198006681-5-21-2019-33-CC-CGOZ-BCDL3A-20190521082336

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 198006681
Report Date: 05/06/2019
Date Signed: 05/21/2019 08:23:43 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 CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME:	CABRAL FAMILY CHILD CARE		FACILITY NUMBER:	198006681
ADMINISTRATOR:	CABRAL,OLGA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(626) 339-9333
CITY:	COVINA	STATE: CA	ZIP CODE:	91722
CAPACITY:	14	CENSUS: 7	DATE:	05/06/2019
TYPE OF VISIT:	Annual/Required	UNANNOUNCED	TIME BEGAN:	08:45 AM
MET WITH:	Olga Cabral, Licensee		TIME COMPLETED:	10:30 AM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	An Annual/Required inspection was conducted by Licensing Program Analyst (LPA) Carlos Gonzalez. LPA met with Olga Cabral, Licensee, who guided Analyst on a tour of the facility. Also present were Licensee's adult children, Raul Gomez Arellano, Peter Gomez Arellano, and Rosemarie Cabral. LPA observed seven (7) children in care, including Licensee's minor grandchild. A facility roster was provided and is current. This is a single story home, consisting of 4 bedrooms, 2 bathrooms, living room, dining room, family room, kitchen. The side yard is used for outdoor play. Children have access to the living room, family room, dining room, kitchen, front bedroom, and bathroom. Off-limits to children in care include: the master bedroom/bathroom and 2 additional bedrooms. The home was inspected for safety, comfort, cleanliness, telephone service, heating and ventilation. Currently residing in the home are Licensee, her 2 adult son's, and minor grandchild. Per Licensee, there are no pets, firearms, or weapons on the premises. LPA did not observe any bodies of water on the premises. The outdoor play yard is adequately fenced. Licensee and Assistant, Rosemarie Cabral, have completed First Aid/CPR, which expire on 06/25/19. The valve on the 2-A:10-B:C fire extinguisher indicates fully charged and the attached service tag indicates it was recently serviced on 03/29/19. The smoke and carbon monoxide detector were tested and are operable. Licensee last conducted a disaster drill on 03/30/19, per the log provided. Incident Medical Services (IMS) policy was discussed. The following was also discussed: Individual's who are 18 years of age or older, living in the home, must be fingerprint cleared, prior to residing in the home. Report continues on next page 1 of 2

SUPERVISOR'S NAME: Katherine Harewood	TELEPHONE: (323) 981-3380
LICENSING EVALUATOR NAME: Carlos Gonzalez	TELEPHONE: (323) 981-3381
LICENSING EVALUATOR SIGNATURE:	DATE: 05/06/2019

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/06/2019

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 CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME: CABRAL FAMILY CHILD CARE	FACILITY NUMBER: 198006681
	VISIT DATE: 05/06/2019

NARRATIVE

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No smoking, No infant walkers, No Johnny jumpers, No Exer-saucers, or any other item that falls into that category, is prohibited in the day care.

Licensee was observed to be operating within the licensed capacity limitations during this inspection. There were no deficiencies noted/or observed during this inspection. Licensee is in compliance with California Code of Regulations, Title 22 requirements. A handwritten report was provided at the time of inspection.

Exit interview conducted with Rosemarie Cabral, Licensee's Assistant.

Report ends page 2 of 2

SUPERVISOR'S NAME: Katherine Harewood	TELEPHONE: (323) 981-3380
LICENSING EVALUATOR NAME: Carlos Gonzalez	TELEPHONE: (323) 981-3381
LICENSING EVALUATOR SIGNATURE:	DATE: 05/06/2019

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/06/2019

LIC809 (FAS) - (06/04)

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