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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198018893
Report Date: 06/14/2019
Date Signed: 06/14/2019 04:14:19 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:PATRICK FAMILY CHILD CAREFACILITY NUMBER:
198018893
ADMINISTRATOR:MARIA ROSA PATRICKFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(323) 470-5436
CITY:MONTEBELLOSTATE: CAZIP CODE:
90640
CAPACITY:14CENSUS: 3DATE:
06/14/2019
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
03:20 PM
MET WITH:Maria Rosa Patrick, LicenseeTIME COMPLETED:
04:30 PM
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Licensing Program Analysts (LPAs) Denise Gibbs and Rita Ramos conducted an unannounced Plan of Correction visit to the above facility. Present at the facility is licensee, Maria Rosa Patrick. There were 3 children present upon arrival.

The deficiencies cited on 05/21/19 have been corrected. LPAs observed and reviewed the following:
  • Pediatric 1st aid and CPR- Licensee provided a copy of the receipt for class taken.
  • A copy of the roster was completed and is current.
  • Disaster Drill was conducted and logged.
  • All hazardous items were cleared from the bathroom and a new latch was purchased for the kitchen sink.
  • Outlet covers were placed on all exposed outlets.
  • Fire Extinguisher was serviced on 5/30/2019.
  • A gate was placed to barricade the bottom of the stairs.
  • Mandated Reporter was taken.
  • Reporting Requirements video was watched and summarized.
  • Proof of immunization's was given.
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SUPERVISOR'S NAME: Brandi VanOostenTELEPHONE: (323) 981-3365
LICENSING EVALUATOR NAME: Denise GibbsTELEPHONE: (323) 558-2794
LICENSING EVALUATOR SIGNATURE:

DATE: 06/14/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/14/2019
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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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 CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME: PATRICK FAMILY CHILD CARE
FACILITY NUMBER: 198018893
VISIT DATE: 06/14/2019
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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 reprehensive. Failure to maintain posting as required will result in a civil penalty of $100.00.

Exit interview was conducted with Licensee Maria Rosa Patrick. Appeal Rights procedures distributed and explained.

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SUPERVISOR'S NAME: Brandi VanOostenTELEPHONE: (323) 981-3365
LICENSING EVALUATOR NAME: Denise GibbsTELEPHONE: (323) 558-2794
LICENSING EVALUATOR SIGNATURE:

DATE: 06/14/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/14/2019
LIC809 (FAS) - (06/04)
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