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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197494524
Report Date: 07/09/2024
Date Signed: 07/11/2024 11:20:20 AM

Document Has Been Signed on 07/11/2024 11:20 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:PEREZ FAMILY CHILD CAREFACILITY NUMBER:
197494524
ADMINISTRATOR/
DIRECTOR:		PEREZ, JOHANAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(323) 304-6887
CITY:WILMINGTONSTATE: CAZIP CODE:
90744
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 2DATE:
07/09/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:11 PM
MET WITH:Miguel R. Guerrero Ruiz - AssistantTIME VISIT/
INSPECTION COMPLETED:
02:30 PM
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On 07/09/2024 Licensing Program Analyst (LPA) Cristina Castellanos conducted an unannounced case management inspection for the purpose of ensuring the standards are being met in accordance with California Tittle 22 Regulations and California Health and Safety Codes.

LPA met with Assistant M. Guerrero and toured the home both indoors and outdoors. During today’s inspection there were 2 children and Assistant M. Guerrero providing care and supervision.

Assistant M. Guerrero stated that Licensee Johana Perez was currently not in the home and had a medical emergency. Assistant M. Guerrero further disclosed that Licensee Johana Perez left at approximately 06:55 a.m. this morning right before he arrived. Assistant M. Guerrero allowed LPA entrance to the home.



At approximately 09:23 a.m. while inspecting the outdoors area Assistant M. Guerrero was on the phone with Licensee Johana Perez. Assistant M. Guerrero then places the call on speaker so Licensee Perez could speak to LPA. LPA proceeded to ask Licensee "What time will you be arriving?" Licensee Perez responded “Around 04:00 p.m. or 5:00 p.m.” At 09:25 a.m. Assistant M. Guerrero mentioned to LPA that the licensee’s mom would be on her way here to assist with the documents requested.

Around 9:31am LPA observed a female arrive and knocked on the door. The female identified herself as Angie Guerrero, Licensee’s mother, who then stated that her daycare was down the street, about two blocks. At approximately 9:43 a.m. Mrs. Guerrero mentioned to LPA that her daughter was out of the state for a doctor’s appointment. LPA observed Mrs. Guerrero leave the home at approximately 11:10 a.m.

Continue
SUPERVISORS NAME: Claudia Escobedo
LICENSING EVALUATOR NAME: Cristina Castellanos
LICENSING EVALUATOR SIGNATURE: DATE: 07/09/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/09/2024
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
EL SEGUNDO CC RO, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME: PEREZ FAMILY CHILD CARE
FACILITY NUMBER: 197494524
VISIT DATE: 07/09/2024
NARRATIVE
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Furthermore, LPA observed three (3) toiletries bottles on the bathtub, two of which had the lid opened and the third one was a pump. LPA observed Assistant M. Guerrero removed all toiletries from the children’s designated bathroom before LPA left the home.

During today’s visit there were two (2) deficiencies cited at this time for violation of Title 22 regulation; (see LIC809-D).

An exit interview was conducted and Plans of Correction were reviewed and developed with Assistant M. Guerrero. A copy of this report and appeal rights were discussed and left with the assistant. 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.
SUPERVISORS NAME: Claudia Escobedo
LICENSING EVALUATOR NAME: Cristina Castellanos
LICENSING EVALUATOR SIGNATURE:

DATE: 07/09/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/09/2024
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 07/11/2024 11:20 AM - It Cannot Be Edited


Created By: Cristina Castellanos On 07/09/2024 at 01:36 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: PEREZ FAMILY CHILD CARE
FACILITY NUMBER: 197494524

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/09/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
07/19/2024
Section Cited
CCR
102417(a)

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Operation of a Family Child Care Home 102417(a)The licensee shall be present in the home and shall ensure...Temporary absences shall not exceed 20 percent of the hours that the facility is providing care per day.
This requirement is not met as evidenced by:
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Licensee Perez agrees to submit a Declaration form LIC855 with a written plan to LPA when leaving out of the state for a doctor's appointment. In the plan Licensee Perez will establish whether she will be closing during those hours not present in the state or if she will be changing the hours of operation via email to LPA by POC due date.
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Based on observation and interviews, the licensee did not comply with the section cited above, Licensee is out of the state for a doctor's appoinment, left around 6:55am and then licensee stated would be coming back around 4:00pm or 5:00pm, which poses/posed a potential health, safety or personal rights risk to persons in care.
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Type B
07/09/2024
Section Cited
CCR102417(g)(4)

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Operation of a Family Child Care Home 102417(g)(4) The home shall be free from defects or conditions which might endanger a child... Poisons, detergents, cleaning compounds, medicines...shall be stored where they are inaccessible to children.
This requirement is not met as evidenced by:
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LPA observed Assistant M. Guerrero removed all toiletries from the children’s designated bathroom before LPA left the home. Assistant Guerrero agrees to maintained all toiletries inaccessible to the children in care and will further discussed with Licensee Perez.
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Based on observation, there were three (3) toiletries bottles on the bathtub in the children’s designated bathroom (No. 1), two of which had the lid opened and the third one was a pump, which poses/posed a potential health, safety or personal rights risk to persons in care.
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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:Cristina Castellanos
LICENSING EVALUATOR SIGNATURE:
DATE: 07/09/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/09/2024


LIC809 (FAS) - (06/04)
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