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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198015968
Report Date: 08/23/2019
Date Signed: 08/23/2019 03:43:58 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 CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME:ESCALANTE FAMILY CHILD CAREFACILITY NUMBER:
198015968
ADMINISTRATOR:ESCALANTE, YESMINFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(213) 399-1291
CITY:LOS ANGELESSTATE: CAZIP CODE:
90026
CAPACITY:14CENSUS: 9DATE:
08/23/2019
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
02:33 PM
MET WITH:Yesmin EscalanteTIME COMPLETED:
03:58 PM
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Licensing Program Analyst (LPA) Lissete Gonzalez conducted a follow-up unannounced case management inspection based on the incident that was reported to the Department on 06/07/2019. Upon arrival, LPA met with Licensee, Yesmin Escalante, who provided LPA a tour of the facility. Census was taken.

On 06/07/2019, an incident was reported to the department stating a child was suffering from a fever and began to have convulsions approximately two hours later at which time paramedics were called and the child was transported to the hospital. LPA conducted interviews with staff and the child’s authorized representative. In addition, LPA obtained and reviewed documentation. Based on the information obtained and LPA observations, LPA determined there were no violations by the facility. The incident report was sent and called in properly and timely, the authorized representative was notified, the child’s medical needs were met, and the Licensee has current First Aid/Infant Pediatric CPR certificates valid through 03/22/2021.

Per California Code of Regulations Title 22, Division 12, no deficiency cited during today's visit. Exit interview conducted with the Licensee, Yesmin Escalante.

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.
SUPERVISOR'S NAME: Adriana HernandezTELEPHONE: (323) 981-3362
LICENSING EVALUATOR NAME: Lissete GonzalezTELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:

DATE: 08/23/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/23/2019
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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