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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197416226
Report Date: 07/24/2019
Date Signed: 07/24/2019 04:46:02 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:GARCIA FAMILY CHILD CAREFACILITY NUMBER:
197416226
ADMINISTRATOR:GARCIA, TONIFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(818) 400-3752
CITY:VAN NUYSSTATE: CAZIP CODE:
91406
CAPACITY:14CENSUS: 15DATE:
07/24/2019
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
03:30 PM
MET WITH:Toni Garcia, LicenseeTIME COMPLETED:
05:30 PM
NARRATIVE
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LPA arrived at the Family Child Care home for the purpose of an Complaint Investigation and observed 2 adult males that live at the home, and both adult males do not have a Criminal Record Clearance. Both adult males are son's of the Licensee.

Licensee was cited Two Type A deficiency for both adults that did not have a Criminal Record Clearance.

Upon receipt of the Type A Violation(s), licensee shall post the report for 30 days in addition to the Notice of Site Visit, provide copies of the licensing report to parents/guardians of children in care at the facility and obtain a signed Acknowledgement of Licensing Reports (LIC 9224) from parent/guardian & place it in each child's file by the close of business the following day or the next day child returns to the facility. The same report must be provided to parents/guardians of children newly enrolled at the facility during the next 12 months & licensee will obtain a signed Acknowledgement of Licensing Reports (LIC 9224) from parent/guardian & place it in each child's file.


Exit interview was conducted, a copy of the report, LIC 809, and notice of cite visit issued.


SUPERVISOR'S NAME: Sharalyn Jenkins-SweetenTELEPHONE: (424) 301-3054
LICENSING EVALUATOR NAME: Sophia Lord-RichardTELEPHONE: (424) 301-3060
LICENSING EVALUATOR SIGNATURE:

DATE: 07/24/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/24/2019
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245

FACILITY NAME: GARCIA FAMILY CHILD CARE
FACILITY NUMBER: 197416226
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/24/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
07/24/2019
Section Cited
CCR
102370(a)
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Criminal Record Clearance-All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1596.871 shall prior to working, residing, or volunteering in a licensed facility:

LPA observed 2 Adults males, who live at
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Licensee will have both adults finger printed to received a Criminal Record Clearance.

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the home, both without a Criminal Record Clearance.

LPA arrived and observed at the Family Child care Home 2 adult males that live in the home, without a Criminal Record Clearance,which poses a potential Health and safety risk to children in Care.
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Type A
08/23/2019
Section Cited
HSC
1597.54(d)
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Application for license-Evidence of a current tuberculosis clearance, as defined in regulations that the department shall adopt, for any adult in the home during the time that children are under care. This requirement may be satisfied by a current certificate, as defined in subdivision (f) of
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Licensee will provide proof of TB Test for both adult males who live in the home.
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Section 121525, that indicates freedom from infectious tuberculosis as set forth in Section 121525.
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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: Sharalyn Jenkins-SweetenTELEPHONE: (424) 301-3054
LICENSING EVALUATOR NAME: Sophia Lord-RichardTELEPHONE: (424) 301-3060
LICENSING EVALUATOR SIGNATURE:

DATE: 07/24/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/24/2019
LIC809 (FAS) - (06/04)
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