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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197419791
Report Date: 11/18/2022
Date Signed: 11/18/2022 11:11:40 AM


Document Has Been Signed on 11/18/2022 11:11 AM - 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:GIANI FAMILY CHILD CAREFACILITY NUMBER:
197419791
ADMINISTRATOR:GIANI, ADRIANAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(818) 364-2228
CITY:SYLMARSTATE: CAZIP CODE:
91342
CAPACITY:14CENSUS: 2DATE:
11/18/2022
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
10:50 AM
MET WITH:Adriana GianaTIME COMPLETED:
11:25 AM
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On 11/18/22 Licensing Program Analyst (LPA) Justin Dorsey conducted an inspection at Giani Family Child Care. The purpose of the inspection was a Plan of Correction visit to review the deficiency cited on 10/26/22. LPA met with Licensee Jorge Giani and Assistant #1 and toured the facility.

The following was observed:
1.) LPA Dorsey observed that Adult #1 was not present in the home. LPA Dorsey also received a written plan from the licensee on how she plans to keep Adult #1 away form the home.

Exit interview conducted a copy of this report, Notice of Site Visit and Deficiency Clearance Letter was given to Assistant Jorge Giani .
SUPERVISOR'S NAME: Claretta YatesTELEPHONE: (661) 202-3318
LICENSING EVALUATOR NAME: Justin DorseyTELEPHONE: (661) 305-3012
LICENSING EVALUATOR SIGNATURE:
DATE: 11/18/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/18/2022
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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