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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198014728
Report Date: 07/20/2023
Date Signed: 07/20/2023 02:59:58 PM


Document Has Been Signed on 07/20/2023 02:59 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
CCLD Regional Office, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754



FACILITY NAME:VAZQUEZ FAMILY CHILD CAREFACILITY NUMBER:
198014728
ADMINISTRATOR:VAZQUEZ, SYLVIAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(626) 409-0379
CITY:EL MONTESTATE: CAZIP CODE:
91732
CAPACITY:14CENSUS: 7DATE:
07/20/2023
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
02:15 PM
MET WITH:Licensee, Sylvia Vazquez TIME COMPLETED:
03:15 PM
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Licensing Program Analysts (LPA) Roxana Lopez conducted an unannounced POC (plan of correction) inspection or case management to insured that the Type A deficiency and 3 Type B (sleep regulation)cited on 07/07/2023 has been cleared. LPA met with Sylvia Vazquez, licensee who guided analyst on a tour of the facility. There were 7 children present during this inspection. 2 being infants.

- LPA observed infants sleeping in appropriate sleeping arrangements

- Playpens were free of any loose items

- LIC 9227 Individual Sleeping Plan on file for 2 infants

- Sleep log available for review for the 2 infants

- LIC 9224 Acknowledgment form is on file

* items pending Pediatric EMSA approved CPR and Mandated Reporter Training Certificate mandatedreporterca.com

LPA’s advised the licensee how to access forms, regulations and quarterly updates on the Child Care Licensing Website at: www.ccld.ca.gov.

LPA cleared deficiencies on this datelicensee. LPA issued POC clearance letter during the visit.

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

A notice of site visit was given and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

Exit interview conducted and report was reviewed with Licensee, Silvia Vaquez .

SUPERVISOR'S NAME: Brandi VanOostenTELEPHONE: (323) 981-3365
LICENSING EVALUATOR NAME: Roxana LopezTELEPHONE: (323) 854-5073
LICENSING EVALUATOR SIGNATURE:
DATE: 07/20/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/20/2023
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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