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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 192000484
Report Date: 03/25/2020
Date Signed: 03/25/2020 10:34:15 AM

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:CASTANEDA FAMILY CHILD CAREFACILITY NUMBER:
192000484
ADMINISTRATOR:CASTANEDA, MARIAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(626) 962-2006
CITY:BALDWIN PARKSTATE: CAZIP CODE:
91706
CAPACITY:14CENSUS: 3DATE:
03/25/2020
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
09:44 AM
MET WITH:Maria CastanedaTIME COMPLETED:
10:48 AM
NARRATIVE
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On March 25, 2020 at 9:44a.m., Licensing Program Analysts (LPAs) Lissete Gonzalez and Nolan Tcheng conducted a Case Management visit. LPAs met with Licensee, Maria Castaneda. The purpose of this report is to address concerns regarding Reporting Requirements.

At 9:04a.m, during an interview with Licensee, Maria Castaneda, she acknowledged an unusual incident occurred at the facility on 2/20/2020 during hours of operation when there were children in care and was not reported to the Department. The Department does not have a record of a phone call to report the unusual incident that occurred on 2/20/2020 or a written report from the Licensee. The unusual incident was not reported to CCLD as required. All unusual incidents must be reported timely to CCLD; with 24 hours by phone as well as in writing within 7 days. A blank copy of the Unusual Incident/Injury Report (LIC624B) was provided and completed at the time of the visit.

The deficiencies listed on the following page are being cited in accordance with California Code of Regulations Title 22. Please see attached LIC 809d.

Deficiencies that are being cited need to be cleared to protect the health and safety of children in care.

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.

Exit interview was conducted with Licensee. Appeal rights explained & provided.
SUPERVISOR'S NAME: Christina GabelmanTELEPHONE: (323) 981-3380
LICENSING EVALUATOR NAME: Lissete GonzalezTELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:

DATE: 03/25/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/25/2020
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 CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME: CASTANEDA FAMILY CHILD CARE
FACILITY NUMBER: 192000484
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/25/2020
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
04/01/2020
Section Cited

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102416.2 Reporting Requirements
The licensee shall report to the Department any of the events as specified in Health and Safety Code Sections 1597.467(b)(1)(A) through (b)(1)(C) that occur during the operation of the family child care home. This requirement was not met as evidenced by: On 3/25/2020, at 9:04a.m., Licensee,
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Maria, acknowledged an unusual incident occurred at the facility on 2/20/2020 during hours of operation and was not reported to the Department within the required 24 hours. The Licensee did not submit a written report within the required 7 days. This poses a potential risk to the health and safety of 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: Christina GabelmanTELEPHONE: (323) 981-3380
LICENSING EVALUATOR NAME: Lissete GonzalezTELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:
DATE: 03/25/2020
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/25/2020
LIC809 (FAS) - (06/04)
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