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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197412464
Report Date: 10/15/2019
Date Signed: 10/15/2019 01:31:40 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME:BERMUDEZ FAMILY CHILD CAREFACILITY NUMBER:
197412464
ADMINISTRATOR:BERMUDEZ, TRACYFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(661) 886-0417
CITY:HAWTHORNESTATE: CAZIP CODE:
90250
CAPACITY:14CENSUS: 10DATE:
10/15/2019
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
01:18 PM
MET WITH:Tracy Bermudez, LicenseeTIME COMPLETED:
01:50 PM
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Licensing Program Analyst (LPA), Shandra Powell, conducted a Unannounced Case Management Inspection following the Department’s receipt of a Case Closure notice dated 09/30/2019 for: Veronica Preciado (ID# 7517413572).

LPA met with Licensee, Tracy Bermudez, on 10/15/19 LPA was guided on a tour by Licensee inside and outside of the home. There were 10 children in care at the time of the inspection.

LPA did not observe Veronica Preciado at the facility during inspection.

LPA discussed with Licensee the notice’s conditions which stated the individual cannot be present in or have contact with clients of any community care facility.

Licensee stated she received notification and came into the Regional Office to meet with LPA regarding notice. LPA did meet with Licensee on that date. LPA left a copy of the Case Closure letter during the inspection.

Licensee stated Veronica Preciado has never worked for the above facility.

During this inspection, LPA Powell received declaration from Licensee that, Veronica Preciado, does not work at the licensed facility address and the licensee is aware of the meaning and understands the details in full of the Case Closure letter. A copy of this declaration has been signed, dated and will be placed in the office physical file.

An exit interview was conducted, and a copy of this report was given to Licensee, Tracy Bermudez, Licensee whose signature confirms today's inspection and report.

SUPERVISOR'S NAME: Mary RuizTELEPHONE: (424) 301-3061
LICENSING EVALUATOR NAME: Shandra PowellTELEPHONE: (323) 981-3383
LICENSING EVALUATOR SIGNATURE:

DATE: 10/15/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/15/2019
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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