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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197410641
Report Date: 01/23/2025
Date Signed: 01/24/2025 08:48:36 AM

Document Has Been Signed on 01/24/2025 08:48 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO CC RO, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME:PENALOZA FAMILY CHILD CAREFACILITY NUMBER:
197410641
ADMINISTRATOR/
DIRECTOR:		CECILIA PENALOZAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(310) 591-9460
CITY:CULVER CITYSTATE: CAZIP CODE:
90230
CAPACITY: 12TOTAL ENROLLED CHILDREN: 12CENSUS: 7DATE:
01/23/2025
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:46 PM
MET WITH:Cecilia PenalozaTIME VISIT/
INSPECTION COMPLETED:
03:36 PM
NARRATIVE
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On 1/23/25 Licensing Program Analyst (LPA) Ranita Richmond and Brittany Lovest arrived at the above named home to complete and unannounced Case Management Deficiencies visit. LPA was greeted by licensee Cecilia Penaloza. LPA toured the home inside and outside for health and safety.

During walk through, LPA observed disinfectant wipes, acetone, beauty products, and other items that could pose danger to children in care stored in the following areas accessible to children in care: the middle medicine cabinet (acetone and beauty products), and on the counter inside the classroom (clorox disinfectant wipes). Citation cited. Type B. LPA witnessed infant child placed on stomach to sleep in play pen. LPA reviewed infant sleep log. Infant sleep log agrees that infant child was placed on stomach to sleep. Infant sleep log has date, time, staff initials, and position of infant sleeping. Citation issued. Type B. repeat Violation. Civil penalties assessed.

LPA reviewed staff file for L. Esquivel. Staff file does not contain TB test dated current from hire date. Citation cited. Type B.

Three type B Citations were cited today, per Title 22 Regulations and Health and Safety Codes. See LIC 809D.

An exit interview was conducted, a copy of this report, and appeal rights were discussed and provided to licensee Cecilia Penaloza.

Notice of Site Visit was provided and required to be posted for 30 days.

SUPERVISORS NAME: Claudia Escobedo
LICENSING EVALUATOR NAME: Ranita Richmond
LICENSING EVALUATOR SIGNATURE: DATE: 01/23/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/23/2025
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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Document Has Been Signed on 01/24/2025 08:48 AM - It Cannot Be Edited


Created By: Ranita Richmond On 01/23/2025 at 02:12 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
, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245

FACILITY NAME: PENALOZA FAMILY CHILD CARE
FACILITY NUMBER: 197410641

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/23/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
02/06/2025
Section Cited
CCR
102417(g)(4)

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102417 Operation of a Family Child Care Home (g) The home shall be free from...conditions which might endanger a child.(4)..,cleaning compounds, medicines ,... and other items which could pose a danger... to children shall be stored where they are inaccessible to children.
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Licensee will make all cleaning compounds, medicines, and other items which pose a danger to children inaccessible by placing them on high shelves or locked cabinets.
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Based on observation, the licensee did not comply with the section cited above evidenced by cleaning compounds, beauty products, and other items which could pose a danger to children were accessible to children in care in bathroom and daycare room.
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Type B
02/06/2025
Section Cited
CCR102425(d)

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102425 Infant Safe Sleep
(d) The provider shall place infants up to 12 month of age on their backs for sleeping.
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Licensee will ensure that all infants 12 months of age and under are placed on their back to sleep. Licensee will ensure that the infant sleep log agrees with infant sleep positions.
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Based on observation and records review, the licensee did not comply with the section cited above evidenced by staff placing infant on stomach to sleep.
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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 Escobedo
LICENSING EVALUATOR NAME:Ranita Richmond
LICENSING EVALUATOR SIGNATURE:
DATE: 01/23/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/23/2025


LIC809 (FAS) - (06/04)
Page: 2 of 3
Document Has Been Signed on 01/24/2025 08:48 AM - It Cannot Be Edited


Created By: Ranita Richmond On 01/23/2025 at 02:31 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
, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245

FACILITY NAME: PENALOZA FAMILY CHILD CARE
FACILITY NUMBER: 197410641

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/23/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
02/06/2025
Section Cited
HSC
1597.622(c)

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§1597.622 Employees... family day care home; immunization requirements;...
(c) The family day care home shall maintain documentation of the required immunizations..,in the person’s personnel record that is maintained by the family day care home.
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Licensee will ensure that TB test is completed by staff and maintained in staff personnel file for review by the department.
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Based on records review, the licensee did not comply with the section cited above evidenced by TB test dated at time of hire not present in personnel file for staff maintained by family day care home.
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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 Escobedo
LICENSING EVALUATOR NAME:Ranita Richmond
LICENSING EVALUATOR SIGNATURE:
DATE: 01/23/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/23/2025


LIC809 (FAS) - (06/04)
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