME: Sumayya Habeebulla
LICENSING EVALUATOR SIGNATURE: DATE: 03/13/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/13/2023
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 3
Document Has Been Signed on 03/13/2023 03:03 PM - It Cannot Be Edited


Created By: Sumayya Habeebulla On 03/13/2023 at 02:34 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 STREET, STE 700
RIVERSIDE, CA 92501

FACILITY NAME: VICTOR FAMILY CHILD CARE
FACILITY NUMBER: 336300474

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/13/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
03/16/2023
Section Cited
CCR
102417(g)(10)

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A baby walker shall not be allowed on the premises of a family child care home in accordance with Health and Safety Code Section 1596.846(b) and (c).This requirement was not met as evidenced by:
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Based on observation and interviews it was observed facility has been using a walker/Exersaucer in the premise which poses a potential, heath, safety or personal rights risk to children in care.
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Licensee agrees to remove the equipment from the premises and submit a statement to the department by the POC due date stating that Licensee has reviewed Title 22 Regulations and will not use any such prohibited equipments.
Type B
03/16/2023
Section Cited
CCR102417(g)(4)

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(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 .....
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 There were cleaning products - Clorox, Lysol and other products on the counter and floor of the kitchen and family room, which poses a potential health, safety or personal rights risk to persons in care.
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This requirement is not met as evidenced by:
Based on observation, the licensee did not comply with the section cited above in having cleaning supplies stored out of reach of children in care>>>>
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Licensee agrees to lock up all cleaning compounds and send pictures of the correction to the department by the POC due 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:Carlos Martinez
LICENSING EVALUATOR NAME:Sumayya Habeebulla
LICENSING EVALUATOR SIGNATURE:
DATE: 03/13/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/13/2023


LIC809 (FAS) - (06/04)
Page: 2 of 3
Document Has Been Signed on 03/13/2023 03:03 PM - It Cannot Be Edited


Created By: Sumayya Habeebulla On 03/13/2023 at 02:44 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 STREET, STE 700
RIVERSIDE, CA 92501

FACILITY NAME: VICTOR FAMILY CHILD CARE
FACILITY NUMBER: 336300474

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/13/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
03/17/2023
Section Cited
CCR
102417(g)(3)

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Where children less than five years old are in care, stairs shall be fenced or barricaded.
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Based on observation and interviews it was observed the stairs were not gated when the childcare children under 5 were present which poses a potential, heath, safety or personal rights risk to children in care
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Licensee agrees to ensure to barricade the stairs at all times when children under 5 are present. Licensee gated the stairs during the visit today.

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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:Carlos Martinez
LICENSING EVALUATOR NAME:Sumayya Habeebulla
LICENSING EVALUATOR SIGNATURE:
DATE: 03/13/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/13/2023


LIC809 (FAS) - (06/04)
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