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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 192006280
Report Date: 08/06/2021
Date Signed: 08/06/2021 04:50:14 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:MARIONA FAMILY CHILD CAREFACILITY NUMBER:
192006280
ADMINISTRATOR:MARIONA, SUSANAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(626) 573-3927
CITY:ROSEMEADSTATE: CAZIP CODE:
91770
CAPACITY:14CENSUS: 11DATE:
08/06/2021
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
03:15 PM
MET WITH:Licensee, Susana MarionaTIME COMPLETED:
05:00 PM
NARRATIVE
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An unannounced Case Management-deficiencies visit was conducted on today's date by Licensing Program Analyst (LPA) Bardo Baluyot to cite for deficiencies regarding an unfingerprinted adult employed as staff discovered during the course of a Complaint investigation by IB which are unrelated to the Complaint allegations. LPA met with Licensee, Susana Mariona who guided the LPA on a tour of the facility. Licensee's adult son Oscar who works as an assistant in the day care and lives in the home provided translation.

Upon LPA's arrival, there were 11 children on site. Census was taken at 3:35 pm. All were school age except for 1 child who is 2.5 years old. There were 3 staff present, including the Licensee's adult son Oscar Mariona.

The following is being cited in accordance to Title 22 of the California Code of Regulations and/or Health and Safety codes:
  • Prior to employment or initial presence in the child care home, all employees and volunteers subject to a criminal record review.

Please refer to 809 D for documentation of deficiencies.

Upon receipt, the Licensee shall post the Notice of Site Visit and the Licensing report. This report and the Notice of Site Visit shall be posted for 30 consecutive days. Failure to maintain posting as required will result in a $100 civil penalty.
SUPERVISOR'S NAME: Ana ChicoTELEPHONE: (323) 981-3351
LICENSING EVALUATOR NAME: Bardo BaluyotTELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:

DATE: 08/06/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/06/2021
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC809 (FAS) - (06/04)
Page: 1 of 3
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: MARIONA FAMILY CHILD CARE
FACILITY NUMBER: 192006280
VISIT DATE: 08/06/2021
NARRATIVE
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A copy of this report shall be provided to the parents/guardians of the children currently enrolled by the next business day or immediately upon return. A copy of this report shall also be provided to the parents/guardians of any children newly enrolled at the facility for the next 12 months. The LIC 9224 Acknowledgement of Receipt of Licensing Reports must be maintained in each child's file immediately upon receipt from the parent. LPA provided Licensee with a blank copy of the LIC 9224 Acknowledgement of Receipt of Licensing Report.

Exit interview was conducted with Licensee, Susana Mariona and son/assistant Oscar Mariona and a copy of the report has been signed by and provided to Licensee Susana Mariona. Appeal Rights procedures provided and explained.
SUPERVISOR'S NAME: Ana ChicoTELEPHONE: (323) 981-3351
LICENSING EVALUATOR NAME: Bardo BaluyotTELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:

DATE: 08/06/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/06/2021
LIC809 (FAS) - (06/04)
Page: 2 of 3
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: MARIONA FAMILY CHILD CARE
FACILITY NUMBER: 192006280
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/06/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
08/06/2021
Section Cited

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Personnel Requirements

Prior to employment or initial presence in the child care home, all employees and volunteers subject to a criminal record review shall:

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(1) Obtain a California clearance or a criminal record exemption as required by law or Department regulations
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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: Ana ChicoTELEPHONE: (323) 981-3351
LICENSING EVALUATOR NAME: Bardo BaluyotTELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:
DATE: 08/06/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/06/2021
LIC809 (FAS) - (06/04)
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