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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198010360
Report Date: 08/11/2021
Date Signed: 08/11/2021 03:37:06 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:VELASCO & CASILLAS FAMILY CHILD CAREFACILITY NUMBER:
198010360
ADMINISTRATOR:VELASCO, A. & CASILLAS A.FACILITY TYPE:
810
ADDRESS:TELEPHONE:
(626) 480-8156
CITY:BALDWIN PARKSTATE: CAZIP CODE:
91706
CAPACITY:14CENSUS: 8DATE:
08/11/2021
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
02:00 PM
MET WITH:VELASCO, DESERIE & CASILLAS, ANGELATIME COMPLETED:
03:45 PM
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Licensing Program Analyst (LPA) Fabiola Vasquez conducted an unannounced case management-other inspection due to an incident that occurred on 05/14/20. LPA met with Licensee Deserie Velasco who guided LPA on a tour of the facility. There were 8 children and 2 staff present upon arrival.

LPA Vasquez conducted interviews with Licensee, Co Licensee and Child 1.Licensee demonstrated where the incident occurred. LPA obtained documentation in the form of pictures during this visit.

The incident that occurred on 05/14/20 was reported to the Department on 05/14/20, via telephone. The facility reported report the Unusual Incident to the Department within the required 24 hours of occurrence.
Based upon information received from the interviews conducted it was determined that the incident was an accident, LPA provided consultation to licensee and Co-licensee on the usage of pods around children. Was advised to talk to children about pods not used for bubbles.

There were no deficiencies cited during today’s inspection

Exit interview conducted with Licensee Deserie Velasco, Appeal Rights and a copy of the report were explained and provided.

Notice of Site Visit has was provided.

SUPERVISOR'S NAME: Claudia GuangorenaTELEPHONE: (323) 981-3417
LICENSING EVALUATOR NAME: Fabiola VasquezTELEPHONE: (626) 361-1267
LICENSING EVALUATOR SIGNATURE:

DATE: 08/11/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/11/2021
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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