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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198018312
Report Date: 10/08/2021
Date Signed: 10/08/2021 03:01:32 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:CIBRIAN FAMILY CHILD CAREFACILITY NUMBER:
198018312
ADMINISTRATOR:MARIA CIBRIANFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(323) 835-6575
CITY:HUNTINGTON PARKSTATE: CAZIP CODE:
90255
CAPACITY:14CENSUS: 8DATE:
10/08/2021
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
01:30 PM
MET WITH:Maria CibrianTIME COMPLETED:
03:10 PM
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Licensing Program Analyst (LPA) Elka Chavez conducted an unannounced case management inspection to follow up on an incident that was reported to the Department on 09/13/2021. Upon arrival, LPA met with Assistant, Maria Rosas, who provided LPA a tour of the facility. Licensee, Maria Cibrian arrived from picking children up from school a few minutes later. Census was taken.

On 09/13/2021, the licensee notified the Department that she was adding square footage to the front of the home. Licensee provided a copy of the permit. The facility reported this incident to the Department within the required 24 hours. The area under construction is off-limit and will not be used for additional space for children in care. During this inspection LPA observed the area to be inaccessible to children in care. LPA observed the area to be fenced and the licensee has added a mesh net to the area under construction. LPA observed the children and parents enter through the side gate leading to the backyard (fenced). The children only have access to the den, the restroom in the den and the backyard (fenced). Once the project is completed the licensee shall provide the Department with a copy of an inspection report.

Per California Code of Regulations Title 22, Division 12, no deficiency cited during today's visit. Exit interview conducted with Licensee, Maria Cibrian.
SUPERVISOR'S NAME: Karen ChambersTELEPHONE: (323) 981-3350
LICENSING EVALUATOR NAME: Elka ChavezTELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:

DATE: 10/08/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/08/2021
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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