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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198011174
Report Date: 07/24/2019
Date Signed: 07/24/2019 08:33:25 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:FIALLOS FAMILY CHILD CAREFACILITY NUMBER:
198011174
ADMINISTRATOR:FIALLOS, ROSAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(323) 232-3292
CITY:LOS ANGELESSTATE: CAZIP CODE:
90037
CAPACITY:14CENSUS: 3DATE:
07/24/2019
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
08:00 AM
MET WITH:Rosa Fiallos, LicenseeTIME COMPLETED:
08:50 AM
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 INSPECTION CONDUCTED IN PARTIAL SPANISH
Licensing Program Analyst (LPA) Denise Gibbs conducted an unannounced POC (Plan of Correction) inspection to ensure that the Type A deficiencies cited on 07/19/19 have been cleared. LPA met with Rosa Fiallos, Licensee, who guided analyst on a tour of the facility. There were 3 children present during this inspection.
The following has been observed:

- Deandre Fiallos and Aura Godoy are associated with the above facility.
- Poison in the kitchen (Raid) was locked in a high cabinet over the washing machine and cleaning and hygienic products in the bathroom were inaccessible to children (high cabinet).

At this time, the facility is in compliance with California Code of Regulations Title 22. Therefore, no deficiencies are being cited.

LPA cleared deficiencies on this date and provided a copy of the Licensing Report to Rosa Fiallos, Licensee. LPA issued POC clearance letter during the visit.

Exit interview was conducted with Rosa Fiallos, Licensee. Appeal rights explained & provided.

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.

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SUPERVISOR'S NAME: Trevino CochranTELEPHONE: (323) 981-3385
LICENSING EVALUATOR NAME: Denise GibbsTELEPHONE: (323) 558-2794
LICENSING EVALUATOR SIGNATURE:

DATE: 07/24/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/24/2019
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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