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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198013306
Report Date: 09/07/2022
Date Signed: 09/07/2022 01:19:47 PM

Document Has Been Signed on 09/07/2022 01:19 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
CCLD Regional Office, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME:ALONZO FAMILY CHILD CAREFACILITY NUMBER:
198013306
ADMINISTRATOR:ALONZO, SUSANAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(323) 313-2223
CITY:MONTEBELLOSTATE: CAZIP CODE:
90640
CAPACITY: 14TOTAL ENROLLED CHILDREN: 10CENSUS: 3DATE:
09/07/2022
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
10:49 AM
MET WITH:Susana Alonzo, Licensee & Alejandro Villagran, AssistantTIME COMPLETED:
01:25 PM
NARRATIVE
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*********************This inspection was conducted in Spanish **************************************
Licensing Program Analyst (LPA) Mireya Garcia conducted an unannounced POC (Plan of Correction) inspection to ensure that the Type A and B deficiencies cited on 06/20/2022 have been cleared. LPA met with Alejandro Villagran, Assistant who guided analyst on a tour of the facility. Licensee was not present during LPAs arrival, at 11:05 am., Licensee arrived. There were 3 children present during upon LPA's arrival with one being an infant. The following has been observed:
  • At 10:49 am., LPA Garcia observed 1 infant (Child #1) sleeping on a high chair with no crib/play yard accessible for child to be removed and placed.
  • At 11:24 am., LPA Garcia observed unlocked poison (Raid spray) under the kitchen sink cabinet. At 12:22 pm., LPA Garcia observed the shed where poisons are stored located outside in the backyard with pad lock unlocked.
  • LPA Garcia observed fire extinguisher fully charged with service tag dated June 21, 2022.
  • LPA Garcia conducted records review of Child #6 file and observed LIC 700 Identification and Emergency Information on file, LIC 995A Family Child Care Home Notification of Parents’ Rights for Child #1, #2, #3 & #6 were completed and on file and LIC 9227 Individual Infant Sleeping Plan was complete for child #1 and was on file.
  • LPA Garcia conducted staff records review and observed immunization records (Pertussis, MMR & Influenza) on file for Licensee & Assistant.

A repeat citation is being issued on this date for a deficiency previously cited on 06/20/22 for Raid being stored unlocked. A civil penalty of $250.00 is being assessed on this date.

Report continues on next page 1 of 2.
SUPERVISORS NAME: Brandi VanOosten
LICENSING EVALUATOR NAME: Mireya Garcia
LICENSING EVALUATOR SIGNATURE: DATE: 09/07/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/07/2022
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME: ALONZO FAMILY CHILD CARE
FACILITY NUMBER: 198013306
VISIT DATE: 09/07/2022
NARRATIVE
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At this time, the licensee is not in compliance with California Title 22 Regulations. The deficiencies listed on the attached LIC 809D are being cited in accordance with California Code of Regulations Title 22.

A copy of this report shall be provided to the parent/guardian of children currently enrolled by the next business day or immediately upon return. A copy of this report shall also be provided to the parent/guardian of any newly-enrolled children for the next 12 months (1 year). The Acknowledgement form must be maintained in each child’s file immediately upon receipt from parent. Licensee was provided with a copy of the parent Acknowledgement of Receipt of Licensing Reports (LIC 9224) Form during this visit.

LPA advised the licensee how to access forms, regulations and quarterly updates on the Child Care Licensing Website at: www.ccld.ca.gov.



LPA issued POC clearance letter during today’s inspections for the deficiencies which had been cleared on 06/20/22 and during today’s visit.

LPA discuss, review and provided Licensee with a copy of the PIN 20-24-CCP-SP; RECENTLY APPROVED SAFE SLEEP REGULATIONS IN EFFECT.

A notice of site visit was given and must remain posted for 30 days.

Exit interview conducted and report was reviewed with Licensee Susana Alonzo.

Report ends here page 2 of 2.

SUPERVISORS NAME: Brandi VanOosten
LICENSING EVALUATOR NAME: Mireya Garcia
LICENSING EVALUATOR SIGNATURE:

DATE: 09/07/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/07/2022
LIC809 (FAS) - (06/04)
Page: 2 of 4
Document Has Been Signed on 09/07/2022 01:19 PM - It Cannot Be Edited


Created By: Mireya Garcia On 09/07/2022 at 12:15 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 CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME: ALONZO FAMILY CHILD CARE
FACILITY NUMBER: 198013306

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/07/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
09/07/2022
Section Cited
CCR
102417(g)(4)(A)

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(g) The home shall be free from defects or conditions which might endanger a child. Safety precautions shall include but not limited to: (4) Poisons, detergents, cleaning compounds, medicines, firearms and other items which could pose a danger if readily available to children shall be stored where they are inaccessible to children. (A) Storage areas for poisons, firearms and other dangerous weapons shall be locked.

This requirement is not met as evidenced by:
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During LPAs inspection Licensee removed the Raid and placed it in the shed and locked the padlock in the shed.
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Based on LPAs observing poison (Raid) stored in unlocked Kitchen cabinet (underneath sink) and unlocked shed where poison's are stored. This poses an immediate health and safety risk to children 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:Brandi VanOosten
LICENSING EVALUATOR NAME:Mireya Garcia
LICENSING EVALUATOR SIGNATURE:
DATE: 09/07/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/07/2022


LIC809 (FAS) - (06/04)
Page: 3 of 4
Document Has Been Signed on 09/07/2022 01:19 PM - It Cannot Be Edited


Created By: Mireya Garcia On 09/07/2022 at 12:30 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 CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME: ALONZO FAMILY CHILD CARE
FACILITY NUMBER: 198013306

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/07/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
09/08/2022
Section Cited
CCR
102425(i)

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102425-Infant Safe Sleep-(i) If an infant falls asleep before being placed in a crib or play yard, the provider shall move the infant to a crib or play yard as soon as possible. This requirement is not met as evidenced by:
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During LPA's inspection LPA provided Assistant with Technical Assistance regarding safe sleep regulations, Assistant removed child from high chair. Per Licensee Child #1 returned today after not attending since June 21, 2022 and kept play yard in the storage area. During LPAs visit Assistant placed play yard in the main day care room for Child #1 to use.
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Based on LPAs observation of Child #1 sleeping on high chair and no crib/play yard accessible to place child in. This poses a potential health and safety risk to children in care.
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Licensee will review PIN 20-24 CCP Regulations with Assistant and will email LPA Garcia by POC due date 09/08/22, written compliance plan that Licensee/Assistant have read and will comply with safe sleeep regulations in order to be in complaince.

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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:Brandi VanOosten
LICENSING EVALUATOR NAME:Mireya Garcia
LICENSING EVALUATOR SIGNATURE:
DATE: 09/07/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/07/2022


LIC809 (FAS) - (06/04)
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