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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198016546
Report Date: 06/27/2024
Date Signed: 06/27/2024 03:02:36 PM

Document Has Been Signed on 06/27/2024 03:02 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:GUILLEMET FAMILY CHILD CAREFACILITY NUMBER:
198016546
ADMINISTRATOR/
DIRECTOR:		GUILLEMET, MELANIEFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(323) 253-6873
CITY:CARSONSTATE: CAZIP CODE:
90746
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 10DATE:
06/27/2024
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:40 PM
MET WITH:Melanie Guillemet / LicenseeTIME VISIT/
INSPECTION COMPLETED:
03:15 PM
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Licensing Program Analyst (LPA) Ashley Calderon conducted an unannounced random annual inspection at the above facility. LPA disclosed the purpose of the inspection and was granted entry into the facility by Licensee Melanie Guillemet.

Facility capacity is in compliance for a Large Family Child Care Home. Hours of operation are Mon-Fri 4:00AM AM - Midnight. Per Licensee, currently does not provide overnight care but is available per families needs. LPA observed upon arrival (3) staff including Licensee and (10) children in care (including 1 infant).

This is a two story home, (4)-Bedrooms and (2)-Bathrooms. LPA was provided a tour of the facility premises alongside with Licensee. The following areas are used for day-care: living room, kitchen and dining area, garage (day care room), backyard (fenced) and a bathroom used for children in care located near kitchen. Off limit areas include: All upstairs and (1) downstairs bedroom, (1) upstairs bathroom and front yard.

All areas identified on the facility sketch that are accessible for children to use were inspected for safety, comfort, and cleanliness. The following was observed and reviewed during this inspection:



LPA observed age appropriate materials and toys. Fireplace in living room secured and barricaded. No large bodies of water was observed in the backyard. Garage is a day care room. LPA reminded Licensee garage is not to be used for eating or napping.

LPA reviewed required posted documentation for Facility License, Publication (PUB) 394- Notification of Parent Rights and Licensing Form (LIC) 9148- Earthquake Preparedness form. Facility records were reviewed: LIC 9040- Facility Roster, LIC 610- Facility Disaster Plan and Fire drill log, last drill conducted on 06/10/24. Per Licensee, does disaster and fire drills monthly per licensee's preference.

(Page 1, Continuation 809-C... )
SUPERVISORS NAME: Valarie Cook
LICENSING EVALUATOR NAME: Ashley Calderon
LICENSING EVALUATOR SIGNATURE: DATE: 06/27/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/27/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 4
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: GUILLEMET FAMILY CHILD CARE
FACILITY NUMBER: 198016546
VISIT DATE: 06/27/2024
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Per Licensee, Food is provided for children in care. Licensee was reminded if children bring food from home it must be labeled with the child’s name and properly stored or refrigerated. LPA observed a pet dog. LPA observed sharps, medications, detergents, cleaning components to be stored in inaccessible cabinets either up high, locked with child safety locks in bathroom or in kitchen. Per licensee, no poisons are stored in the home. LPA reminded Licensee poisons when stored need to be key locked and inaccessible to children. LPA Calderon observed fire extinguisher serviced and charged. Per Licensee, either gets extinguisher inspected by a company or buys a new one yearly and keeps receipt for proof.

LPA reviewed staff and children records. LPA observed Medication for child #3 stored inaccessible to children in care. Per Licensee, medication is brought back and forth from child's home to facility. All (5) children records were reviewed and proper documentation were in place. Licensee's Mandated Reporter Certificate expires 8/16/24, Licensee, Staff #2 and Staff #3 did not have a valid Pediatric First Aid and CPR that follows Licensing Regulations, deficiency cited. LPA Calderon gave advise to Licensee and explained for assistant staff Mandated Reporter should state Child Care Provider unless they are Volunteers.

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.

Licensee 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.

(Page 2, Continuation 809-C...)
SUPERVISORS NAME: Valarie Cook
LICENSING EVALUATOR NAME: Ashley Calderon
LICENSING EVALUATOR SIGNATURE:

DATE: 06/27/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/27/2024
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: GUILLEMET FAMILY CHILD CARE
FACILITY NUMBER: 198016546
VISIT DATE: 06/27/2024
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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.

This facility provides Incidental Medical Services – IMS. LPA reviewed storage of medication and equipment/supplies, and reviewed children’s, personnel, and administrative records. For IMS information see PIN 22-02-CCP. The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice) or (800) 514- 0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA are available at: https://www.ada.gov/resources/child-care-centers/.

Licensee 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.

During the exit interview, the Licensee, confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS. Based on today’s visit, Per California Code of Regulations Title 22 this facility was provided (1) deficiency, on LIC809-D page..

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

Exit interview conducted and report was reviewed with the licensee Melanie Guillemet.

SUPERVISORS NAME: Valarie Cook
LICENSING EVALUATOR NAME: Ashley Calderon
LICENSING EVALUATOR SIGNATURE:

DATE: 06/27/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/27/2024
LIC809 (FAS) - (06/04)
Page: 4 of 4
Document Has Been Signed on 06/27/2024 03:02 PM - It Cannot Be Edited


Created By: Ashley Calderon On 06/27/2024 at 02:32 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: GUILLEMET FAMILY CHILD CARE
FACILITY NUMBER: 198016546

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/27/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102416(c)
Personnel Requirements
(c) The licensee and other personnel as specified shall complete training on preventive health practices, including pediatric cardiopulmonary resuscitation and pediatric first aid, pursuant to Health and Safety Code Section 1596.866.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on LPA Calderon observation during record review Licensee, Staff #2 and #3 had a CPR/First Aid that was not EMSA certified nor American Red Cross / Heart Association, the licensee did not comply with the section cited above in [3] out of [3] persons which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 07/19/2024
Plan of Correction
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Licensee and assistant staff will obtain proper CPR and First Aid and provide pictures of certificate by POC due date.
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:Valarie Cook
LICENSING EVALUATOR NAME:Ashley Calderon
LICENSING EVALUATOR SIGNATURE:
DATE: 06/27/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/27/2024


LIC809 (FAS) - (06/04)
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