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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198400347
Report Date: 04/13/2022
Date Signed: 04/13/2022 05:18:16 PM

Document Has Been Signed on 04/13/2022 05:18 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:LUGO FAMILY CHILD CAREFACILITY NUMBER:
198400347
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 5DATE:
04/13/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
02:00 PM
MET WITH:Denise Lugo, LicenseeTIME COMPLETED:
05:30 PM
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Licensing Program Analyst (LPA) Alicia Mooberry conducted a Required Annual Inspection to the above facility. LPA met with Denise Lugo, Licensee. LPA explained the purpose of the inspection and provided the inspection Entrance Checklist, LIC 126. Licensee provided tour of facility. LPA inspected rooms/areas on the facility sketch in which child-care services are provided and to which children have access. Per licensee, the hours of operation are Monday-Friday 6:00am-6:00pm. There were 2 children present including and infant age 4 months.

Individual identified by licensee residing in the home were discussed and noted and have obtained a fingerprint clearance.

This a single story home consisting of 3 bedrooms and 2 bathroom. The home is located in the rear of a two (2 )home lot.

Areas accessible to children: Bedroom 2 and 3, bathroom in the hallway, living room, kitchen and backyard.

Off limit areas, per Licensee and facility sketch are: Master bedroom and bathroom, detached garage and front of house. LPA observed items in the front of the home that can pose a danger to children in care and advised licensee to take extra care that children don't have access. LPA observed the front door closed and locked during this inspection.

The detached garage was observed to the closed. At 2:34pm LPA observed the wall heater in the living room without a barrier. This poses a potential risk to the health and safety of children in care. Per licensee, the heater has not worked since she has lives in the home. LPA observed that the heater has been painted over sealing the vent door on tho bottom - it cannot be opened. Licensee will request landlord provide a note from the gas if the gas has been shut off.

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SUPERVISORS NAME: Valarie Cook
LICENSING EVALUATOR NAME: Alicia Mooberry
LICENSING EVALUATOR SIGNATURE: DATE: 04/13/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/13/2022
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: LUGO FAMILY CHILD CARE
FACILITY NUMBER: 198400347
VISIT DATE: 04/13/2022
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LPA observed outlet covers through out home. The children access the back yard through the kitchen.

All areas identified on the facility sketch that are accessible for children to use were inspected for safety, comfort, and cleanliness. There are safety locks in the kitchen cabinets under the sink where cleaning products are kept.

LPA reminded licensee to ensure off limit areas are kept 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 required posted documentation in the daycare area including: 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 and Earthquake/Disaster Drill.

Smoke and carbon monoxide detectors were tested and are operable. Fire extinguisher indicated fully charged, licensee stated it has not been serviced since it was purchased on 8/21, this poses a potential risk to the health and safety of children in care. Licensee was reminded that the fire extinguisher needs to be serviced yearly.


LPA observed that detergents, cleaning compounds are in the kitchen and bathroom inaccessible to children. Licensee states that there are no poisons stored in the home and understands that all poisons must be lock, not only inaccessible to children. Per Licensee there are no firearms or weapons stored in the home.

Isolation area for sick children waiting to be picked up is in living room, away from the other children.


There are no bodies of water nor pets on the premises.

Infant Care: The licensee is currently caring for infants. LPA discussed the new Safe sleep regulations, including LIC 9227 Infant Sleep Plan for infants under 12 months, 15-minute sleep check documentation for infants 0-24 months, and provided PIN 20-24-CCP. Infants sleep in the living room where they are monitored.

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). LPA observed that licensee has a copy of the LIC 9227 and will have parents of children under 12 months of age.


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

DATE: 04/13/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/13/2022
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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: LUGO FAMILY CHILD CARE
FACILITY NUMBER: 198400347
VISIT DATE: 04/13/2022
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Licensee is current on Pediatric First Aid and CPR certification, Proof of immunizations against measles, pertussis and influenza, Mandated Reporter Training.

Currently, children are using the back yard for outdoor play. The outdoor play area was observed to be fenced. There are gates on both sides of the yard that lead to the front house. LPA observed that the outdoor yard has toys and other adequate materials for children. LPA reminded licensee to ensure the gates are always closed and locked and to make sure there are no hazardous item in the outside play area.

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

LPA states they are implementing COVID-19 precautions. Including daily temperature checks and encouraging parents to pick up at the door, COVID posting in bathroom were observed.

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 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.

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 [email protected]. 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.

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

DATE: 04/13/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/13/2022
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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: LUGO FAMILY CHILD CARE
FACILITY NUMBER: 198400347
VISIT DATE: 04/13/2022
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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.

Based on the LPA's observations and records review the following deficiencies will be cited as a result of this inspection (See LIC 809D)

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

Exit interview was conducted with Denise Lugo, Licensee. Appeal right were discussed and a copy provided to licensee.

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

DATE: 04/13/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/13/2022
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Document Has Been Signed on 04/13/2022 05:18 PM - It Cannot Be Edited


Created By: Alicia Mooberry On 04/13/2022 at 03:41 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: LUGO FAMILY CHILD CARE
FACILITY NUMBER: 198400347

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/13/2022

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 observations, the licensee did not comply with the section cited above due to the 2A10BC fire extinguisher does not have a service tag which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 04/20/2022
Plan of Correction
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Per licensee the fire extinguisher has not been serviced since 02/21. Licensee stated they will have the fire extinguisher serviced and provide proof to LPA via email by POC due date.
Type B
Section Cited
CCR
102417(g)(1)
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: (1) Fireplaces and open face heaters shall be screened to prevent access by children. The home shall contain a fire extinguisher and smoke detector device which meet standards established by the State Fire Marshall.

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 the wall heater in the living room does not have a barricade and is accessible to children in care which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 04/20/2022
Plan of Correction
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Per licensee, the wall heater has never worked. The wall heater will be made inaccessible and picture will be sent 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:Alicia Mooberry
LICENSING EVALUATOR SIGNATURE:
DATE: 04/13/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/13/2022


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