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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 192004922
Report Date: 07/05/2022
Date Signed: 07/05/2022 04:12:24 PM


Document Has Been Signed on 07/05/2022 04:12 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:GARCIA FAMILY CHILD CAREFACILITY NUMBER:
192004922
ADMINISTRATOR:GARCIA, EVELIAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(562) 215-3559
CITY:HAWAIIAN GARDENSSTATE: CAZIP CODE:
90716
CAPACITY:14CENSUS: 8DATE:
07/05/2022
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
02:50 PM
MET WITH:Evelia Garcia, LicenseeTIME COMPLETED:
04:30 PM
NARRATIVE
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Licensing Program Analysts (LPAs) Alicia Mooberry and Austin Estrada conducted a case management inspection. LPA met with Evelia Garcia, A tour of the facility was provided. Also Present was Daisy Garcia, Licensee's daughter and assistant.

During tour of facility LPA observed the following deficiencies: Child #1 a 3 month old infant was observed strapped in an incline sleeper - Fisher Price Model T8379 this poses an immediate risk to the health and safety of children in care. Infant was supervised by Daisy Garcia, Assistant. LPA Mooberry asked Licensee and assistant to remove infant from the inclined sleeper. Assistant then placed infant in a crib in the living room. LPA Mooberry provided extensive Technical Assistance on Safe Sleep, providing PIN 20-24-CCP in both English and Spanish and a copy of LIC 9227 and sample of infant Sleep Log.



Deficiencies cited are on attached LIC 809D. 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 during this visit. A copy of the Parent Notification Requirements was also provided to the licensee.

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.

Exit interview was conducted with Evelia Garcia, Licensee.

SUPERVISOR'S NAME: Valarie CookTELEPHONE: (323) 513-3858
LICENSING EVALUATOR NAME: Alicia MooberryTELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:
DATE: 07/05/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/05/2022
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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Document Has Been Signed on 07/05/2022 04:12 PM - It Cannot Be Edited

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: GARCIA FAMILY CHILD CARE
FACILITY NUMBER: 192004922

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/05/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
07/05/2022
Section Cited

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There shall be one crib or play yard for each infant who is unable to climb out of the crib or play yard. All cribs or play yards shall meet the United States Consumer Product Safety Commission safety standards.
This requirement is not met as evidenced by:
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LPAs observed Child #1, a 3 month old infant strapped in an incline sleeper - Fisher Price Model T8379 this poses an immediate 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: Valarie CookTELEPHONE: (323) 513-3858
LICENSING EVALUATOR NAME: Alicia MooberryTELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:
DATE: 07/05/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/05/2022
LIC809 (FAS) - (06/04)
Page: 2 of 2