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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198019446
Report Date: 07/15/2019
Date Signed: 07/15/2019 02:32:45 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: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: 11DATE:
07/15/2019
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
02:00 PM
MET WITH:Lorena Valentina Escamilla, LicenseeTIME COMPLETED:
02:45 PM
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 THIS INSPECTION WAS CONDUCTED IN SPANISH AND ENGLISH
Licensing Program Analysts (LPAs) Rita Ramos and Alicia Mooberry conducted an unannounced case management inspection to the above facility. LPAs met with Lorena Valentina Escamilla, Licensee, who guided analysts on a tour of the facility. Also present during the inspection was Gabriela Diosdado, Assistant. There were 11 children present upon arrival. Licensee's husband, Guillermo Escamilla arrived during the inspection as well.

The purpose for the inspection was to obtain signatures on an amended report.

There were no deficiencies cited during today's inspection.

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, 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: 07/15/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/15/2019
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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