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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198011345
Report Date: 07/17/2019
Date Signed: 07/17/2019 03:48:42 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 CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME:CHAVERO-RAMIREZ FAMILY CHILD CAREFACILITY NUMBER:
198011345
ADMINISTRATOR:CHAVERO, MARGARITAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
3232330252
CITY:LOS ANGELESSTATE: CAZIP CODE:
90037
CAPACITY:14CENSUS: 13DATE:
07/17/2019
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
03:30 PM
MET WITH:LicenseeTIME COMPLETED:
04:15 PM
NARRATIVE
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While conducting an investigation for a complaint, Licensing Program Analyst (LPA) Tiffanie Tran observed the following deficiencies:

While conducting children's files review, facility failed to maintain complete record for child 1 through 8, some were missing immunization record. LPA did not observe children's record for child 9 through 13.
Licensee agrees to complete all enrolled children's files and facility roster then meet LPA at the Monterey Park Office located at 1000 Corporate Center Drive, Suite 200B Monterey Park, CA 91754 at 10:00AM to clear the citation.

Facility was cited a type B deficiencies. See Facility Evaluation Report LIC 809D for deficiency cited.

A copy of this report was provided to the licensee and an exit interview was conducted.
SUPERVISOR'S NAME: Trevino CochranTELEPHONE: (323) 981-3350
LICENSING EVALUATOR NAME: Tiffanie TranTELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:

DATE: 07/17/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/17/2019
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 CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME: CHAVERO-RAMIREZ FAMILY CHILD CARE
FACILITY NUMBER: 198011345
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/17/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
07/22/2019
Section Cited
CCR
102417(8)(a)
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Based on record review the licensee failed to provide proof of maintain current facility roster for all enrolled children.
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Licensee agrees to complete all enrolled children's files and facility roster then meet LPA at the Monterey Park Office located at 1000 Corporate Center Drive, Suite 200B Monterey Park, CA 91754 at 10:00AM to clear the citation.
Type B
07/22/2019
Section Cited
CCR
102421
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Based on record review the licensee failed to maintain complete record for child 1 through 8, some were missing immunization record. LPA did not observe children's record for child 9 through 13.
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Licensee agrees to complete all enrolled children's files and facility roster then meet LPA at the Monterey Park Office located at 1000 Corporate Center Drive, Suite 200B Monterey Park, CA 91754 at 10:00AM to clear the citation.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Trevino CochranTELEPHONE: (323) 981-3350
LICENSING EVALUATOR NAME: Tiffanie TranTELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:

DATE: 07/17/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/17/2019
LIC809 (FAS) - (06/04)
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