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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 191811185
Report Date: 11/08/2019
Date Signed: 11/08/2019 03:30:20 PM

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 CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME:ANA MENDEZ, NORMA ARCA AND CAMILO ARCAFACILITY NUMBER:
191811185
ADMINISTRATOR:MENDEZ, ANA M.FACILITY TYPE:
810
ADDRESS:TELEPHONE:
(213) 484-9487
CITY:LOS ANGELESSTATE: CAZIP CODE:
90026
CAPACITY:14CENSUS: 6DATE:
11/08/2019
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
02:55 PM
MET WITH:Norma ArcaTIME COMPLETED:
03:45 PM
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Licensing Program Analyst (LPA) Lissete Gonzalez conducted an unannounced Plan of Correction inspection to determine whether the deficiency cited on 9/24/2019 has been corrected. Upon arrival, LPA met with Licensees Norma Arca and Camilo Arca. Also present during today's visit co-licensee, Ana Mendez. There were 6 children present, 3 being infants.

Based on LPA’s observations and record review, the following deficiency cited on 9/24/2019 has been corrected: 102416.5(d)(1) – Staffing Ratio and Capacity

LPA Gonzalez reviewed the schedule provided by Licensee, Norma Arca, of all of the children enrolled. The schedule includes different days and time of attendance for the 5 infants enrolled at the day care. LPA observed staffing ratio and capacity to be in compliance.

Per California Code of Regulations Title 22, Division 12, no deficiency was cited during today's visit. Exit interview conducted with Licensee, Norma Arca.

The Notice of Site Visit (LIC 9213) – must remain posted for 30 days during the hours of operation after each site visit by a licensing representative. Failure to maintain posting as required will result in a civil penalty of $100.00.
SUPERVISOR'S NAME: Christina GabelmanTELEPHONE: (323) 981-3380
LICENSING EVALUATOR NAME: Lissete GonzalezTELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:

DATE: 11/08/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/08/2019
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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