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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198400347
Report Date: 03/03/2023
Date Signed: 03/03/2023 03:25:04 PM

Document Has Been Signed on 03/03/2023 03:25 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: 3DATE:
03/03/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:55 AM
MET WITH:Denise Lugo, LicenseeTIME COMPLETED:
04:00 PM
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Licensing Program Analyst (LPA) Alicia Mooberry conducted a Required Annual Inspection on this date. Upon arrival at 11:55am LPA met with licensee Denise Lugo, Licensee, explained the purpose of inspection and provided the Inspection Entrance Checklist, LIC 126. Licensee guided LPA on tour of the facility.

At 11:58am licensee opened door to a closed bedroom, LPA observed Child #1, 15 month old infant, sleeping in a crib, child was laying on a pillow and surrounded with blankets, this poses an immediate risk to the health and safety of persons in care. Licensee removed the child from the crib (Photo taken).

LPA inspected rooms 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 3 children present, including 1 infant. Also present was Jose Lugo and Eva Lugo, Licensee's parents and Volunteers. All adults present have received the required background clearance. Individuals residing in the home were discussed and noted. The licensee has applied for a capacity increase for a Large Family Child Care license up to Capacity of 14. A fire clearance was granted on 02/23/2023. LPA discussed capacity limitations of a Large FCC. If no qualified assistant is available the license capacity returns to a Small FCC.

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

Areas accessible to children: Three (3) Bedrooms, the bathroom in the hallway, living room, kitchen and backyard. Off limit areas, per Licensee and facility sketch are: The bathroom and closet in the Master bedroom detached garage and front area of the house.

Off limit areas were observed to be closed with doorknob safety locks. The detached garage was observed to be closed. LPA observed the wall heater in the living room has had the gas valve turned off by Sempra Energy. LPA observed portable heaters that are not hot to the touch used to keep the home comfortable. -------Page 1 -Report Continues

SUPERVISORS NAME: Valarie Cook
LICENSING EVALUATOR NAME: Alicia Mooberry
LICENSING EVALUATOR SIGNATURE: DATE: 03/03/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/03/2023
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: 03/03/2023
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LPA observed all required documents posted in the facility in a location visible to parent/guardians of children in care. Including Facility License, Publication (PUB) 394- Notification of Parent Rights and Licensing Form (LIC) 9148- Earthquake Preparedness form. LPA observed completed LIC 9040- Facility Roster, LIC 610- Facility Disaster Plan.

Smoke and carbon monoxide detectors were tested and are operable. Fire extinguisher indicated fully charged and was serviced on 04/2022, Licensee was reminded that fire extinguisher needs to be serviced yearly. The home maintains telephone service via cell phone. The home is observed to be clean and orderly. There are toys and other age appropriate material available for children. LPA observed that cleaning compounds and sharp items are in kitchen in locked cabinet inaccessible to children. The bathroom that children use is located in the hallway and observed to be clean and free of hazards.


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. There are no pets in the home. No bodies of water on the premises.
Isolation area for sick children waiting to be picked up is in living room, away from the other children.

Per licensee, there is one (1) infant enrolled in care. Licensee will review the Safe sleep regulations and provided a written plan of care for Infants. Each infant has their own play yard or crib. LPA discussed the safe sleep regulations with licensee including PIN 20-24-CCP 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.

Currently, children are using the back yard for outdoor play. The outdoor play area was observed to be fenced. LPA observed that the outdoor yard has toys and other materials for children to play with. LPA did not observe any objects that could be hazardous to children in care.


Children’s records were reviewed according to the LIC 126 and found complete. Licensee has current CPR/1st Aid Expires on 12/2024

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

DATE: 03/03/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/03/2023
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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: 03/03/2023
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Per licensee current volunteers do not have the required Pediatric First Aid and CPR certification, Mandated Reporter Training Certificate, Proof of immunizations against measles, pertussis and influenza or influenza declination, TB clearance or risk assessment, or LIC 9108- Statement Acknowledging Requirement to Report Child Abuse. Licensee was reminded to ensure all documents are completed prior to individuals assisting with the licensed child care.

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

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.

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.

Based on the LPA's observations and records review the following deficiencies will be cited today in accordance with California Title 22 Regulations.

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 (LIC 9224 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 Licensee, Denise Lugo. Appeal Rights were discussed and a copy provided.
SUPERVISORS NAME: Valarie Cook
LICENSING EVALUATOR NAME: Alicia Mooberry
LICENSING EVALUATOR SIGNATURE:

DATE: 03/03/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/03/2023
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 03/03/2023 03:25 PM - It Cannot Be Edited


Created By: Alicia Mooberry On 03/03/2023 at 02:22 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: LUGO FAMILY CHILD CARE
FACILITY NUMBER: 198400347

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/03/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
102425(j)(5)
Infant Safe Sleep
The provider shall supervise infants while they are sleeping and adhere to the following requirements: If the infant is sleeping in a separate room from where the provider is stationed, the door to the room the infant is sleeping in shall remain open at all times.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on [(observation) (interview) (record review)], the licensee did not comply with the section cited above in one out of one infant in care Child #1 age 15 months was observed laying down inside a play yard in a bedroom with closed door which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 03/03/2023
Plan of Correction
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Licensee removed the 15 month old infant from the play yard. Per licensee, they will review the Safe Sleep regulations and provide a written plan on how they will ensure infants in care are provided a safe environment.
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:Alicia Mooberry
LICENSING EVALUATOR SIGNATURE:
DATE: 03/03/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/03/2023


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Document Has Been Signed on 03/03/2023 03:25 PM - It Cannot Be Edited


Created By: Alicia Mooberry On 03/03/2023 at 02:22 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: LUGO FAMILY CHILD CARE
FACILITY NUMBER: 198400347

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/03/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Section Cited
Administration of Child Day Care Licensing
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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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 record review and interview, the licensee did not comply with the section cited above in that 2 out of 2 adult volunteers assisting with childcare did not have the required CPR/1st Aid cerirfication which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 03/20/2023
Plan of Correction
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Per licensee, they will provide proof of correction to LPA by email 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: 03/03/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/03/2023


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