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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198010516
Report Date: 10/26/2022
Date Signed: 10/26/2022 10:32:12 AM

Document Has Been Signed on 10/26/2022 10:32 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
MONTEREY PARK S WEST, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME:DYCUS FAMILY CHILD CAREFACILITY NUMBER:
198010516
ADMINISTRATOR:DYCUS, MOLLY V.FACILITY TYPE:
810
ADDRESS:TELEPHONE:
(562) 868-7880
CITY:NORWALKSTATE: CAZIP CODE:
90650
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 5DATE:
10/26/2022
TYPE OF VISIT:Case Management - Annual ContinuationUNANNOUNCEDTIME BEGAN:
09:20 AM
MET WITH:Licensee Molly DycusTIME COMPLETED:
10:45 AM
NARRATIVE
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On 10/26/22 at 9:20 AM, Licensing Program Analysts (LPAs) Austin Estrada and Jeanette Estrada conducted a Case Management Annual Continuation at the above facility. On 10/21/22 LPAs conducted a Required Annual Inspection at this facility. Due to technical difficulties, the Inspection Tool was not completed, and the deficiencies were not cited on the LIC 809D. The purpose of today's inspection was to complete the Inspection Tool and issue the deficiencies observed during the required annual visit on 10/21/22. LPAs met with Licensee, Molly Dycus and informed her of the visit.

There were 5 children present when LPAs arrived. LPAs did not observe deficiencies in the facility during today's visit.

Based on the LPAs observations and record review conducted on 10/21/22 the following deficiencies listed on the attached LIC 809D are being cited in accordance with the California Code of Regulations Title 22.
Two Type B citations were issued for: regulation 102425(b) Infant Safe Sleep- regarding the child observed with a blanket in the crib and Health and Safety Code 1597.622(c) regarding the Licensee not having proof of required immunization's.

Deficiencies that are being cited need to be cleared to protect the children's health and safety.

Exit interview was conducted and the report was reviewed with Licensee Molly Dycus. A notice of cite visit was given and must remain posted for 30 days.

Appeal rights were provided to Licensee.
SUPERVISORS NAME: Valarie Cook
LICENSING EVALUATOR NAME: Austin Estrada
LICENSING EVALUATOR SIGNATURE: DATE: 10/26/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/26/2022
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 10/26/2022 10:32 AM - It Cannot Be Edited


Created By: Austin Estrada On 10/26/2022 at 10:02 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
, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME: DYCUS FAMILY CHILD CARE
FACILITY NUMBER: 198010516

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/26/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102425(b)
Infant Safe Sleep
(b) Cribs or play yards shall be free from all loose articles and objects.

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 by allowing C1 to sleep with a blanket while in a play yard which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 10/21/2022
Plan of Correction
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LPA immdiately removed the blanket from the play yard. LPA was provided safe sleep regulations to review.
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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Based on record review, the licensee did not comply with the section cited above in not having immunizations records for
Meseals, Pertussis, TB, and Influenza or Influenza delcination readily avaiable at the time of inspection which poses a
potential health, safety or personal rights risk to persons in care.
POC Due Date: 11/28/2022
Plan of Correction
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Licensee will provide proof of vaccinations via email to LPA by POC due date.
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:Valarie Cook
LICENSING EVALUATOR NAME:Austin Estrada
LICENSING EVALUATOR SIGNATURE:
DATE: 10/26/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/26/2022


LIC809 (FAS) - (06/04)
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