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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197410641
Report Date: 03/12/2025
Date Signed: 03/14/2025 10:49:21 AM

Document Has Been Signed on 03/14/2025 10:49 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: 9DATE:
03/12/2025
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:41 AM
MET WITH:Cecilia PenalozaTIME VISIT/
INSPECTION COMPLETED:
11:42 AM
NARRATIVE
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On 3/12/25 Licensing Program Analyst (LPA) Ranita Richmond arrived at the above named home to complete and unannounced Case Management Deficiencies visit. LPA was greeted by licensee Cecilia Penaloza. LPA observed 9 children in care being supervised and cared for by licensee and 2 fingerprint cleared assistants. LPA toured the home inside and outside for health and safety.

During walk through, LPA reviewed infant sleep log. Infant sleep log does not adhere to documentation of how infant child was placed to sleep or staff initials. Citation issued. Type B. See LIC 809D. LPA provided licensee with infant sleep chart as a guide. The infant sleep chart includes areas to document the following: child care facility, caregivers, name of child, child's date of birth, waiver, date, time, initials, position, comments, and instructions. Licensee agrees that the infant sleep chart includes all information necessary to document infant sleep. Licensee will use the form or create her own form to include all information on infant sleep chart provided as guide by LPA.


One type B Citation was 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: 03/12/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/12/2025
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 03/14/2025 10:49 AM - It Cannot Be Edited


Created By: Ranita Richmond On 03/12/2025 at 11:00 AM
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: 03/12/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
03/26/2025
Section Cited
CCR
102425(j)(2)(D)

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102425 Infant Safe Sleep(j) The provider shall supervise infants while they are sleeping and... (2) The provider shall...document...:(D) Documentation shall be maintained in the infant’s file...for review... This requirement is not met as evidenced by:
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Licensee will complete infant sleep chart to include child care facility, caregivers, name of child, child's date of birth, waiver (if applicable), date, time, initials, position, and comments(if applicable) daily as needed while infants sleep.
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Per LPA observation of records reviewed, LPA reviewed infant sleep log and observed that Infant sleep log does not adhere to documentation of how infant child was placed to sleep or staff initials.
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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: 03/12/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/12/2025


LIC809 (FAS) - (06/04)
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