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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 192005364
Report Date: 10/20/2023
Date Signed: 10/20/2023 04:25:10 PM


Document Has Been Signed on 10/20/2023 04:25 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 CNTR DR. 200-B
MONTEREY PARK, CA 91754



FACILITY NAME:CASAVIELLES FAMILY CHILD CAREFACILITY NUMBER:
192005364
ADMINISTRATOR:CASAVIELLES ELDA-YANELYSFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(626) 919-7523
CITY:LA PUENTESTATE: CAZIP CODE:
91744
CAPACITY:14CENSUS: 10DATE:
10/20/2023
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
03:15 PM
MET WITH:Elda CasaviellesTIME COMPLETED:
04:30 PM
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On 10/20/2023, Licensing Program Analyst (LPA), Carolyn Tuba conducted an unannounced POC (plan of correction) inspection to ensure the deficiencies cited on 6/7/2023 have been cleared. A COVID risk assessment was conducted. LPA met with Licensee, Elda Casavielles, and LPA observed 10 children present at the facility during this inspection with 2 assistants.

LPA reviewed mandated reporting certificate was completed by the Licensee and her assistant. Certificates expires on 06/14/2025 and 6/15/2025. LPA advised Licensee that anyone working directly with children requires the Mandated Reporting training.

LPA reviewed CPR/1st Aid cards which include EMSA stickers and expire 6/2025 for both Licensee and her assistants.

During the visit LPA reviewed the 15-minute sleep log for children who are 24 months and younger and found that Licensee is documenting but not keeping the forms in the child’s file. LPA advised to keep in each child’s file for review. Licensee will email a copy of the log by 10/27/2023. LPA reviewed immuinizations for the Licensee and reviewed that she had proof of her TB, MMR and Tdap, however her assistant does not have the current proof of her immunization's. LPA has advised Licensee to email the proof of the MMR, Tdap and TB for her assistant. LPA is issuing an extension of the POC until 11/3/2023.

LPA cleared the deficiencies on this date and issued a POC clearance letters during this visit and provided a copy to the Licensee.

At this time, the facility is in compliance with California Code of Regulations Title 22. Therefore, no deficiencies are being cited.

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SUPERVISOR'S NAME: Ana ChicoTELEPHONE: (323) 981-3374
LICENSING EVALUATOR NAME: Carolyn TubaTELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:
DATE: 10/20/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/20/2023
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: CASAVIELLES FAMILY CHILD CARE
FACILITY NUMBER: 192005364
VISIT DATE: 10/20/2023
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A notice of site visit was given and must remain posted for 30 days.

Exit interview conducted and report was reviewed with the Licensee, Elda Casavielles
SUPERVISOR'S NAME: Ana ChicoTELEPHONE: (323) 981-3374
LICENSING EVALUATOR NAME: Carolyn TubaTELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:

DATE: 10/20/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/20/2023
LIC809 (FAS) - (06/04)
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