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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198009014
Report Date: 07/06/2023
Date Signed: 08/17/2023 03:23:41 PM

Document Has Been Signed on 08/17/2023 03:23 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 S WEST, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME:VELASCO FAMILY CHILD CAREFACILITY NUMBER:
198009014
ADMINISTRATOR:VELASCO, SONIAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(323) 773-2792
CITY:MAYWOODSTATE: CAZIP CODE:
90270
CAPACITY: 14TOTAL ENROLLED CHILDREN: 12CENSUS: 9DATE:
07/06/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:38 PM
MET WITH:Licensee - Sonia VelascoTIME COMPLETED:
03:45 PM
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Licensing Program Analyst (LPA) R. Derraco conducted an unannounced required one year inspection to the above facility on 07/06/23. LPA arrived at the facility at 12:38 PM and met with licensee, Sonia Velasco, who guided analyst on a tour of the facility. Also present during this inspection was an S2. Per Licensee, there are 12 children that are currently enrolled. There were 9 children present upon arrival, and 4 of the children present are infants.

This is a one-story home which consists of 3 bedrooms, 2 bathrooms, kitchen/dining room, living room, a detached garage, front yard (fenced) and backyard fenced. The off limit areas include 2 bedrooms, 1 bathroom, garage and back yard.

The main care area is located in bedroom 2. LPA observed an electric infant rocker, sleeping mats, age appropriate toys, children's reading material, child sized table with chairs, and a wall mounted television. Emergency Disaster Plan, Parent's Rights Poster and the Facility License were observed to be posted. LPA observed an infant play pen located in the open area of the dining room. LPA also observed two Foundations wooden feeding table. LPA advised licensee that feeding tables should only be used as instructed in User Manual. LPA also advised licensee to not have children in sitting in feeding table unless they are eating. During inspection, LPA observed only 1 Graco Pack and Play playpen available in the home. Per licensee she only owns one playpen. Licensee also states that children nap on sleeping mats. LPA advised licensee that a citation under California Code of Regulation (CCR) section 102425(a) will be issued. The licensee states that she provides food for children in care. The kitchen area was observed to have child locks on all cabinets beneath the counter top. Per licensee, cleaning supplies and other cleaning agents are kept locked beneath the kitchen sink. No sharp or pointy objects were observed to be accessible in the kitchen. The bathroom was observed to be sanitary with an operable sink, faucet and toilet. Doors leading to off-limit rooms were
(page 1 of 4)
SUPERVISORS NAME: Karen Chambers
LICENSING EVALUATOR NAME: Randy Derraco
LICENSING EVALUATOR SIGNATURE: DATE: 07/06/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/06/2023
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
MONTEREY PARK S WEST, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME: VELASCO FAMILY CHILD CARE
FACILITY NUMBER: 198009014
VISIT DATE: 07/06/2023
NARRATIVE
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First Aid and CPR. The licensee's Pediatric First Aid and CPR expires in 05/2025. LPA observed that the Licensee and assistant do not have proof of the Mandated Reporter AB 1207 compliant Child Care Training Certificate on file. Licensee states she has not renewed the training and only has taken it once. LPA advised licensee that a citation under Health and Safety Code section 159.6.8662(b)(1) will be issued. File review was observed to have proper mandated immunization records. Children's records were reviewed, including emergency information and were observed to be complete, however LPA did not observed an infant sleep chart or an Individual Infant Sleep Plan for the infants in care. Licensee states she was unaware of the requirement to document infant sleep. LPA advised licensee that a citation under CCR section 1024250)(2) and section 102425(c) will be issued. A current children's roster was available for review.

Incidental Medical Services (IMS}:
IMS was discussed with licensee. Per licensee, there are no children enrolled that require IMS 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.

LPA advised the licensee to access forms, regulations and quarterly updates online at: www.cdss.ca.gov. The following documents were were provided and discussed with the licensee:
- PIN 20-24-CCP - Recently Approved Safe Sleep Regulations in Effect
- UC 9227 - Individual Infant Sleep Plan
- Infant Sleep Chart

Licensee was advised that the infant sleep chart is not a resource and cannot be found on the Department website.

The following deficiencies listed on the attached UC 809 (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 & safety.
(page 3 of 4)
SUPERVISORS NAME: Karen Chambers
LICENSING EVALUATOR NAME: Randy Derraco
LICENSING EVALUATOR SIGNATURE:

DATE: 07/06/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/06/2023
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 S WEST, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME: VELASCO FAMILY CHILD CARE
FACILITY NUMBER: 198009014
VISIT DATE: 07/06/2023
NARRATIVE
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observed to be closed with a door knob cover. The outdoor play area is located on the driveway. Per licensee, she stores the outdoor play equipment on the side of the house and brings it out to the driveway when it's time to play. Per licensee. she does not have children outside when it is hot or raining. LPA observed outdoor furniture with a shade and perimeter fencing in the outdoor play area. LPA did not observe the following items during the inspection: Infant Walkers, Johnny Jumpers, Saucer Chairs. No bodies of water were observed in the back yard play area. No pets were observed on the premises. Smoking is prohibited in a licensed Family Child Care Home. Per Licensee, no one smokes in the home.
Individuals residing in the home were noted and discussed. Licensee 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 violated.

All areas identified on the facility sketch that are accessible for children to use were inspected for safety, comfort, and cleanliness. There is telephone service via a land line. LPA observed a wall heater next to the bathroom to have a fire proof cover that has been screwed into the wall to prevent movement. LPA observed window mounted air conditioning units throughout the home. Licensee states that there are no firearms stored in the home. The licensee understands that storage areas for poisons must be locked, not just inaccessible. The valve on the required 2A-10BC fire extinguisher indicates fully charged. LPA observed the purchase receipt date of the fire extinguisher to be 06/05/21. LPA advised licensee that a citation under CCR Section 102417(g)(1) will be issued. Smoke and carbon monoxide detectors were tested and are operable.

Safe sleep guidelines were discussed with licensee. LPA discussed the safe sleep regulations with licensee and discussed the Child Care Licensing Safe Sleep webpage at
https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPA 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.

The licensee and other personnel have completed training on preventive health practices including Pediatric (page 2 of 4)
SUPERVISORS NAME: Karen Chambers
LICENSING EVALUATOR NAME: Randy Derraco
LICENSING EVALUATOR SIGNATURE:

DATE: 07/06/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/06/2023
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 S WEST, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME: VELASCO FAMILY CHILD CARE
FACILITY NUMBER: 198009014
VISIT DATE: 07/06/2023
NARRATIVE
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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 the licensee Sonia Velasco.

(page 4 of 4)
SUPERVISORS NAME: Karen Chambers
LICENSING EVALUATOR NAME: Randy Derraco
LICENSING EVALUATOR SIGNATURE:

DATE: 07/06/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/06/2023
LIC809 (FAS) - (06/04)
Page: 4 of 6
Document Has Been Signed on 08/17/2023 03:23 PM - It Cannot Be Edited


Created By: Randy Derraco On 08/17/2023 at 02:48 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 CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME: VELASCO FAMILY CHILD CARE
FACILITY NUMBER: 198009014

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/06/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102417(g)(1)
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: (1) Fireplaces and open face heaters shall be screened to prevent access by children. The home shall contain a fire extinguisher and smoke detector device which meet standards established by the State Fire Marshall.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, interview and record review, the home did not contain a fire extinguish which meets standards established by the State Fire Marshall, which poses a potential Health, safety and/or personal rights risk to persons in care.
POC Due Date: 07/15/2023
Plan of Correction
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 Licensee states she will email LPA a copy of the receipt of a new fire extinguisher or a copy of the service tag.
Type B
Section Cited
CCR
102425(a)
Infant Safe Sleep
(a) There shall be one crib or play yard for each infant who is unable to climb out of the crib or play yard.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, interview and record review. the licensee did not provide one crib or play yard for each infant in care. which poses a potential Health, safety and/or personal rights risk to persons in care.
POC Due Date: 07/15/2023
Plan of Correction
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LPA advised licensee that a POC visit will be needed to clear citation.
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:Karen Chambers
LICENSING EVALUATOR NAME:Randy Derraco
LICENSING EVALUATOR SIGNATURE:
DATE: 07/06/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/06/2023


LIC809 (FAS) - (06/04)
Page: 2 of 6

Created By: Randy Derraco On 08/17/2023 at 02:48 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 CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME: VELASCO FAMILY CHILD CARE
FACILITY NUMBER: 198009014

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/06/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102425(j)(2)
Infant Safe Sleep
The provider shall supervise infants while they are sleeping and adhere to the following requirements: The provider shall check and document the following:

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, interview and record review, the licensee did not document sleep position of infants in care every 15 minutes which poses a potential Health, safety and/or personal rights risk to persons in care.
POC Due Date: 07/15/2023
Plan of Correction
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LPA advised licensee that a POC visit will be needed to clear citations.
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 observation, interview and record review, the licensee did not renew mandated reporter training which poses a potential Health, safety and/or personal rights risk to persons in care.
POC Due Date: 07/15/2023
Plan of Correction
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Licensee advised she will email a copy of the completed training certificate to LPA.
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:Karen Chambers
LICENSING EVALUATOR NAME:Randy Derraco
LICENSING EVALUATOR SIGNATURE:
DATE: 07/06/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/15/2023


LIC809 (FAS) - (06/04)
Page: of
Document Has Been Signed on 08/17/2023 03:23 PM - It Cannot Be Edited


Created By: Randy Derraco On 08/17/2023 at 02:49 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 CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME: VELASCO FAMILY CHILD CARE
FACILITY NUMBER: 198009014

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/06/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102425(c)
Infant Safe Sleep
An Individual Infant Sleeping Plan [LIC 9227 (3/20)] shall be completed for each infant up to 12 months of age the provider has in care and included in the infant's file at the facility.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, interview and record review, the licensee did not complete an lndividuatl Infant Sleeping Plan [(UC 9227 (03/20)) which poses a potential Health, safety and/or personal rights risk to persons in care.
POC Due Date: 07/15/2023
Plan of Correction
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4
LPA advised that a POC visit will be needed to clear citation.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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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:Karen Chambers
LICENSING EVALUATOR NAME:Randy Derraco
LICENSING EVALUATOR SIGNATURE:
DATE: 07/06/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/06/2023


LIC809 (FAS) - (06/04)
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