Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198006831
Report Date: 10/20/2015
Date Signed 10/20/2015 01:59:58 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME:VILLARREAL FAMILY CHILD CAREFACILITY NUMBER:
198006831
ADMINISTRATOR:VILLARREAL, SYLVIAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(562) 692-9283
CITY:WHITTIERSTATE: CAZIP CODE:
90606
CAPACITY:14CENSUS: 3DATE:
10/20/2015
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
12:45 PM
MET WITH:Sylvia VillarrealTIME COMPLETED:
02:15 PM
NARRATIVE
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ANNUAL RANDOM VISIT CONDUCTED IN ENGLISH
3 An Annual Random visit was conducted by Cynthia Reyes LPA. Met with licensee, who guided the analyst on a tour of the facility on this date. This is a single story home. Residing in facility are 4 Adults and 3 Children. The home was inspected for safety, comfort, cleanliness, telephone service, heating and ventilation, inaccessibility to poisons, detergents, cleaning compounds, medicines, and hazardous items that can pose a danger to children.

Areas used by children were inspected as follows: living room, dining room, family room, 1 bath rooms, and front yard.

There are NO weapons, firearms, YES *swimming pool or spa on the premises. The pool is located in the rear of the facility. The patio door leading to the pool has an attached door alarm with a lock. The gate surrounding the pool provides a clear visible view of the pool. The gate is self latching and also has locks attached. The pool currently meets Title 22 Regulations regarding pools. The backyard is adequately fenced. There are age appropriate toys and equipment on the premises. The carbon monoxide and fire extinguisher (2A 10BC) are in operable condition. CPR/First Aid Exp. 01/2017

Areas off limits include: Back Yard, 2 bedrooms, 1 bathroom, kitchen, and Garage
**Rooms that are off-limits need to be made inaccessible during operating hours** .

-Child Care Roster, Disaster Plan, Emergency Disaster Drill and Children's Records were reviewed.
-Children records and required licensing forms were discussed as well as mandated child abuse reporting and criminal records clearance (finger prints and child abuse clearance) requirement.
-Web site address to order forms: http://www.dss.cahwnet.gov/cdssweb/On-lineFor_293.htm#l
-INTERNET ADDRESS: http://www.ccld.ca.gov – To access licensing forms, updates and Title 22.
SUPERVISOR'S NAME: Claudia GuangorenaTELEPHONE: (323) 981-3417
LICENSING EVALUATOR NAME: Cynthia ReyesTELEPHONE: (323) 981-3369
LICENSING EVALUATOR SIGNATURE:

DATE: 10/20/2015
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/20/2015
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 4


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME: VILLARREAL FAMILY CHILD CARE
FACILITY NUMBER: 198006831
VISIT DATE: 10/20/2015
NARRATIVE
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The following was discussed: Individuals who are 18 years of age or older living in the home must be finger print cleared prior to licensure. Individuals within one month of their 18th birthday must be fingerprinted immediately. The existing, immediate $100 per individual Civil Penalty has been increased to an immediate $100 per day Civil Penalty, for a maximum of five days for the first violation and a maximum of 30 days for subsequent violations. If an individual has a clearance with the Department a criminal record clearance may be transferred. LIC 9182 Criminal Background Clearance Transfer Request may be used. No smoking, No infant walkers, Johnny jumpers, exersaucers and any other item that falls into that category, earthquake – fire, disaster drills and safety, posting requirements, children records requirements, mandated child abuse and injury/ death reporting, criminal records, child abuse clearance and criminal records transfer requirements, SIDS, Never Shake A Baby, Incidental Medical Services was discussed.

Applicant has been advised of the following:.
· Pools should be inaccessible by a pool cover or a 5-foot fence around the perimeter of the pool. If the fence is made out of chain link, the opening should not allow a golf ball to pass through. Fences made out of mesh will need to be approved by the department. Mesh fence will remain in place whenever licensed care is provided, and as long as the mesh fence makes the swimming pool inaccessible to children as determined by licensing staff- Licensee’s initials ( ).
· Pool cover label should read F1346-91 American Society for Testing Material and it should be able to withstand the weight of an adult without water above cover when standing.
· Dog(s) and or pets should be isolated from children in care.
· It is recommended that a First Aid kit be available on premises.
100% Outdoor supervision is required at all times. If outdoor area not adequately fenced provider must be with children at all times when outdoors. Licensee's Initials( ).

Upon receipt, licensee shall post and provide copies of this licensing report to parents/guardians of children in care at the facility and to parents/guardians of children newly enrolled at the facility during the next 12 months. When a type A deficiency is cited.

The following deficiency's are cited in accordance with Title 22 of California Code of Regulations and discussed with licensee: See 809 D attached.

An exit interview conducted with licensee, appeal rights, progressive civil penalties were explained including a copy of this report was given to the licensee and LIC 9213—Notice of Site Visit was posted during this visit. Notice of Site Visit must be posted for 30 days. Failure to post required visit reports for 30 consecutive days will result in immediate civil penalty assessment of $100.

SUPERVISOR'S NAME: Claudia GuangorenaTELEPHONE: (323) 981-3417
LICENSING EVALUATOR NAME: Cynthia ReyesTELEPHONE: (323) 981-3369
LICENSING EVALUATOR SIGNATURE:

DATE: 10/20/2015
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/20/2015
LIC809 (FAS) - (06/04)
Page: 2 of 4


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME: VILLARREAL FAMILY CHILD CARE
FACILITY NUMBER: 198006831
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/20/2015
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
10/30/2015
Section Cited
102417
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OPERATION OF A FAMILY CHILD CARE HOME

LPA observed that the smoke detectors are not in operable condition.
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Licensee states she will place new batteries in the smoke detectors by the POC date and SEND PROOF
Type B
10/30/2015
Section Cited
102417
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OPERATION OF A FAMILY CHILD CARE HOMEThe home shall be free from defects or conditions which might endanger a child.

LPA observed in the children's bathroom under the sink in the cabinets and on a shelve, several hazardous cleaning solutions.
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Licensee states will remove all hazardous items or place latches on cabinets to ensure hazardous items are made inaccessible to the children at all times during the day care days and hours. SEND PROOF
Type B
10/30/2015
Section Cited
102417(g)
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OPERATION OF A FAMILY CHILD CARE HOME. The home shall be free from defects or conditions which might endanger a child.

-There were several unused, unprotected electrical outlets observed in the home and garage (activity space)
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Licensee states she will put electrical outlet covers in all unused, unprotected electrical outlets by the POC date. SEND PROOF
Type B
10/30/2015
Section Cited
102421(a)
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Childs Records. The licensee shall maintain, in each child’s record, the signed & dated notice form LIC 995A, Parents Rights Notice. Children #1, 3, & 5 were all missing the signed Parent's Rights Notice.
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Licensee shall provide to the parents/legal guardians of all children enrolled, the Parents Rights Notice. Licensee shall maintain the signed form in each of the children's records. SEND PROOF BY THE POC 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: Claudia GuangorenaTELEPHONE: (323) 981-3417
LICENSING EVALUATOR NAME: Cynthia ReyesTELEPHONE: (323) 981-3369
LICENSING EVALUATOR SIGNATURE:

DATE: 10/20/2015
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/20/2015
LIC809 (FAS) - (06/04)
Page: 4 of 4


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME: VILLARREAL FAMILY CHILD CARE
FACILITY NUMBER: 198006831
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/20/2015
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
10/20/2015
Section Cited
102370(d)(1)
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Criminal Record Clearance. All individuals subject to a criminal record review as specified in Section 1596.871 prior to working, residing or volunteering in a licensed home, shall obtain a California clearance or a criminal record exemption as required by the Department.
Civil Penalty assessed.
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Licensee states will have her son fingerprint cleared immediately. Licensee states will send proof by the POC date.
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At the time of this visit, the LPA was able to determine that the licensee son turned 18 in August and is still living in the home unfingerprint cleared.
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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: Claudia GuangorenaTELEPHONE: (323) 981-3417
LICENSING EVALUATOR NAME: Cynthia ReyesTELEPHONE: (323) 981-3369
LICENSING EVALUATOR SIGNATURE:

DATE: 10/20/2015
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/20/2015
LIC809 (FAS) - (06/04)
Page: 3 of 4