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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198019269
Report Date: 12/12/2019
Date Signed: 12/12/2019 03:07:28 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:NEVAREZ FAMILY CHILD CAREFACILITY NUMBER:
198019269
ADMINISTRATOR:MARYANA NEVAREZFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(562) 704-2487
CITY:LONG BEACHSTATE: CAZIP CODE:
90815
CAPACITY:14CENSUS: 12DATE:
12/12/2019
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
01:42 PM
MET WITH:Maryana NevarezTIME COMPLETED:
03:25 PM
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A Plan of Corrections inspection was conducted by Licensing Program Analyst (LPA) Timothy Fields. LPA met with licensee Maryana Nevarez to address deficiencies cited on 11/19/19. Licensee's assistant along with 12 children were present during todays inspection. The following deficiencies were previously cited:
  1. 102417(g)(4) Operations of a Family Child Care Home.
  2. 102416.5(d)(1) Staff Ratio and Capacity.
  3. 102417(g)(1) Operation of a Family Child Care Home.
  4. 1596.8662 Mandated Reporter Training.
  5. 1597.622(a)(1) Employee Immunization records.
LPA was guided on a tour of the home and observed licensee's barrier isolating the laundry room from the accessible kitchen, making cleaning compounds inaccessible. After reviewing records LPA confirmed one school age child, three infants, and eight preschool age children were in care. Licensee and her assistant have completed the mandated reporter training.

A barricade has been placed in front of the fireplace. Licensee contacted the gas company and scheduled an appointment for today 12/12/19 to have the wall heater disconnected. Shut off notice will be submitted to the department. Vaccinations for licensee's assistant were reviewed. Licensee provided confirmation testing was done for her vaccinations. Results will be submitted to the department upon receipt.

At the time of the Annual Random inspection licensee's Pediatric CPR/First Aid certification had expired but her assistants certification was valid. No citation was given. Licensee has since updated her certification which expires 11/24/2021. LPA has determined licensee is now in compliance with the above regulations on this date.
SUPERVISOR'S NAME: Trevino CochranTELEPHONE: (323) 981-3350
LICENSING EVALUATOR NAME: Timothy FieldsTELEPHONE: (323) 981-3431
LICENSING EVALUATOR SIGNATURE:

DATE: 12/12/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/12/2019
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 CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME: NEVAREZ FAMILY CHILD CARE
FACILITY NUMBER: 198019269
VISIT DATE: 12/12/2019
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Exit interview conducted with licensee. Appeal Rights provided and explained. Notice of Site Visit must be posted for (30) days. Failure to do so may result in a $100.00 civil penalty.

Web site address to order forms: http://www.dss.cahwnet.gov/cdssweb/On-lineFor_293.htm#l
INTERNET ADDRESS: http://www.ccld.ca.gov – To access licensing forms, updates and Title 22.
SUPERVISOR'S NAME: Trevino CochranTELEPHONE: (323) 981-3350
LICENSING EVALUATOR NAME: Timothy FieldsTELEPHONE: (323) 981-3431
LICENSING EVALUATOR SIGNATURE:

DATE: 12/12/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/12/2019
LIC809 (FAS) - (06/04)
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