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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198015168
Report Date: 06/09/2022
Date Signed: 06/09/2022 04:15:23 PM

Document Has Been Signed on 06/09/2022 04:15 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 CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME:VILLAMIL FAMILY CHILD CAREFACILITY NUMBER:
198015168
ADMINISTRATOR:MARIA V. & JASMIN V.FACILITY TYPE:
810
ADDRESS:TELEPHONE:
(562) 215-4575
CITY:HAWAIIAN GARDENSSTATE: CAZIP CODE:
90716
CAPACITY: 14TOTAL ENROLLED CHILDREN: 11CENSUS: 8DATE:
06/09/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:25 PM
MET WITH:Maria Villamil, LicenseeTIME COMPLETED:
04:15 PM
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On 6/9/22 at 12:25/22 Licensing Program Analyst (LPA) Alicia Mooberry conducted a Required Annual Inspection in Spanish with Maria Villamil, Licensee. LPA explained the purpose of the inspection and provided with Entrance Checklist, LIC 126. Licensee provided tour of facility. LPA inspected rooms/areas on the facility sketch, including off limit areas. Per licensee the hours of operation are Monday-Friday 5:30 am - 5:30 pm. There were 8 children present (including 1 infant: 3 months). Also present was Jasmin Villamil, co-licensee and Maria Mariano, Assistant. All adults present have received Criminal Background clearance. Individuals residing in the home were discussed and noted. The facility was observed to within the capacity limitations.

At 12:29pm, LPA observed that Child #1, Infant of 3 months of age, napping in a crib in the living room, laying on a lose blanket, this poses a potential risk to the health and safety of children in care. LPA reviewed the Safe Sleep regulations with licensee that state infants should not have lose items or blankets while they sleep.

This is a single story home consisting of: 3 bedroom/2 bathrooms, living room, dining room, kitchen, detached garage, storage room and bathroom/laundry area in the back yard.

Areas designated for childcare use are the living room, kitchen and bathroom. The backyard areas in front and behind the garage. The bathroom (also used as laundry room) connected to the garage.

Off limit areas, per Licensee and facility sketch are: 3 bedrooms, detached garage, storage area (next to the garage) and dog run in the backyard. Licensee has 3 small dogs kept in the dog run in back yard.

All areas identified on the facility sketch in which child-care services are provided and to which children have access were inspected for safety, comfort, and cleanliness.

Smoke and carbon monoxide detectors were tested and are operable. Fire extinguisher indicated fully charged and was serviced 12/16/22, Licensee was reminded that fire extinguisher needs to be serviced yearly. The home maintains telephone service via cell phone. -------Page 1 – Report Continues

SUPERVISORS NAME: Valarie Cook
LICENSING EVALUATOR NAME: Alicia Mooberry
LICENSING EVALUATOR SIGNATURE: DATE: 06/09/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/09/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.

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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 CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME: VILLAMIL FAMILY CHILD CARE
FACILITY NUMBER: 198015168
VISIT DATE: 06/09/2022
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LPA observed a fireplace in the rear off limits bedroom of the home, the door was closed and locked making room inaccessible to children in care.

The home is observed to be clean and orderly. There are toys and other age appropriate material available for children. LPA observed that detergents, cleaning compounds are in kitchen with safety lock inaccessible to children. Detergents in the laundry room are kept in overhead cabinets with safety latch. Isolation area for sick children waiting to be picked up is in living room, away from the other children. Per Licensee there are no firearms or weapons stored in the home.

LPA observed required posted documentation in facility entrance which included: Facility License, Publication (PUB) 394- Notification of Parent Rights and Licensing Form (LIC) 9148- Earthquake Preparedness form. LPA observed completed facility records including; LIC 9040- Facility Roster, LIC 610- Facility Disaster Plan

Infant Care: Per licensee, there are currently 4 infants in care. LPA reviewed with licensee the new Safe sleep regulations and provided PIN 20-24-CCP. LPA observed LIC 9227 Infant Sleep Plan for infants under 12 months, and observed 15-minute sleep check documentation for infants 0-24 months.

Licensee states the following a sleep supervision plan for infants: Infants sleep in the living room. each infant has individual crib or play yard. Infants are su

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.

Currently, children are using the back yard for outdoor play. The outdoor play area was observed to be enclosed. At 12:50pm LPA observed a looped cord hanging low from shade in backyard area that is accessible to children in care. This poses a potential risk to the health and safety of children in care. Licensee tied the cord making it out of reach of children. LPA advised licensee to ensure the cord does not untangle and fall again. The outdoor play area is located behind the garage and has toys and other materials for children to play with. LPA observe area to be free of hazardous to children in care.

---------Page 2 – Report Continues

SUPERVISORS NAME: Valarie Cook
LICENSING EVALUATOR NAME: Alicia Mooberry
LICENSING EVALUATOR SIGNATURE:

DATE: 06/09/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/09/2022
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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 CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME: VILLAMIL FAMILY CHILD CARE
FACILITY NUMBER: 198015168
VISIT DATE: 06/09/2022
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Children’s records were reviewed for (LIC) 282- Affidavit Regarding Liability Insurance, Immunization's Records, LIC 700- Identification and Emergency Information, LIC 627- Consent for Medical Treatment, LIC 995A Notification of Parents’ Rights, and documentation of 15-minute Infant Sleep Check (0-24 months)

Staff records were reviewed for approved Pediatric First Aid and CPR certification, LIC-501: Personnel


Record, LIC 508-Criminal Record Statement, LIC 9052- Employee Rights, Proof of immunizations against measles, pertussis and influenza or influenza declination, TB clearance or risk assessment, LIC 9108- Statement Acknowledging Requirement to Report Child Abuse and current Mandated Reporter Training Certificate.
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.

LPA observed that licensee is implementing COVID-19 precautions and procedures. Temperature checks are taken and children are screened upon arrival. Staff was observed to be wearing masks.

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

To improve the quality and value of the new inspection process, a survey will 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 tools, please send them by email 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.

Based on the LPA's observations and records review the following deficiencies will be cited today in accordance with California Title 22 Regulations.


A notice of site visit was given and must remain posted for 30 days.
Exit interview conducted and report was reviewed with the Licensee, Maria Villamil, Appeal Rights were discussed and a copy provided.
SUPERVISORS NAME: Valarie Cook
LICENSING EVALUATOR NAME: Alicia Mooberry
LICENSING EVALUATOR SIGNATURE:

DATE: 06/09/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/09/2022
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Document Has Been Signed on 06/09/2022 04:15 PM - It Cannot Be Edited


Created By: Alicia Mooberry On 06/09/2022 at 03:08 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: VILLAMIL FAMILY CHILD CARE
FACILITY NUMBER: 198015168

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/09/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102417(g)
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:

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 that a looped cord hanging low from shade in backyard area that is accessible to children in care which posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 06/09/2022
Plan of Correction
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Licensee tied the cord making it out if reach of children. Defeciency corrected during inspection.
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 in Child #1, was laying on a lose blanket while they slept this poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 06/09/2022
Plan of Correction
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Licensee removed the blanket and provided a written plan on how they will implement the Safe Sleep regulations and provide training to staff and parents. Defeciency corrected during inspection.
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:Alicia Mooberry
LICENSING EVALUATOR SIGNATURE:
DATE: 06/09/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/09/2022


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