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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198019446
Report Date: 06/18/2019
Date Signed: 06/18/2019 11:33:25 AM

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:CUERVO & ESCAMILLA FAMILY CHILD CAREFACILITY NUMBER:
198019446
ADMINISTRATOR:G. CUERVO & L. ESCAMILLAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(818) 397-4038
CITY:MONTEBELLOSTATE: CAZIP CODE:
90640
CAPACITY:14CENSUS: 3DATE:
06/18/2019
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
10:55 AM
MET WITH:Lorena Valentina EscamillaTIME COMPLETED:
11:50 AM
NARRATIVE
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 THIS INSPECTION WAS CONDUCTED IN ENGLISH AND IN SPANISH
Licensing Program Analysts (LPAs) Rita Ramos and Denise Gibbs conducted an unannounced case management inspection to the facility above. LPAs met with Licensees Lorena Valentina Escamilla and Guillermo Escamilla. Also present during the inspection was Gabriela Diosado, assistant. There were 3 children upon arrival.

During the inspection LPAs observed that the children's roster was not updated (pictures were taken) . When touring the outdoor yard, LPAs observed that there are tools and hazardous materials on the yard (pictures were taken). Per Licensee Lorena Valentina Escamilla, the yard was recently remodeled. LPAs advised the Licensee that they need to inform the Department prior to making any structural changes to the home.

Due to LPAs observations and the information disclosed by the Licensee, the following deficiencies are being cited in accordance with 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 Lorena Valentina Escamilla, Licensee and Guillermo Escamilla, Co-Licensee, including, but not limited to Provider Rights, Appeal Procedures and Agencies Consultative Role.
SUPERVISOR'S NAME: Katherine HarewoodTELEPHONE: (323) 981-3380
LICENSING EVALUATOR NAME: Rita RamosTELEPHONE: (323) 981-3985
LICENSING EVALUATOR SIGNATURE:

DATE: 06/18/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/18/2019
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC809 (FAS) - (06/04)
Page: 1 of 2
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: CUERVO & ESCAMILLA FAMILY CHILD CARE
FACILITY NUMBER: 198019446
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/18/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
07/02/2019
Section Cited
CCR
102417(g)(8)
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Operation of a Family Child Care Home

Each family child care home shall have a current roster of children as specified in Health and Safety Code Section 1596.841.
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The roster was updated during the inspection.
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This requirement is not met as evidenced by LPAs observing that there is no updated roster. This poses a potential health and safety risk to children in care.
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Type B
07/02/2019
Section Cited
CCR
102416.3
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Alterations to Existing Buildings or Grounds

Prior to making alterations or additions to a family child care home or grounds, the licensee shall notify the Department of the proposed change
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Per Licensee, the yard will be cleaned out and a report of the remodelling will be submitted by POC due date of 07/02/19.
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This requirement is not met as evidenced by LPAs observing that the backyard was recently remodeled and Licensee's own disclosure of the recent construction. This poses a potential health and safety risk to 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: Katherine HarewoodTELEPHONE: (323) 981-3380
LICENSING EVALUATOR NAME: Rita RamosTELEPHONE: (323) 981-3985
LICENSING EVALUATOR SIGNATURE:

DATE: 06/18/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/18/2019
LIC809 (FAS) - (06/04)
Page: 2 of 2