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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198005294
Report Date: 08/22/2019
Date Signed: 08/22/2019 09:59:34 AM

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:HOFFMAN FAMILY CHILD CAREFACILITY NUMBER:
198005294
ADMINISTRATOR:HOFFMAN, EVAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(562) 805-6444
CITY:BELLFLOWERSTATE: CAZIP CODE:
90706
CAPACITY:14CENSUS: 5DATE:
08/22/2019
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
08:32 AM
MET WITH:Eva HoffamnTIME COMPLETED:
10:10 AM
NARRATIVE
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Licensing Program Analysts (LPAs) Warren Birks and Elka Chavez conducted an unannounced Case Management inspection to verify if deficiencies from a previous 2017 inspection have been cleared. LPAs met with Licensee Eva Hoffman who along with cleared assistant T. Howard were caring for five children (2 infants and 4 preschool).

The following deficiencies were corrected in 2017:

1. Operation of a Family Child Care Home: Licensee removed shampoos, mouthwash during the 2017 visit.

2. Operation of a Family Child Care Home: Licensee installed locks on kitchen drawer to make all kitchen kitchen utensils inaccessible during the 2017 visit.

3. Operation of a Family Child Care Home: Licensee installed a new play structure and removed a damaged wooden table in 2017.

4. Licensing Fee: Licensee's fees were made current on 3/22/2017. Note: Licensee also paid a late payment for 2019 to be current.

Deficiencies that Remain Open: Immunizations: Evidence of MMR for Licensee.

The Notice of Site Visit (LIC 9213) and Licensing Report– must remain posted for 30 days during the hours of operation after each site visit by a licensing representative. Failure to maintain posting as required will result in a $100.00 civil penalty. Exit interview conducted with Licensee Hoffman.
SUPERVISOR'S NAME: Karen ChambersTELEPHONE: (323) 980-4934
LICENSING EVALUATOR NAME: Warren BirksTELEPHONE: 323-981-3373
LICENSING EVALUATOR SIGNATURE:

DATE: 08/22/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/22/2019
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: HOFFMAN FAMILY CHILD CARE
FACILITY NUMBER: 198005294
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/22/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
09/23/2019
Section Cited
HSC
1597.622
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Employees or volunteers at family day care home; immunization requirements; records; exemptions: (2) If a person meets all other requirements for employment or volunteering, as applicable, but needs additional time to obtain and provide his or her immunization records, the person may be employed or volunteer conditionally for a
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Licensee indicated that she will provide evidence of MMR.
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maximum of 30 days upon signing and submitting a written statement attesting that he or she has been immunized as required. This requirement was not met as evidenced by: Licensee cannot locate evidence of MMR for Licensee.
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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: Karen ChambersTELEPHONE: (323) 980-4934
LICENSING EVALUATOR NAME: Warren BirksTELEPHONE: 323-981-3373
LICENSING EVALUATOR SIGNATURE:

DATE: 08/22/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/22/2019
LIC809 (FAS) - (06/04)
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