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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 191502175
Report Date: 05/15/2023
Date Signed: 05/15/2023 05:12:48 PM

Document Has Been Signed on 05/15/2023 05:12 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
L.A. DAY CARE-EAST, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME:PLAY FACTORYFACILITY NUMBER:
191502175
ADMINISTRATOR:LANA SHIFFLETFACILITY TYPE:
850
ADDRESS:9723 GARIBALDI AVE.TELEPHONE:
(626) 285-9223
CITY:TEMPLE CITYSTATE: CAZIP CODE:
91780
CAPACITY: 74TOTAL ENROLLED CHILDREN: 74CENSUS: 65DATE:
05/15/2023
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
02:31 PM
MET WITH:Lana Shifflet, DirectorTIME COMPLETED:
05:15 PM
NARRATIVE
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Licensing Program Analyst (LPA) M. García conducted a Case Management Deficiencies Inspection to address citations observed during today’s inspection. LPA met with Lana Shifflet, Director who provided LPA with a tour of the facility both indoors and outdoors. There were sixty-five (65) children present in the facility at the time of inspection.

During a walk-through of the facility, LPA observed in the outdoor 2-year-old side yard that Staff #1 Teacher, Alexandra M. Ragos is not associated to the facility. Upon inspection of the ladybug room LPA observed that Staff #2 Teacher, Deysi Ahumada was also not associated to the facility. LPA also observed in the outdoor sand play area that Staff #3 Teacher, Victoria Castillo-Estrada is not associated to the facility. LPA called the Regional Office and determined through Department of Social Services (DSS) Guardian Background Check System and Licensing Information System (LIS) that Staff #2, #3 are both fingerprint cleared; however, they are not associated to the facility. Director and Staff #2 both stated that Deysi has been employed with the facility since two weeks ago. Director and Staff #3 both stated that Victoria has been employed with the facility since August of 2021.

REPORT CONTINUES ON NEXT PAGE 1 OF 2.

SUPERVISORS NAME: Brandi VanOosten
LICENSING EVALUATOR NAME: Mireya Garcia
LICENSING EVALUATOR SIGNATURE: DATE: 05/15/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/15/2023
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
L.A. DAY CARE-EAST, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME: PLAY FACTORY
FACILITY NUMBER: 191502175
VISIT DATE: 05/15/2023
NARRATIVE
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In records review of Staff #1 file, LPA Garcia observed DSS Caregiver Background Check Bureau (CBCB) letter head dated 02/21/2020 for immediate action required-Criminal Record Exemption needed for Alexandra Ragos. During this inspection Director could not provide LPA with exemption approval/denial from CBCB. Per Director supporting documentation for an exemption request was submitted via mail to CBCB on 03/25/2020 however, Director could not provide LPA with any proof of mailing. Director states, Staff #1 was not removed from the facility and remained in the facility while the exemption request was evaluated however, when LPA Garcia asked Director, if follow up was completed on this matter to ensure that Staff #1 exemption was approved or denied Director could not respond. This poses an immediate risk to the health and safety of children in care. A civil penalty of $1,500.00 was assessed on this day.

The deficiencies listed on the following pages were observed by the LPA and are being cited in accordance with California Code of Regulations Title 22 and/or the Health and Safety Code. Please see attached LIC 809d. Deficiencies that are being cited need to be cleared to protect the children’s health & safety.

A copy of this report shall be provided to the parent/guardian of children currently enrolled by the next business day or immediately upon return. A copy of this report shall also be provided to the parent/guardian of any newly enrolled children for the next 12 months (1 year). Acknowledgement of Receipt (LIC 9224 form) must be maintained in each child’s file immediately upon receipt from parent Director was provided with a copy of the Acknowledgement of Receipt of Licensing Reports (LIC 9224) Form (English/Spanish/Chinese).


A notice of site visit was given and must remain posted for 30 days.
Exit interview conducted and report was reviewed with facility representative, Lana Shifflet. REPORT ENDS HERE PAGE 2 OF 2.
SUPERVISORS NAME: Brandi VanOosten
LICENSING EVALUATOR NAME: Mireya Garcia
LICENSING EVALUATOR SIGNATURE:

DATE: 05/15/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/15/2023
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 05/15/2023 05:12 PM - It Cannot Be Edited


Created By: Mireya Garcia On 05/15/2023 at 04:06 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
, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME: PLAY FACTORY
FACILITY NUMBER: 191502175

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/15/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
05/15/2023
Section Cited
CCR
101170(e)(1)

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101170-Criminal Record Clearance:(e) All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1596.871 shall prior to working, residing or volunteering in a licensed facility: (1) Obtain a California clearance or a criminal record exemption as required by the Department. This requirement is not met as evidenced by:
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Per Director, a exemption request packet was mailed on March 25, 2020 however, will follow up on 05/16/2023 with the DPSS-Caregiver Background check Bureau to obtain an update regarding exemption approval or denial to ensure Staff #1 is cleared to be at the facility. During LPA's visit at 2:45 pm, staff #1 left the facility.
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LPA's record review and Director interview disclosure that Staff #1- Alexandra Ragos has criminal record exemption needed since February 21, 2020. This poses an immediate risk to the health and safety of children in care.
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Type A
05/15/2023
Section Cited
CCR101216(i)(2)

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Personnel Requirements-Prior to employment or initial presence in the child care center, all employees and volunteers subject to a criminal record review shall: (2) Request a transfer of a criminal record clearance as specified in Section 101170(f). This requirement is not met as evidenced by
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During LPAs inspection, during records review LPA observed the LIC 9182 & LIC 508 forms complete for Staff #2 & Staff #3, however no proof was provided that documents were submitted to the department for processing.
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During LPA's inspection LPA called the Regional Office and determined through DSS Guardian Background Check System and Licensing Information System (LIS) that Staff #2 & Staff #3 are both fingerprint cleared; however, they are not associated to the facility. This poses an immediate risk to the health and safety of children in care.
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 LPA was provided assistance via telephone from regional office to associate Staff #2 and #3 during this inspection. Per Director moving forward she will ensure staff are associated to the facility prior to employment.
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:Brandi VanOosten
LICENSING EVALUATOR NAME:Mireya Garcia
LICENSING EVALUATOR SIGNATURE:
DATE: 05/15/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/15/2023


LIC809 (FAS) - (06/04)
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