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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198018861
Report Date: 08/07/2023
Date Signed: 08/07/2023 04:08:30 PM


Document Has Been Signed on 08/07/2023 04:08 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 CENTER DR 200B
MONTEREY PARK, CA 91754



FACILITY NAME:ANDRADE & CRUZ FAMILY CHILD CAREFACILITY NUMBER:
198018861
ADMINISTRATOR:A., CLAUDIA & C., HUMBERTOFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(562) 519-6817
CITY:HAWAIIAN GARDENSSTATE: CAZIP CODE:
90716
CAPACITY:14CENSUS: 7DATE:
08/07/2023
TYPE OF VISIT:Case Management - Legal/Non-complianceUNANNOUNCEDTIME BEGAN:
03:13 PM
MET WITH:Claudia AndradeTIME COMPLETED:
04:20 PM
NARRATIVE
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An unannounced Case Management inspection was conducted today by Regional Manager (RM) Sharon Greene and Licensing Program Analyst (LPA) Raul Navarro, for the purpose of serving a Temporary Suspension Order (TSO) on 08/07/2023 at 03:13PM.

RM and LPA met with Licensees, Claudia Andrad with whom the Temporary Suspension Order was discussed. The following documents were reviewed, explained and distributed to Licensees during this inspection:

· Order for Temporary Suspension Order (TSO) of License Prior to Hearing
· Statement of Respondent
· Government Code Statutes
· Summary Instructions For Licensees
· Summary of Charges
· Accusation (License Revocation)
· Request for Discovery
· Notice of Defense (2)

Temporary Suspension Order - CLOSED FOR BUSINESS notice was posted adjacent to the front door entrance of the facility which is known as the primary day care entrance. The Licensees was advised that removal of this notice is punishable as a misdemeanor with a fine of up to $500.00. The notice shall be posted until further notice by the Order of the Director of the Department of Social Services. A copy of this Temporary Suspension Order will be mailed to the local Resource & Referral agency. Any further communication should be directed to our Department’s Legal Division. -----------------PAGE 1
SUPERVISOR'S NAME: Karen ChambersTELEPHONE: (323) 980-4934
LICENSING EVALUATOR NAME: Raul NavarroTELEPHONE: 323-981-3388
LICENSING EVALUATOR SIGNATURE:
DATE: 08/07/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/07/2023
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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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: ANDRADE & CRUZ FAMILY CHILD CARE
FACILITY NUMBER: 198018861
VISIT DATE: 08/07/2023
NARRATIVE
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During interviews conducted it was disclosed that on or about August 2022, Licensees failed to properly report an allegation of inappropriate contact between Child #1 and Licensee.

A deficiency for failure to report the allegation to the department is listed on the following page and is being cited in accordance with California Code of Regulations Title 22. Please see attached LIC 809-D. The deficiency that is being cited needs to be cleared to protect the children’s health & safety.

Exit interview was conducted with Claudia Andrade, Licensees, including, but not limited to Appeal Procedures and Appeal Rights. Temporary suspension order was posted on the front door.--------PAGE 2

SUPERVISOR'S NAME: Karen ChambersTELEPHONE: (323) 980-4934
LICENSING EVALUATOR NAME: Raul NavarroTELEPHONE: 323-981-3388
LICENSING EVALUATOR SIGNATURE:

DATE: 08/07/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/07/2023
LIC809 (FAS) - (06/04)
Page: 2 of 3
Document Has Been Signed on 08/07/2023 04:08 PM - It Cannot Be Edited

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: ANDRADE & CRUZ FAMILY CHILD CARE
FACILITY NUMBER: 198018861

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/07/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
08/14/2023
Section Cited
CCR
102416.2(b)(3)(C)

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(b) The licensee shall report to the Department any of the events as specified in Health and Safety Code Sections 1597.467(b)(1)(A) through (b)(1)(C) that occur during the operation of the family child care home. (C) Any unusual incident or child absence that threatens the physical or
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Per Licensee, she will send a written Unusual Incident Report LIC 624b detailing what was reported in August 2022 and submit report to LPA by the POC date of 8/14/23.
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emotional health or safety of any child. This requirement was not met as evidenced by on or about August 2022, Licensees failed to properly report an allegation of inappropriate contact between Child #1 and Licensee. This is a potential risk to the health and safety of children in care.
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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: Karen ChambersTELEPHONE: (323) 980-4934
LICENSING EVALUATOR NAME: Raul NavarroTELEPHONE: 323-981-3388
LICENSING EVALUATOR SIGNATURE:
DATE: 08/07/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/07/2023
LIC809 (FAS) - (06/04)
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