198009860-10-1-2021-33-CC-FVAZ-C7DRB9-20211001125223

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 198009860
Report Date: 10/01/2021
Date Signed: 10/01/2021 12:52:30 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 CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME:	DIAZ FAMILY CHILD CARE		FACILITY NUMBER:	198009860
ADMINISTRATOR:	LAURA DIAZ		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(626) 815-5925
CITY:	AZUSA	STATE: CA	ZIP CODE:	91702
CAPACITY:	14	CENSUS: 5	DATE:	10/01/2021
TYPE OF VISIT:	Case Management - Other	UNANNOUNCED	TIME BEGAN:	09:30 AM
MET WITH:	Laura Diaz		TIME COMPLETED:	01:00 PM

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	Licensing Program Analyst's (LPA's) Fabiola Vasquez and Lilli Babcock conducted an unannounced case management other inspection to follow up on the compliance office meeting on 07/26/19. Licensee was placed on required visit until 7/2022 by the department. Licensee guided LPA's on a tour of the facility. There were 5 children 2 being infants and 2 staff present upon arrival. LPAs conducted interviews and reviewed documentation during this visit. LPAs followed up on the deficiencies presented to the licensee on 07/26/19 during a compliance office meeting. Criminal Record Clearance 102370 (d): 12/23/2008 Personnel Records 102416.1(a)(10): 5/31/2012 Reporting Requirements 102416.2 (b) : 9/18//2012 Employees or volunteers;immunization requirements;records;exemptions H&S1596.7995: 1/30/2018 Mandate Reporter Training H&S1596.8662: 1/23/2019 Employees or volunteers; immunization requirements; records;exemptions H&S1596.7995(a)(1): 5/17/2019. At this time licensee has provided updated documents and proof for the above deficiencies. Licensee disclosed that her daughter stays with her during the nighttime and goes to work in the morning and is not in the facility during the hours of operation. LPAs provided and acquired the LIC 9182 Criminal Background Clearance Transfer Request form during the inspection. Licensee was advised that the daughter has to be associated and can not be in the facility during the hours of operation. LPAs did not observe the daughter during todays visit. Licensee was informed to start going onto the Community Care Licensing website at www.ccld.ca.gov to get the Quarterly updates which has good information. PAGE 1 OF 2.

SUPERVISOR'S NAME: Claudia Guangorena	TELEPHONE: (323) 981-3417
LICENSING EVALUATOR NAME: Fabiola Vasquez	TELEPHONE: (626) 361-1267
LICENSING EVALUATOR SIGNATURE:	DATE: 10/01/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/01/2021

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: DIAZ FAMILY CHILD CARE	FACILITY NUMBER: 198009860
	VISIT DATE: 10/01/2021

NARRATIVE

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Copies provided; Infant Safe Sleep Regulations, LIC 9227, LIC 508.

Licensing will be stay on required visits until 7/2022.

There were no deficiencies cited during today’s inspection

The Notice of Site Visit (LIC 9213) – 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 civil penalty of $100.00. Exit interview was conducted with Laura Diaz, Licensee including, but not limited to Provider Rights, Appeal Procedures

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SUPERVISOR'S NAME: Claudia Guangorena	TELEPHONE: (323) 981-3417
LICENSING EVALUATOR NAME: Fabiola Vasquez	TELEPHONE: (626) 361-1267
LICENSING EVALUATOR SIGNATURE:	DATE: 10/01/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/01/2021

LIC809 (FAS) - (06/04)

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