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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198014224
Report Date: 12/20/2024
Date Signed: 12/20/2024 02:45:51 PM

Document Has Been Signed on 12/20/2024 02:45 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 SW RO, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME:OLMOS FAMILY CHILD CAREFACILITY NUMBER:
198014224
ADMINISTRATOR/
DIRECTOR:		OLMOS, EUSEBIAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(562) 422-0896
CITY:LONG BEACHSTATE: CAZIP CODE:
90805
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 9DATE:
12/20/2024
TYPE OF VISIT:Annual/RandomANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
11:30 AM
MET WITH:Licensee - Eusebia OlmosTIME VISIT/
INSPECTION COMPLETED:
02:55 PM
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On December 20, 2024 at 11:30a.m. Licensing Program Analyst (LPA) Keneisha Dunlap arrived at the above facility for the purpose of an unannounced Annual Inspection. LPA Dunlap announced the purpose of the visit and was granted entry into the facility by Licensee Eusebia Olmos. The Licensee daughter- Areli Olmos translated conversation throughout the entire inspection. There are 14 children enrolled, and 9 children present at the time of inspection. The hours of operation are Monday- Saturday from 4:00am-1:00am. All adults in the home were discussed and background and fingerprinted cleared. License, facility sketch, earthquake disaster checklist, disaster plan, and PUB 394 posted.

At 12:15pm LPA Dunlap requested a current disaster log drill. The Licensee stated that they do not have a current disaster log drill. LPA Dunlap provided a non department form for future use for the Licensee to keep track of future drills. This poses a potential health and safety risk to children in care. Technical Violation will be issued

Licensee does have current LIC 9040 (facility roster)..

This is a one-story home which consists of 4 bedrooms, 2 bathrooms, kitchen/dining room, living room, garage, front yard and backyard (fenced). The off limit areas include 2 bedrooms, garage, and front yard.



The main care area is located in the back of the home in bedroom 2. LPA observed age appropriate toys, child sized tables, child sized chairs, art supplies, a wall mounted air conditioning unit, and a wall mounted TV. LPA observed bedroom 1 to have a baby changing station, napping mats, and playpens. A gate was observed at the entrance of bedroom 1 making the hallway inaccessible. LPA observed main care area to be in good condition, free of sharp, loose or pointed parts.
The living room is an additional care area. There is a TV, age-appropriate table and chairs. There are cubbies for children to store their personal belongings. LPA observed main care area to be in good condition, free of sharp, loose or pointed parts. Page 1 of 6
SUPERVISORS NAME: Karen Chambers
LICENSING EVALUATOR NAME: Keneisha Dunlap
LICENSING EVALUATOR SIGNATURE: DATE: 12/20/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/20/2024
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
MONTEREY PARK SW RO, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME: OLMOS FAMILY CHILD CARE
FACILITY NUMBER: 198014224
VISIT DATE: 12/20/2024
NARRATIVE
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The kitchen area is accessible to children. The cabinets have safety latches making cleaning products inaccessible to children in care. The drawers have safety latches making them in inaccessible to children in care. The knives are stored in drawer with safety latches.

The bathroom area has a working toilet and sink. The cabinet and drawers has a safety latch making it inaccessible to children. The second bathroom has safety latches on cabinets and drawers making it inaccessible to children.

The outdoor area for play has artificial grass is the back yard which has a gate closing off the sides. The yard has a basketball hoop, picnic tables, shaded area, toys, slide structure, and bikes. LPA observed outdoor area to be in good condition, free of sharp, loose or pointed parts.

LPA observed a dual smoke detector and carbon monoxide detector to be operable.

LPA observed a fire extinguisher with a tag date of 7/24/24.

At 12:50pm, LPA Dunlap observed the following:

Staff Files:

Staff # 1

File is missing all required licensing documents

CPR expiration date of 6/18/25

Mandated Reporter expiration date of 11/8/24

(Assistant) Staff # 2

File immunization record in folder

No Mandated Reporter

No Health & Safety Certificate

CPR expiration date of 2/11/25 File is missing all required licensing documents Page 2 of 6

SUPERVISORS NAME: Karen Chambers
LICENSING EVALUATOR NAME: Keneisha Dunlap
LICENSING EVALUATOR SIGNATURE:

DATE: 12/20/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/20/2024
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 SW RO, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME: OLMOS FAMILY CHILD CARE
FACILITY NUMBER: 198014224
VISIT DATE: 12/20/2024
NARRATIVE
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Staff # 3

File has immunization record in folder.

No Mandated Reporter.

CPR expiration date of 11/24/26

File is missing all required licensing documents

Staff # 4

File has immunization record in folder.

CPR expiration date of 8/10/26

Mandated Reporter expiration date of 12/16/23

File is missing all required licensing documents


Staff #2 missing Health & Safety Training Certificate. This poses a potential health and safety risk to children in care. Technical Violation will be issued.
Staff 2 & 3 missing mandated reporter certificate. This poses a potential health and safety risk to children in care. Technical Violation will be issued.
Staff 1, 2, 3, 4-missing all required licensing forms in file. This poses a potential health and safety risk to children in care. Type B will be issued.
Copies of all the licensing forms were given to the Licensee by LPA Dunlap during visit.

Child #1

All required licensing forms (except LIC995A & LIC627)

Immunization record missing

Child #2

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SUPERVISORS NAME: Karen Chambers
LICENSING EVALUATOR NAME: Keneisha Dunlap
LICENSING EVALUATOR SIGNATURE:

DATE: 12/20/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/20/2024
LIC809 (FAS) - (06/04)
Page: 3 of 12
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MONTEREY PARK SW RO, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME: OLMOS FAMILY CHILD CARE
FACILITY NUMBER: 198014224
VISIT DATE: 12/20/2024
NARRATIVE
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Child #3
All required licensing forms (except LIC995A & LIC627)

Immunization is in file.

Child #4

All required licensing forms (except LIC995A & LIC627)

Immunization is in file.

4 out of 4 children files Files had LIC995 for Child Care. Files had LIC627 for Children's Residential. This poses a potential health and safety risk to children in care. Technical Violation will be issued.



1 out of 4 children files missing immunization record. This poses a potential health and safety risk to children in care. Technical Violation will be issued.

Copies of all the licensing forms were given to the Licensee by LPA Dunlap during visit.

The Licensee stated that they do provide meals for children.

The Licensee has a landline that they use.

The Licensee stated they do not have any children that they administer medication to at this time.

The Licensee states that when children are in sick, they are placed in the main care area by the door.

The Licensee stated there are no firearms in the home.

The Licensee stated that there are no smokers in the home.

The Licensee stated that there are 2 dogs on the premises.
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SUPERVISORS NAME: Karen Chambers
LICENSING EVALUATOR NAME: Keneisha Dunlap
LICENSING EVALUATOR SIGNATURE:

DATE: 12/20/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/20/2024
LIC809 (FAS) - (06/04)
Page: 4 of 12
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MONTEREY PARK SW RO, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME: OLMOS FAMILY CHILD CARE
FACILITY NUMBER: 198014224
VISIT DATE: 12/20/2024
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The Licensee stated that they do provide transportation for children in the morning and afternoon.

The Licensee stated that they do have first aid kit.

The Licensee does provide nap time. Cots, and playpens are stored in the main care area.

To improve the quality and value of the new inspection process, a survey may be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or CARE tools, please send email inquiries to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/inspection-process

Criminal Record Clearance - Family Child Care Homes Licensee Eusebia Olmos was reminded that all adults 18 and over living or working in the home, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, 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 for a maximum of 5 days or, if the penalty is for a repeat violation, for a maximum of 30 days per person will be assessed if this regulation is violated.

Safe Sleep

LPA discussed the safe sleep regulations with Licensee Eusebia Olmos and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-andresources/safe-sleep as an additional resource. LPA also informed Licensee Eusebia Olmos 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.

Incidental Medical Services (IMS)

Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02- CCP. 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) Page 5 of 6

SUPERVISORS NAME: Karen Chambers
LICENSING EVALUATOR NAME: Keneisha Dunlap
LICENSING EVALUATOR SIGNATURE:

DATE: 12/20/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/20/2024
LIC809 (FAS) - (06/04)
Page: 5 of 12
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MONTEREY PARK SW RO, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME: OLMOS FAMILY CHILD CARE
FACILITY NUMBER: 198014224
VISIT DATE: 12/20/2024
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 514-0301 (voice)/ (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: https://www.ada.gov/resources/child-carecenters/.

MyChildCarePlan.org – Centers and Family Child Care Homes Licensee Eusebia Olmos was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain child care by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.

Megan’s Law - Family Child Care Homes During the exit interview, the Licensee Eusebia Olmos confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS.

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

Appeal rights explained and given to Licensee Eusebia Olmos.

5 Technical Violations will be issued during today’s visit.

1 Type B will be issued during today’s visit.

Exit interview conducted and report was reviewed with the Licensee Eusebia Olmos.

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SUPERVISORS NAME: Karen Chambers
LICENSING EVALUATOR NAME: Keneisha Dunlap
LICENSING EVALUATOR SIGNATURE:

DATE: 12/20/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/20/2024
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 12/20/2024 02:45 PM - It Cannot Be Edited


Created By: Keneisha Dunlap On 12/20/2024 at 02:01 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: OLMOS FAMILY CHILD CARE
FACILITY NUMBER: 198014224

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/20/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102416.1(a)
Personnel Records
(a) Personnel records shall be maintained on each employee and shall contain the following information:

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 4 out of 4 staff files did not have all required licening documents in file, which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 01/08/2025
Plan of Correction
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The Licensee will have all staff fill out required forms.
The Licnesee shall send LPA proof of all documemts filled out by the POC date.
The Licensee shall keep all copies in staff files.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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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:Karen Chambers
LICENSING EVALUATOR NAME:Keneisha Dunlap
LICENSING EVALUATOR SIGNATURE:
DATE: 12/20/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/20/2024


LIC809 (FAS) - (06/04)
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