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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198011809
Report Date: 11/09/2020
Date Signed: 11/10/2020 09:41:30 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:AGUILAR FAMILY CHILD CAREFACILITY NUMBER:
198011809
ADMINISTRATOR:AGUILAR, OLGAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
5624233603
CITY:LONG BEACHSTATE: CAZIP CODE:
90805
CAPACITY:14CENSUS: DATE:
11/09/2020
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
03:00 PM
MET WITH:Olga Aguilar, LicenseeTIME COMPLETED:
03:30 PM
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Due to COVID-19 and precautionary measures, Licensing Program Analyst (LPA) T. Tran delivered the Incident Report by use of via email to Olga Aguilar, Licensee on 11/09/2020.

Licensing Program Analyst (LPA) T. Tran conducted a Case Management Incident by via telephone to follow up on a self-reported incident on 08/20/2020 regarding an enrolled child came to school with a minor scrape on child's left eye. Based on the available information that were gathered through interviews, the injury did not occurred at the daycare. Child had confirmed that while going swimming with family child accidentally scraped left eye by the pool. No medical attention required. Therefore, this incident was not result in the Title 22 Regulations for Personal Rights violation. No deficiency was cited.

Exit interview was conducted with the noted person by via telephone during which appeal rights were explained. This report along with a copy of the appeal rights will be sent to licensee by via email with a read receipt or confirmation of receipt of email, which will act as the licensee's signature.
SUPERVISOR'S NAME: Trevino CochranTELEPHONE: (323) 981-3350
LICENSING EVALUATOR NAME: Tiffanie TranTELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:

DATE: 10/30/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/30/2020
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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