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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 191609404
Report Date: 02/15/2024
Date Signed: 02/15/2024 11:53:49 AM

Document Has Been Signed on 02/15/2024 11:53 AM - 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: 6CENSUS: 2DATE:
02/15/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
09:50 AM
MET WITH:Licensee Concepcion Ruiz-Chavarin TIME COMPLETED:
10:05 AM
NARRATIVE
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Licensing Program Analysts (LPAs) Jeanette Estrada and Jonnisha Culbert conducted an unannounced case management inspection at the facility above. LPAs met with Licensee Concepcion Ruiz-Chavarin and explained the reason for the visit. Licensee provided a tour of the facility. There were two children in care.

Upon entrance to the facility LPAs observed an infant in a car seat on top of the couch. The infant was covered up to their chest in a blanket. Per the Licensee, she had just gotten home from dropping off another child at school and was waiting for the infant to wake up to feed them. LPAs did not observe the Licensee pull into the facility prior to their arrival at the facility. Per Licensee, she had dropped off the other child at the school around 9AM.

Licensee immediately removed infant from the car seat and placed them in an empty play yard located in the on limits living room.

A type A citation is being cited today regarding regulation 102425(h) infant safe sleep. California Code of Regulations, (Title 22, Division 12, Chapter 1), are being cited on the attached LIC 9099D.

A copy of this report shall also be posted where the parent/guardian of children enter and exit the facility. Both the notice of site visit and licensing report shall remain posted for 30 consecutive days. Failure to maintain posting as required will result in a $100.00 civil penalty. A copy of this report shall be provided to the parent/guardian of children currently enrolled by the next business day or immediately upon their return. A copy of this report shall also be provided to the parent/guardian of any newly enrolled child for the next 12 months. A signed Acknowledgement of Receipt (LIC9224) shall be in each child’s file, acknowledging receipt.

The notice of site visit was posted where the parent/guardian of children enter and exit the facility.

Exit interview conducted and a copy was given to the Licensee Concepcion Ruiz.

SUPERVISORS NAME: Valarie Cook
LICENSING EVALUATOR NAME: Jeanette Estrada
LICENSING EVALUATOR SIGNATURE: DATE: 02/15/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/15/2024
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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Document Has Been Signed on 02/15/2024 11:53 AM - It Cannot Be Edited


Created By: Jeanette Estrada On 02/15/2024 at 10:13 AM
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: 02/15/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
02/16/2024
Section Cited
CCR
102425(h)

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102425(h)Car seats shall only be used for transportation purposes and shall not be used for sleeping.
This requirement was not met as evidenced by
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Licensee immediately removed infant from the car seat and placed them in an empty play yard located in the living room.
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Based on observation and interview the Licensee did not ensure that the infant was removed from the car sea upon arrival to the facilit. This poses an immediate risk to the health, safety and personal rights 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: 02/15/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/15/2024


LIC809 (FAS) - (06/04)
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