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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 191614561
Report Date: 08/10/2022
Date Signed: 08/10/2022 02:44:22 PM


Document Has Been Signed on 08/10/2022 02:44 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, 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:
08/10/2022
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
01:50 PM
MET WITH:Blanca VillalobosTIME COMPLETED:
02:55 PM
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On 8/10/2021, Licensing Program Analyst (LPA), Loyce Phillips met with Licensee, Blanca Villalobos today for the purpose of conducting a Plan of Correction inspection. During this unannounced inspection, there were no children or staff. LPA observed the following corrections:

· Infant sleep log was completed for the infants in care.
· Pediatric CPR/First Aid completed on 5/4/2022.
· LIC 9227 Individual Infant Sleep Plan completed.

Citations have been cleared.

An exit interview was conducted. A copy of this report, notice of site visit, deficiencies clearance letters were discussed and provided to Licensee, Blanca Villalobos.
SUPERVISOR'S NAME: Peter FloresTELEPHONE: (424) 301-3063
LICENSING EVALUATOR NAME: Loyce PhillipsTELEPHONE: (424) 301-3206
LICENSING EVALUATOR SIGNATURE:
DATE: 08/10/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/10/2022
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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