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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197409384
Report Date: 05/20/2022
Date Signed: 05/20/2022 01:35:44 PM


Document Has Been Signed on 05/20/2022 01:35 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, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551



FACILITY NAME:SANTANA FAMILY CHILD CAREFACILITY NUMBER:
197409384
ADMINISTRATOR:SANTANA, MARTA L.FACILITY TYPE:
810
ADDRESS:TELEPHONE:
(818) 367-5632
CITY:SYLMARSTATE: CAZIP CODE:
91342
CAPACITY:14CENSUS: 5DATE:
05/20/2022
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
12:10 PM
MET WITH:Maria Becerra TIME COMPLETED:
01:50 PM
NARRATIVE
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On 05/20/22 Licensing Program Analyst (LPA) Justin Dorsey, met withAssistant Maria Becerra for a Case Management - Deficiencies inspection.


During the inspection the following was observed:
  • LPA Dorsey found during interview that licensee Santana has been out of home since 05/18/22 and will return 05/23/22. Per Assistant #1 the daycare has continued care since 05/18/22, during the visit LPA Dorsey observed 5 children in care. Facility was cited a type B citation, LPA advised licensee that children should not return to the home until she returns home.
  • LPA Dorsey observed an infant sleeping with a blanket in their crib. LPA Dorsey gave facility a Technical Assistance and gave a copy and went over PIN 20-24-CPP with Assistant Maria Becerra.


.An exit interview was conducted, a copy of this report was read over the phone to Licensees daughter.
SUPERVISOR'S NAME: Claretta YatesTELEPHONE: (661) 202-3318
LICENSING EVALUATOR NAME: Justin DorseyTELEPHONE: (661) 305-3012
LICENSING EVALUATOR SIGNATURE:
DATE: 05/20/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/20/2022
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 05/20/2022 01:35 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, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551


FACILITY NAME: SANTANA FAMILY CHILD CARE
FACILITY NUMBER: 197409384

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/20/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
05/23/2022
Section Cited

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102417 Operation of a Family Child Care Home (a)The licensee shall be present in the home and shall ensure that children in care are supervised at all time...Temporary absences shall not exceed 20 percent of the hours that the facility is providing care per day.This requirement is not met as evidenced by:
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Based on interview the licensee has not been present in the home since 05/18/22, which poses a potential Health, Safety or Personal Rights risk to 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: Claretta YatesTELEPHONE: (661) 202-3318
LICENSING EVALUATOR NAME: Justin DorseyTELEPHONE: (661) 305-3012
LICENSING EVALUATOR SIGNATURE:
DATE: 05/20/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/20/2022
LIC809 (FAS) - (06/04)
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