198019679-1-28-2021-33-CC-MGAA-BXQ34S-20210128165536

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 198019679
Report Date: 01/28/2021
Date Signed: 01/28/2021 04:56:04 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:	ANDRADE FAMILY CHILD CARE		FACILITY NUMBER:	198019679
ADMINISTRATOR:	ESTELA ANDRADE		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(626) 421-1662
CITY:	EL MONTE	STATE: CA	ZIP CODE:	91732
CAPACITY:	14	CENSUS: 1	DATE:	01/28/2021
TYPE OF VISIT:	Case Management - Incident	UNANNOUNCED	TIME BEGAN:	03:00 PM
MET WITH:	Licensee, Estela Andrade		TIME COMPLETED:	03:55 PM

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25

On January 28, 2021 at 3:00 p.m., Licensing Program Analyst (LPA) Mireya García contacted the facility via telephone due to COVID 19 and precautionary measures in order to conduct a Case Management Incident report tele-visit due to an incident that occurred on January 11, 2021. This inspection was conducted with Licensee, Estela Andrade via a tele-inspection by use of Facetime. At 3:03 p.m., the call was transferred into a Facetime tele-inspection. LPA M. García discussed the purpose of the call. During this tele-inspection the Licensee took this LPA on a virtual tour of the facility. Census was taken. There were no day care children present. Licensee’s own grandchild was present.

LPA interviewed Licensee and went over Incident report with Licensee.

On January 11, 2021 a day care child was bit by a dog on the right side of face (cheek) while child was in the outdoor play area (back yard). Dog entered the side gate of the home and Licensee could not reach the dog on time to stop the bit. Child was taken to the emergency room and received stiches.

LPA M. García requested pictures of the child’s injury and including the facility roster.

REPORT CONTINUES ON NEXT PAGE: 1 OF 2.

SUPERVISOR'S NAME: Valarie Cook	TELEPHONE: (323) 981-3362
LICENSING EVALUATOR NAME: Mireya Garcia	TELEPHONE: (323) 558-2192
LICENSING EVALUATOR SIGNATURE:	DATE: 01/28/2021

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/28/2021

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: ANDRADE FAMILY CHILD CARE	FACILITY NUMBER: 198019679
	VISIT DATE: 01/28/2021

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

The investigation will continue in order to conduct further interviews and/or obtain additional documentation.

Due to insufficient information available at this time, the incident needs further investigation.

A Notice of Site Visit was not provided to Licensee, Estela Andrade since a physical inspection was not conducted.

Exit interview was conducted with Licensee, Estela Andrade via tele-inspection, during which Appeal Rights were verbally explained to Licensee. A copy of this report (LIC 809) has been signed by LPA García. This report, along with a copy of the Appeal Rights (LIC 9058) will be scanned via e-mail to Estela Andrade, who understands that an electronic “Read Receipt” and/or confirmation of receipt of the e-mail confirms receipt of the report and constitutes an electronic signature. The facility representative was provided with the mailing address to the Monterey Park Regional Office (1000 Corporate Center Drive, Suite 200B, Monterey Park, CA 91754) and agrees to send a copy of the signed LIC 809 reports by email to LPA and mail originals forms to the office.

END OF REPORT: PAGE 2 OF 2

SUPERVISOR'S NAME: Valarie Cook	TELEPHONE: (323) 981-3362
LICENSING EVALUATOR NAME: Mireya Garcia	TELEPHONE: (323) 558-2192
LICENSING EVALUATOR SIGNATURE:	DATE: 01/28/2021

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/28/2021

LIC809 (FAS) - (06/04)

Page: 2 of 2