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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198019425
Report Date: 09/17/2019
Date Signed: 09/17/2019 04:02:40 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:RIVERA GUERRA FAMILY CHILD CAREFACILITY NUMBER:
198019425
ADMINISTRATOR:ANA MARGARITA RIVERAGUERRAFACILITY TYPE:
850
ADDRESS:232 N. HERBERT AVE.TELEPHONE:
(323) 738-9706
CITY:LOS ANGELESSTATE: CAZIP CODE:
90063
CAPACITY:14CENSUS: 3DATE:
09/17/2019
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
03:01 PM
MET WITH:Ana Margarita Rivera GuerraTIME COMPLETED:
04:15 PM
NARRATIVE
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 Visit was conducted in Spanish

Licensing Program Analysts (LPAs) Mireya Garcia and Crystal Green conducted an unannounced case management inspection at the above facility due to deficiencies observed. LPAs met with Ana Margarita Rivera Guerra Licensee, who guided analysts on a tour of the facility also present was Licensee's Assistant, Destiny Guerra. Upon arrival there were 3 children present (2 being infants).

During the inspection, LPAs observed that in the accessible restroom inside the tub area, a bucket with a mop was filled with water (Pictures were taken). In addition, there were also shampoo’s accessible to children (Pictures were taken) in the tub area of the restroom. Per Licensee children use the restroom with adult supervision. LPA Garcia consulted with Licensee about the items observed being accessible to children. LPA asked Licensee to empty out the water from the bucket and to place the shampoo’s where it is inaccessible to children. Licensee corrected the deficiencies during this inspection. A declaration was obtained from Licensee regarding this observation. Licensee was also provided with a copy of Child Care Provider's Guide to Safe Sleep, by American Academy of Pediatrics.

The following deficiency on the attached LIC 809 (Deficiency Page) is being cited in accordance with California code of Regulations Title 22.

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. Exit interview was conducted with Ana Margarita Rivera Guerra Licensee, including but not limited to Provider Rights, Appeal Procedures and Agencies Consultative Role.
SUPERVISOR'S NAME: Adriana HernandezTELEPHONE: (323) 981-3362
LICENSING EVALUATOR NAME: Mireya GarciaTELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:

DATE: 09/17/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/17/2019
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: RIVERA GUERRA FAMILY CHILD CARE
FACILITY NUMBER: 198019425
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/17/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
10/18/2019
Section Cited

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Operation of a Family Child Care Home. The home shall be free from defects or conditions which might endanger a child.
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This requirement is not met as evidenced by LPAs observation and interview that there were shampoo’s and there was a mop in a bucket with water accessible in the tub area of the restroom. This poses a potential health and safety risk to children in care.
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LPAs advised Licensee to attend orientation on 10/16/2019 from 9am-12 noon at the Monterey Park Regional Office. Licensee is to provide copy of certificate of attendance via text to LPA Garcia on 10/18/2019.

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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: Adriana HernandezTELEPHONE: (323) 981-3362
LICENSING EVALUATOR NAME: Mireya GarciaTELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:
DATE: 09/17/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/17/2019
LIC809 (FAS) - (06/04)
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