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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197493735
Report Date: 12/19/2019
Date Signed: 12/19/2019 01:50:46 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME:VAZQUEZ FAMILY CHILD CAREFACILITY NUMBER:
197493735
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY:8CENSUS: 5DATE:
12/19/2019
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
11:49 AM
MET WITH:Silvia Avalos_Licensee AssistantTIME COMPLETED:
01:10 PM
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Licensing Program Analyst (LPA) Reiko Jones-Modeste conducted an unannounced inspection to increase capacity at the facility listed above. LPA met with Silvia Avalos the Licensee Assistant who guided analyst on a tour of the facility. LPA observed five children in care. Per the Licensee four adults currently reside in the home. Licensee stated operating hours will be Monday-Saturday 23 hours per day. Care will be provided for children ages 0-12 y/o. The Fire Department has granted clearance for a maximum capacity of 14 children, fire clearance received on 12/3/19.

All areas identified on the facility sketch were inspected. This is a one-story home that includes three bedrooms, one full restroom, kitchen, living room, dining room, backyard and front yard (fenced) and garage. The home was inspected for safety, comfort, cleanliness, telephone service, heating and ventilation, as well as any hazardous items that may pose a danger to children.

Off limits/inaccessible to daycare children: Kitchen. This area was observed inaccessible with a child safety gate.
Accessible to daycare children: All bedrooms, one restroom, living room, dining room, front yard and backyard.

At this time, the licensee is in compliance with California Title 22 Regulations. Therefore, there are no citations being issued today. LPA will recommend the increase in capacity as the licensee meets requirements for an increase and the fire clearance was received and granted for 14 children.

LPA advised the applicant how to access forms, regulations and quarterly updates on the Child Care Licensing Website at: www.ccld.ca.gov

SUPERVISOR'S NAME: Trevino CochranTELEPHONE: (323) 981-3385
LICENSING EVALUATOR NAME: Reiko JonesTELEPHONE: (323) 558-2739
LICENSING EVALUATOR SIGNATURE:

DATE: 12/19/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/19/2019
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, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME: VAZQUEZ FAMILY CHILD CARE
FACILITY NUMBER: 197493735
VISIT DATE: 12/19/2019
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Per applicant, there are no other licenses held at this location.

Once licensed, the applicant is required to adhere to the terms and limitations as stated on the license.

Upon receipt the Licensee shall post the Notice of Site Visit. This report and the Notice of Site Visit shall be posted for 30 consecutive days. Failure to maintain posting as required will result in a $100.00 civil penalty.

Exit interview was conducted with the Licensee Assistant, who is in agreement with the above. A copy of this report and all other licensing reports must be made available to the public for three years.

SUPERVISOR'S NAME: Trevino CochranTELEPHONE: (323) 981-3385
LICENSING EVALUATOR NAME: Reiko JonesTELEPHONE: (323) 558-2739
LICENSING EVALUATOR SIGNATURE:

DATE: 12/19/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/19/2019
LIC809 (FAS) - (06/04)
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