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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198016465
Report Date: 06/11/2019
Date Signed: 06/11/2019 11:36:55 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:CARDENAS FAMILY CHILD CAREFACILITY NUMBER:
198016465
ADMINISTRATOR:CARDENAS, MARIAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(323) 569-6474
CITY:LOS ANGELESSTATE: CAZIP CODE:
90002
CAPACITY:14CENSUS: 8DATE:
06/11/2019
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
11:01 AM
MET WITH:Maria CardenasTIME COMPLETED:
11:45 AM
NARRATIVE
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Licensing Program Analysts (LPAs) Ariel Cazares and Dayna Chambers conducted an unannounced case management inspection on this date. Upon arrival LPAs met with Licensee Maria Cardenas and observed 8 children and 2 additional assistants.

On this date LPAs reviewed children's records and roster. LPAs observed that 2 children's files were missing and not available for review. The children's roster was not current and missing 7 children's information.

The facility is being cited for the violations observed. See 809-D for details of deficiencies.

Exit interview conducted with Licensee Maria Cardenas. A copy of this report was provided along with appeal rights.

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: Claudia GuangorenaTELEPHONE: (323) 981-3417
LICENSING EVALUATOR NAME: Ariel AlmazanTELEPHONE: (323) 981-2949
LICENSING EVALUATOR SIGNATURE:

DATE: 06/11/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/11/2019
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 2
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: CARDENAS FAMILY CHILD CARE
FACILITY NUMBER: 198016465
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/11/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
06/18/2019
Section Cited
CCR
102417(g)(8)
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Each family child care home shall have a current roster of children as specified in Health and Safety Code Section 1596.841.
This requirement has not been met as evidenced by as evidence by LPAs review of roster. Roster was not current. This poses a potential risk to the health and safety of children in care.
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Per licensee, she will update roster and submit a copy to LPA by POC due date of 6/18/19.
Type B
06/18/2019
Section Cited
CCR
102421
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Child's Records

This requirement has not been met as evidenced by LPA's review of children's file. Child #16 and #17 did not have a file available.
This poses a potential risk to the health and safety of children in care.
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Per licensee, she will provided LPA a copy of the files for children by POC due date of 6/18/19.
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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: Claudia GuangorenaTELEPHONE: (323) 981-3417
LICENSING EVALUATOR NAME: Ariel AlmazanTELEPHONE: (323) 981-2949
LICENSING EVALUATOR SIGNATURE:

DATE: 06/11/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/11/2019
LIC809 (FAS) - (06/04)
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