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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 192008660
Report Date: 09/23/2021
Date Signed: 09/23/2021 04:55:42 PM

Document Has Been Signed on 09/23/2021 04:55 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:PRIETO FAMILY CHILD CAREFACILITY NUMBER:
192008660
ADMINISTRATOR:PRIETO, MARIAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(323) 233-2459
CITY:LOS ANGELESSTATE: CAZIP CODE:
90037
CAPACITY: 14TOTAL ENROLLED CHILDREN: 0CENSUS: 6DATE:
09/23/2021
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
02:00 PM
MET WITH:Mirsa Prieto, LicenseeTIME COMPLETED:
03:00 PM
NARRATIVE
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Licensing Program Analysts (LPA) Denise Gibbs conducted an unannounced case management inspection to the above facility on 9/23/21 at 2:00 PM. LPA was initially met by Teresa Morelos, Facility Representative one (FR1), who guided analysts on a tour of the facility. Shortly after Mirsa Preito, Facility Representative Two (FR2) took over tour. The purpose of this inspection is check for the health and safety of the children in care.

There were four children present upon arrival, one chid arrived shortly after. During inspection of facility LPA observed off limits garage open in the backyard. LPA inspected garage and observed a cleared path leading to a restroom. LPA asked FR1 if the children use that restroom and she stated that they use the restroom in the house but some times they use that one. LPA observed multiple items stored in the garage piled up high, which could potentially fall and be hazardous for the children. LPA asked ask FR2 to close and lock the door, which she did.

LPA walked through the main care area in the living room as indicated on the facility sketch and observed items that are an immediate risk to children in care. LPA observed the gate to the off limits kitchen is no longer in place. In the kitchen LPA observed TheraFlu on the sink at children's reach. Under the sink LPA observed accessible cabinets with no child lock and multiple cleaning products. Adjacent to the kitchen LPA observed a mobile island cabinet with nine knives stored openly accessible to children, off bug spray, Alka Seltzer gummies and Vitamin gummies at children's reach. In the living room, on a low counter LPA observed Imodium medicine and bug spray at children's level.

Based on the LPA observations and interview, the following deficiencies listed on the attached LIC 809D (deficiency page) are being cited in accordance with California Code of Regulations Title 22. Deficiencies that are being cited need to be cleared to protect the children’s health & safety.

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SUPERVISORS NAME: Trevino Cochran
LICENSING EVALUATOR NAME: Denise Gibbs
LICENSING EVALUATOR SIGNATURE: DATE: 09/23/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/23/2021
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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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: PRIETO FAMILY CHILD CARE
FACILITY NUMBER: 192008660
VISIT DATE: 09/23/2021
NARRATIVE
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A copy of this report shall be provided to the parent/guardian of children currently enrolled by the next business day or immediately upon return. A copy of this report shall also be provided to the parent/guardian of any newly enrolled children for the next 12 months (1 year). The Acknowledgement form must be maintained in each child’s file immediately upon receipt from parent. Licensee was provided with a copy of the parent Acknowledgement of Receipt of Licensing Reports Form during this visit.

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

Exit interview conducted and report was reviewed with the Facility Representative, Mirsa Prieto.

SUPERVISORS NAME: Trevino Cochran
LICENSING EVALUATOR NAME: Denise Gibbs
LICENSING EVALUATOR SIGNATURE:

DATE: 09/23/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/23/2021
LIC809 (FAS) - (06/04)
Page: 2 of 3
Document Has Been Signed on 09/23/2021 04:55 PM - It Cannot Be Edited


Created By: Denise Gibbs On 09/23/2021 at 04:22 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: PRIETO FAMILY CHILD CARE
FACILITY NUMBER: 192008660

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/23/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
09/24/2021
Section Cited
CCR
102417(g)(4)

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102417(g)(4) Operation of a Family Child Care Home(g) The home shall be free from defects or conditions which might endanger a child... (4)Poisons, detergents, cleaning compounds, medicines...shall be stored where they are inaccessible to children.
This requirement was not met as evidenced by:
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Per Facility Representative as soon as the children leave she will have time to put the gate back in place in the kitchen and make the medication inaccessible. With the gate in place she will store the knives in a cabinet in the kitchen inaccessible to children. Facility representative will email pictures to LPA by 9/24/21.
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Based on observation and interview facility representative did not ensure knives, cleaning products and medication were inaccessible.
This poses an immediate Health, Safety 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:Trevino Cochran
LICENSING EVALUATOR NAME:Denise Gibbs
LICENSING EVALUATOR SIGNATURE:
DATE: 09/23/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/23/2021


LIC809 (FAS) - (06/04)
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