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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 191609404
Report Date: 11/08/2023
Date Signed: 11/08/2023 03:16:34 PM

Document Has Been Signed on 11/08/2023 03:16 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:RUIZ-CHAVARIN FAMILY CHILD CAREFACILITY NUMBER:
191609404
ADMINISTRATOR:CONCEPCION RUIZ CH.FACILITY TYPE:
810
ADDRESS:TELEPHONE:
(424) 406-2106
CITY:CARSONSTATE: CAZIP CODE:
90746
CAPACITY: 12TOTAL ENROLLED CHILDREN: 7CENSUS: 5DATE:
11/08/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
02:46 PM
MET WITH:Licensee Concepcion Ruiz-ChavarinTIME COMPLETED:
03:20 PM
NARRATIVE
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Licensing Program Analysts (LPAs) Jeanette Estrada and Anthony Padilla conducted an unannounced Case Management inspection at the facility listed above. LPAs met with Licensee.
LPAs observed five children in care.
During today's visit, LPAs observed a bottle of bleach and several other cleaning supplies in the kitchen on the counter. Per Licensee, items were being used prior to children's arrival from school. Licensee removed items and placed them outside. LPAs also observed a bottle of rubbing alcohol in the living room area. LPAs observed a container of insect poison in the backyard. Licensee removed the rubbing alcohol and placed it in an upper cabinet in the hallway. Licensee was advised to place poison in a locked container. Children were not observed outside during the inspection.
A type B citation is being issued today regarding operation of a family child care home.

A notice of site visit was given and must remain posted for 30 days. Exit interview conducted and report was reviewed with Licensee Concepcion Ruiz-Chavarin. Appeal rights were explained and provided.
SUPERVISORS NAME: Valarie Cook
LICENSING EVALUATOR NAME: Jeanette Estrada
LICENSING EVALUATOR SIGNATURE: DATE: 11/08/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/08/2023
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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Document Has Been Signed on 11/08/2023 03:16 PM - It Cannot Be Edited


Created By: Jeanette Estrada On 11/08/2023 at 03:02 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: RUIZ-CHAVARIN FAMILY CHILD CARE
FACILITY NUMBER: 191609404

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/08/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
11/09/2023
Section Cited
CCR
102417(g)(4)

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The home shall be free from...conditions which might endanger a child:Poisons, detergents, cleaning compounds, medicines.. and other items which could pose a danger if readily available to children shall be stored where they are inaccessible to children.
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Licensee removed the cleaning compounds and medicine from the kitchen and living room area. Licensee stated the poison in the backyard will be placed in a locked storage area. A photo will be provided to LPA by 11/9/23.
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This requirement is not met as evidenced by: Based on LPA observation the Licensee did not ensure the inaccessibility of cleaning compounds, medicine and poisons iin areas on limits to children. This poses a potential 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:Valarie Cook
LICENSING EVALUATOR NAME:Jeanette Estrada
LICENSING EVALUATOR SIGNATURE:
DATE: 11/08/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/08/2023


LIC809 (FAS) - (06/04)
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