198019679-2-19-2021-33-CC-MGAA-BYDVLZ-20210219153246

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 198019679
Report Date: 02/19/2021
Date Signed: 02/19/2021 03:33:17 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: 0	DATE:	02/19/2021
TYPE OF VISIT:	Case Management - Incident	UNANNOUNCED	TIME BEGAN:	03:03 PM
MET WITH:	Licensee, Estela Andrade		TIME COMPLETED:	03:17 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 February 19, 2021 at 3:03 p.m., Licensing Program Analyst (LPA) Mireya García, contacted Licensee, Estela Andrade, via telephone due to COVID-19 and precautionary measures in order to follow up on an incident that was reported to the Department on 01/12/2021. At 3:10 p.m., the call was transferred into a Face time tele-inspection. LPA García discussed the purpose of the call. During this tele-inspection the Licensee took this LPA on a virtual tour of the facility. There were no day care children observed to be present at the facility during this tele-inspection. On 01/12/21, an unusual incident report was made to the department regarding an incident that involved a child who sustained injury that required medical attention. The facility reported this incident to the Department within the required 24 hours. Based on information obtained during interviews conducted with Licensee, the dog owner and parent of child in question, LPA Garcia determined that a visiting family member’s dog entered the premises while Licensee and day care children were in the back yard. Before the side gate could completely close the dog ran in and bit a day care child in the face (right cheek). Although Licensee was present and observed the incident, Licensee could not reach the dog in time to stop the bite. Child was taken to the doctor and received stiches. Child has returned to day care. 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: 02/19/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/19/2021

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: ANDRADE FAMILY CHILD CARE	FACILITY NUMBER: 198019679
	VISIT DATE: 02/19/2021

NARRATIVE

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Based on information obtained during this investigation, no follow up is necessary regarding the incident reported. The facility followed all proper procedures; Licensee administered first aid, child’s parent was notified, incident report was sent in properly and timely and all medical needs were met. Per Licensee, she has spoken to her family members and approved visitors to ensure that the gate is kept closed and locked at all times during the day care hours (LPA observed padlock placed on gate). In addition, per Licensee no dogs will be allowed near or in day care during the hours of operation.

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 Garcia and mail originals forms to the office.

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SUPERVISOR'S NAME: Valarie Cook	TELEPHONE: (323) 981-3362
LICENSING EVALUATOR NAME: Mireya Garcia	TELEPHONE: (323) 558-2192
LICENSING EVALUATOR SIGNATURE:	DATE: 02/19/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/19/2021

LIC809 (FAS) - (06/04)

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