<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198011174
Report Date: 06/27/2024
Date Signed: 06/27/2024 02:17:22 PM


Document Has Been Signed on 06/27/2024 02:17 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MONTEREY PARK SW RO, 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:
06/27/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Rosa FiallosTIME COMPLETED:
02:30 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
On 6/27/24 at 1:00 PM Licensing Program Analysts (LPA) Claudia Kam conducted an Unannounced case management visit for follow up on a UIR reported to the department on 6/21/24 to the above facility. LPA disclosed the purpose of the inspection and met with Licensee, Rosa Fiallos who guided the LPA on a tour of the facility.

There were 3 children, and 3 staff present during the inspection.


LPA completed a review of child and staff’s records review. Interviews were conducted with staff present at time of incident, licensee, and 2 assistants, child interview was unable to be conducted as child was not verbal and could not be qualified at time of visit.

Based on interviews conducted and record reviewed, it appears that the facility had followed the health and safety protocol of the department. The licensee and staff administered first aid immediately, and CPR is current for all staff and licensee. Licensee called paramedics and notified the department and parent immediately within required timelines.

Based on the available information it does not appear this incident was the result of a Title 22 violation for lack of care and supervision.

No deficiency was cited at this time. A notice of site visit was given and must remain posted for 30 days.
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 conducted and report was reviewed with the licensee Rosa Fiallos.
SUPERVISOR'S NAME: Denise GibbsTELEPHONE: (323) 981-3385
LICENSING EVALUATOR NAME: Claudia KamTELEPHONE: (626) 602-6842
LICENSING EVALUATOR SIGNATURE:
DATE: 06/27/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/27/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 1