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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 192001144
Report Date: 03/05/2025
Date Signed: 03/10/2025 04:55:46 PM

Document Has Been Signed on 03/10/2025 04:55 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
MONTEREY PARK CC RO, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME:PLASENCIA FAMILY CHILD CAREFACILITY NUMBER:
192001144
ADMINISTRATOR/
DIRECTOR:		PLASENCIA, DOLORESFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(626) 353-0702
CITY:MONROVIASTATE: CAZIP CODE:
91016
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 4DATE:
03/05/2025
TYPE OF VISIT:Required - 3 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:00 AM
MET WITH:Delores PlasenciaTIME VISIT/
INSPECTION COMPLETED:
02:00 PM
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Licensing Program Analyst (LPA) Kamile Martin and Cynthia Reyes conducted an unannounced 3 year annual inspection in English on this date. This inspection is to ensure the health and safety standards as required by the regulations governing childcare homes are met. LPA's met with Licensee Dolores Plasencia and a copy of the Entrance Checklist for Child Care homes form (LIC 126) was provided. The facility operating hours are from 6 AM to 530 PM, Monday through Friday.

Licensee guided analysts on a tour of the facility. Per Licensee, there are no infants currently enrolled. A current children’s roster was available for review. There was 3 children present upon arrival. 1 child arrived at 10:00am while this inspection was already in process.

The licensee states that 3 adults and 0 children currently live in the home. All adults present in the home have obtained a criminal record clearance or exemption prior to working, residing or volunteering in the licensed child care home. Licensee states that there are no firearms or weapons in the home. There are no swimming pools or bodies of water observed on the premises. There were age appropriate toys and play equipment.

Areas that are accessible to children are as follows: Family room, W/Covered fire place, bathroom and back yard.

Areas off limits: Garage, Master bedroom W/Bath, 2 bedrooms, dinning area, front living room and front yard. **Rooms that are off-limits need to be made inaccessible during operating hours** The Licensee does understand that licensing staff may have access to off-limit areas during inspection visit if necessary.
Continue on next page.
SUPERVISORS NAME: Christina Gabelman
LICENSING EVALUATOR NAME: Kamile Martin
LICENSING EVALUATOR SIGNATURE: DATE: 03/05/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/05/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.

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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
MONTEREY PARK CC RO, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME: PLASENCIA FAMILY CHILD CARE
FACILITY NUMBER: 192001144
VISIT DATE: 03/05/2025
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The following was observed and reviewed during this inspection.
All areas identified on the facility sketch were inspected for safety, comfort, and cleanliness. There is telephone service via a land line however it is not working as of this date and a cellphone that stays at the facility during operation hours. There is ventilation and heating (central).

Several different cleaning compounds were observed to be accessible to children under the kitchen sink as the plastic locks are broken and are easy to open. The restroom that children use was observed to be clean and free of hazardous materials. Kitchen is off limits but LPAs observed licensee walk in the kitchen holding a child. LPAs informed licensee no children are allowed at any time in the off limits kitchen.

LPA's observed a fireplace in the home and it is barricaded. The valve on the required 2A 10BC fire extinguisher indicates fully charged with last service date of 02/12/2025. Smoke detector tested not operable and carbon monoxide detector was tested and is operable. All large family day care homes shall conduct fire and disaster drills at least once every 3 months, and document the date and time of each drill. No proof of any drills conducted. Parent’s Rights Poster and the Facility License were observed to be posted on the parent board and visible to parents and all to see. Emergency disaster plan missing from parent board.

The home is observed to be clean and orderly. There are toys available for children. Appropriate sleeping arrangements which consist of 1 pack in play for one of the toddlers and cots are used for the other children.


Licensee states that they are currently caring for infants. LPA's discussed the safe sleep regulations with licensee Dolores and discussed the Child Care Licensing Safe Sleep web page at: https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPA 's also informed licensee of the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at https://www.cpsc.gov/ and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment.

All documents keep for 3 years and keep copy's of everything you mail/Email to the department

SUPERVISORS NAME: Christina Gabelman
LICENSING EVALUATOR NAME: Kamile Martin
LICENSING EVALUATOR SIGNATURE:

DATE: 03/05/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/05/2025
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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
MONTEREY PARK CC RO, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME: PLASENCIA FAMILY CHILD CARE
FACILITY NUMBER: 192001144
VISIT DATE: 03/05/2025
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Smoking is prohibited in a licensed Family Child Care Home. Per Licensee, no one smokes in the home.
LPA's did not observe any objects that can pose a danger to children in care. There are 4 small dogs on the premises outside. The licensee is observed to be operating within the license capacity limitations.

Children’s records were reviewed and proof of all children TB was missing. Emergency information was reviewed and none were observed to have missing information.

The licensee and other personnel have completed training on preventive health practices including Pediatric First Aid and CPR. The licensee Pediatric First Aid and CPR expires on 3/16/26 There are first aid supplies available.

LPA's observed that the Licensee does not have proof of all immunization records for herself. Licensee Mandated Reporter AB 1207 compliant Child Care Training Certificate is not on file Per licensee her name was spelled wrong and Resource and Referral never updated and sent licensee the certificate. Mandated reporter training must be completed every 2 years. www.mandatedreporterca.com.

LPA's advised the licensee to access forms, regulations and quarterly updates on line at: www.ccld.ca.gov.


Reporting Unusual Incidents: MPROIncidentReports@dss.ca.gov. CCL Resources for Parents & Providers: https://ccld.childcarevideos.org/ Provider Information Notices (PINs): https://www.cdss.ca.gov/inforesources/community-care-licensing/policy/provider-information-notices/child-care

Licensee Dolores was reminded that all adults 18 and over living or working in the home, including employees and volunteers, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a licensed Family Child Care Home. A civil penalty of $100.00 minimum/day up to $500.00 maximum per day/per person will be assessed if this regulation is

SUPERVISORS NAME: Christina Gabelman
LICENSING EVALUATOR NAME: Kamile Martin
LICENSING EVALUATOR SIGNATURE:

DATE: 03/05/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/05/2025
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
MONTEREY PARK CC RO, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME: PLASENCIA FAMILY CHILD CARE
FACILITY NUMBER: 192001144
VISIT DATE: 03/05/2025
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IMS (Not at this time)
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

To improve the quality and value of the new inspection process, a survey will be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or tools, please send them by email to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/process.

Based on Licensing staff observations, interview, and record review, the following deficiencies listed on the attached LIC 809D (deficiency page) are being cited in accordance with California Code of Regulations Title 22. Deficiencies that are being cited need to be cleared to protect the children’s health and safety. LPA provided consultation during this inspection.

Also, LPA Martin and Reyes informed the licensee, Delores Plasencia to provide a copy of this licensing report dated 03/05/25 that documents any Type A citations to parents/guardians of all children currently enrolled by the next business day or the next day the children are in care, and to any newly enrolled parents/guardians for 12 months from the date of this report. A signed Acknowledgement of Receipt of Licensing Report (LIC 9224), or other written statement, must be placed in the child's file for verification.

A notice of site visit was given and must remain posted 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 Licensee, Dolores Plasencia. During the exit interview Delores Plasencia, Licensee, confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS

SUPERVISORS NAME: Christina Gabelman
LICENSING EVALUATOR NAME: Kamile Martin
LICENSING EVALUATOR SIGNATURE:

DATE: 03/05/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/05/2025
LIC809 (FAS) - (06/04)
Page: 3 of 7
Document Has Been Signed on 03/10/2025 04:55 PM - It Cannot Be Edited


Created By: Kamile Martin On 03/05/2025 at 12:28 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: PLASENCIA FAMILY CHILD CARE
FACILITY NUMBER: 192001144

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/05/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
102417(g)(4)
Operation of A Family Child Care Home
(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, medicines, firearms and other items which could pose a danger if readily available to children shall be stored where they are inaccessible to children.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, the licensee did not comply with the section cited above in 1 out of 1 identifiers which poses an immediate health, safety or personal rights risk to persons in care.
LPA observed cleaning solutions bleach clorax wipes and dish soap under the unlocked sink in the kitchen.
POC Due Date: 03/06/2025
Plan of Correction
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Licensee states will remove all items from underneath the sink and will submitt email stating it was removed and take a photo to show items removed.
Type A
Section Cited
CCR
102417(g)(9)
Operation of A Family Child Care Home
(g) The home shall be free from defects or conditions which might endanger a child. Safety precautions shall include but not limited to: (9) Each family child care home shall have a written disaster plan of action prepared on a form approved by the Department. All children, age and ability permitting, and the provider, the assistant provider, and other members of the household, shall be instructed in their duties under the disaster plan. As their age and ability permit, newly enrolled children shall be informed promptly of their duties as required in the plan.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation and record review , the licensee did not comply with the section cited above in 1 out of 1identifiers which poses an immediate health, safety or personal rights risk to persons in care.

No Disaster plan (LIC 610A) avaialble.
POC Due Date: 03/06/2025
Plan of Correction
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Per Licensee she will complete form this evening and email LPA Reyes the copy as well as send a photo of the form posted on the board.
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:Christina Gabelman
LICENSING EVALUATOR NAME:Kamile Martin
LICENSING EVALUATOR SIGNATURE:
DATE: 03/05/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/05/2025


LIC809 (FAS) - (06/04)
Page: 5 of 7
Document Has Been Signed on 03/10/2025 04:55 PM - It Cannot Be Edited


Created By: Kamile Martin On 03/05/2025 at 12:28 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: PLASENCIA FAMILY CHILD CARE
FACILITY NUMBER: 192001144

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/05/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102417(g)(9)(A)
Operation of A Family Child Care Home
(g) The home shall be free from defects or conditions which might endanger a child. Safety precautions shall include but not limited to: (9) Each family child care home shall have a written disaster plan of action prepared on a form approved by the Department. All children, age and ability permitting, and the provider, the assistant provider, and other members of the household, shall be instructed in their duties under the disaster plan. As their age and ability permit, newly enrolled children shall be informed promptly of their duties as required in the plan. (A) Each family child care home shall conduct fire drills and disaster drills at least once every six months.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation and record review, the licensee did not comply with the section cited above in 1 out of 1 identifiers which poses/posed a potential health, safety or personal rights risk to persons in care.

Licensee has no documentation for emergency drills
POC Due Date: 03/14/2025
Plan of Correction
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 licensee has found her copy of Disaster drills and the last one performed was 1/15/25. She will email along with other corrections
Type B
Section Cited
HSC
1596.8662(b)(1)
Administration of Child Day Care Licensing
(1) On or before March 30, 2018, a person who, on January 1, 2018, is a licensed child day care provider, administrator, or employee of a licensed child day care facility shall complete the mandated reporter training provided pursuant to paragraphs (2) and (3) of subdivision (a), and shall complete renewal mandated reporter training every two years following the date on which he or she completed the initial mandated reporter training.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review the licensee did not comply with the section cited above in 1 out of 1 identifiers which poses a potential health, safety or personal rights risk to persons in care

Licensee has not taken the mandated reporter training.
POC Due Date: 03/14/2025
Plan of Correction
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Per licensee she will complete course online and email LPA Reyes the certificate.
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:Christina Gabelman
LICENSING EVALUATOR NAME:Kamile Martin
LICENSING EVALUATOR SIGNATURE:
DATE: 03/05/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/05/2025


LIC809 (FAS) - (06/04)
Page: 6 of 7
Document Has Been Signed on 03/10/2025 04:55 PM - It Cannot Be Edited


Created By: Kamile Martin On 03/05/2025 at 12:28 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: PLASENCIA FAMILY CHILD CARE
FACILITY NUMBER: 192001144

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/05/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
HSC
1597.622(c)
Administration of Child Day Care Licensing
(c) The family day care home shall maintain documentation of the required immunizations or exemptions from immunization, as set forth in this section, in the person's personnel record that is maintained by the family day care home.

This requirement is not met as evidenced by:
Deficient Practice Statement
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3
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Based on record review the licensee did not comply with the section cited above in 1 out of 1 identifiers which poses a potential health, safety or personal rights risk to persons in care .

Per licensee no proof of mmr tdap flu and TB immuniztions
POC Due Date: 03/14/2025
Plan of Correction
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2
3
4
Section Cited
Deficient Practice Statement
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2
3
4
POC Due Date:
Plan of Correction
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2
3
4
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:Christina Gabelman
LICENSING EVALUATOR NAME:Kamile Martin
LICENSING EVALUATOR SIGNATURE:
DATE: 03/05/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/05/2025


LIC809 (FAS) - (06/04)
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