Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198006831
Report Date: 03/20/2018
Date Signed 03/20/2018 02:18:53 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) 447-0149
CITY:WHITTIERSTATE: CAZIP CODE:
90606
CAPACITY:14CENSUS: 7DATE:
03/20/2018
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
12:15 PM
MET WITH:Sylvia Villarreal TIME COMPLETED:
02:25 PM
NARRATIVE
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ANNUAL RANDOM VISIT CONDUCTED IN ENGLISH
An Annual Random Inspection 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 2 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. Days & Hours 7 AM-6 PM

Areas used by children were inspected as follows: kitchen, 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. Licensee Ped. CPR/First Aid Exp. 04/2019

Areas off limits include: Back Yard, 2 bedrooms, 1 bathroom 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.
SUPERVISOR'S NAME: Claudia GuangorenaTELEPHONE: (323) 981-3417
LICENSING EVALUATOR NAME: Cynthia ReyesTELEPHONE: (323) 981-3369
LICENSING EVALUATOR SIGNATURE:

DATE: 03/20/2018
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/20/2018
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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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: 03/20/2018
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( ).

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

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: 03/20/2018
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/20/2018
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
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: 03/20/2018
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
03/30/2018
Section Cited
CCR
102416.3(a)(6)
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ALTERATION TO EXISTING BUILDING OR GROUNDS Prior to any alteration, the licensee shall notify the Department of any change from an area of the home previously identified as “off limits” to an area where care & supervision will be provided to children in care.
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Licensee stated she want to request to use the kitchen for the children, LPA did a walk threw with the licensee & advised Licensee what needs to be fixed. Licensee states she will send the department a letter on how she will ensure the kitchen will be in compliance at all times. by the POC date.
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LPA observed a child sitting on the Kitchen floor, before and after children walked threw the kitchen which is an "off limit" area to the children in care.
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Type B
03/30/2018
Section Cited
CCR
102423(a)(2)(4)
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Personal Rights: Each child receiving services from a family child care home shall have certain rights. These rights include, but are not limited to, the following: To be free from corporal or unusual punishment, infliction of pain, humiliation, intimidation, ridicule, coercion, threat, mental abuse, or
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Licensee states she will go on the department web site per the LPA who is requesting that her & her Staff review the Department’s training videos at https://ccld.childcarevideos.org/ in regards to personal rights which will assist in increasing their understanding of
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other actions of a punitive nature, including, but not limited to: interference with eating, sleeping or toileting. LPA observed licensee granddaughter eating apple sauce in front of the other children. Other children were waiting for their lunch & 1 child was seen reaching & following her for her snack.
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children's personal rights.
Licensee will send a certificate or letter to the department on what she reviewed by the POC date.
Licensee ended up feeding all the children together at the same time as her granddaughter on this 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: 03/20/2018
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/20/2018
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
CCLD Regional Office, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME: VILLARREAL FAMILY CHILD CARE
FACILITY NUMBER: 198006831
VISIT DATE: 03/20/2018
NARRATIVE
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-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.

AB1207 Mandated Child Abuse Reporting – Implementation was discussed with Licensee. Website provided: http://mandatedreporterca.com/

Health & Safety Code 1597.622(a1)

Employees or volunteers at family day care home; immunization requirements; records; exemptions. 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.



Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Family Child Care Homes Section 102417. 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: http://www.ada.gov/childqanda.htm
SUPERVISOR'S NAME: Claudia GuangorenaTELEPHONE: (323) 981-3417
LICENSING EVALUATOR NAME: Cynthia ReyesTELEPHONE: (323) 981-3369
LICENSING EVALUATOR SIGNATURE:

DATE: 03/20/2018
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/20/2018
LIC809 (FAS) - (06/04)
Page: 3 of 4