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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197409434
Report Date: 03/04/2024
Date Signed: 03/04/2024 03:58:05 PM


Document Has Been Signed on 03/04/2024 03:58 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
EL SEGUNDO CC NORTH, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245



FACILITY NAME:SANTANA FAMILY CHILD CAREFACILITY NUMBER:
197409434
ADMINISTRATOR:SANTANA, LAURA A.FACILITY TYPE:
810
ADDRESS:TELEPHONE:
(818) 912-3763
CITY:VAN NUYSSTATE: CAZIP CODE:
91406
CAPACITY:14CENSUS: 6DATE:
03/04/2024
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Laura Santana, LicenseeTIME COMPLETED:
04:00 PM
NARRATIVE
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On 3/4/2024 at 1:09 PM, Licensing Program Analyst (LPA) Elicia Calvillo conducted an unannounced visit. LPA identified self and met with Laura Santana, Licensee, who guided analyst on a tour of the inside and outside of the facility. LPA observed 6 Children, Licensee, and 2 staff.

At 1:25 PM, Licensee stated Angel G, Guzman, is an adult living in the home and licensee confirmed that the adult has been living in the home for over 5 days and did not have a Criminal Record Clearance associated with facility. LPA did not have the individual on the Guardian Roster and contacted the Regional Office and office staff confirm that the Angel G. Guzman is not associated to the facility.

Licensee was reminded that all adults 18 and over living or working in the home, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a licensed Family Child Care Home. A civil penalty of $100.00 minimum/day for a maximum of 5 days or, if the penalty is for a repeat violation, for a maximum of 30 days per person will be assessed if this regulation is violated.

As a result of today's visit, a Type A Deficiency was issued for regulation 102370(d)(1) Criminal Record Clearance and a Plan of Correction is due 3/5/2024. A Civil Penalty of $500.00 will be assessed today due to the adult living the home did not have a Criminal Record Clearance associated to the facility.

A notice of site visit was given and must remain posted for 30 days, exit interview conducted and report was reviewed with the licensee Laura Santana.
SUPERVISOR'S NAME: Rita RamosTELEPHONE: (424) 301-3061
LICENSING EVALUATOR NAME: Elicia CalvilloTELEPHONE: (424) 301-3016
LICENSING EVALUATOR SIGNATURE:
DATE: 03/04/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/04/2024
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 2


Document Has Been Signed on 03/04/2024 03:58 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
EL SEGUNDO CC NORTH, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245


FACILITY NAME: SANTANA FAMILY CHILD CARE
FACILITY NUMBER: 197409434

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/04/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
03/05/2024
Section Cited
CCR
102370(d)(1)

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102370 Criminal Record Clearance (d) All individuals subject to a criminal record review… shall prior to working, residing, or volunteering in a licensed facility: (1) Obtain a California clearance ... as required by the Department This requirement is not met as evidenced by:
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Adult living in the home will complete the Livescan by 3/5/2024 and will provide LPA a confirmation of the completed Livescan on 3/6/2024 by email.
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Based on review of Guardian associations Angel G. Guzman, adult living in home does not have criminal record clearance but is not associated to the facility. Licensee confirm that adult has been living in home for over 5 days but did not specify the exact date.
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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: Rita RamosTELEPHONE: (424) 301-3061
LICENSING EVALUATOR NAME: Elicia CalvilloTELEPHONE: (424) 301-3016
LICENSING EVALUATOR SIGNATURE:
DATE: 03/04/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/04/2024
LIC809 (FAS) - (06/04)
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