<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 191614561
Report Date: 07/09/2019
Date Signed: 07/09/2019 08:41:30 AM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME:VILLALOBOS, BLANCA FAMILY DAY CAREFACILITY NUMBER:
191614561
ADMINISTRATOR:BLANCA VILLALOBOSFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(310) 399-6766
CITY:VENICESTATE: CAZIP CODE:
90291
CAPACITY:12CENSUS: DATE:
07/09/2019
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
07:15 AM
MET WITH:Blanca Villalobos, licenseeTIME COMPLETED:
08:45 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
On 7/9/2019 at 7:15am Licensing program analyst (LPA) Denise Miranda arrived at the facility to conduct a Plan of Correction visit for the following deficiencies below, cited during the Annual Random visit conducted on 6/26/2019. LPA met with licensee, Blanca Villalobos, who provided LPA with a tour of the home to observe the corrections. During this inspections were present licensee and two assistants no children in care.
At 8:15am LPA observed three children arrived at the facility.

LPA observed the following correction: The deficiency has been corrected and cleared.

1) 102417(b) Operation of a Family Child Care Home. The home shall be kept clean and orderly.

LPA observed all corrections. These deficiencies have been corrected and cleared.

The facility was found to be in substantial compliance per Title 22 Regulations.

A copy of report, a Notice of Site Visit were issued and explained to the Licensee.



This report must be posted for 30 days from today,
SUPERVISOR'S NAME: Jennie FerreiraTELEPHONE: (424) 301-3067
LICENSING EVALUATOR NAME: Denise MirandaTELEPHONE: (424) 301-3055
LICENSING EVALUATOR SIGNATURE:

DATE: 07/09/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/09/2019
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC809 (FAS) - (06/04)
Page: 1 of 1