<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198019825
Report Date: 04/27/2020
Date Signed: 04/28/2020 09:44:18 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:MORENO FAMILY CHILD CAREFACILITY NUMBER:
198019825
ADMINISTRATOR:BERNANDITA A. MORENOFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(626) 403-2833
CITY:ALHAMBRASTATE: CAZIP CODE:
91803
CAPACITY:14CENSUS: 2DATE:
04/27/2020
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
04:04 PM
MET WITH:Bernandita Moreno, LicenseeTIME COMPLETED:
04:10 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
A Case Management Incident inspection was conducted by Licensing Program Analyst (LPA), Fabiola Vasquez. The department received the report on 12/20/19, regarding a child who fell and hit the side of her right eye on a lounge chair. Due to COVID-19 and precautionary measures. This inspection was conducted with Bernandita Moreno, Licensee via a tele-inspection by use of Facetime. During this tele-inspection the Licensee took LPA on a tour of the home via Facetime. During this tour the following was noted: Census: 2 infants in care

Exit phone interview was conducted with Licensee Bernandita Moreno. Appeal Rights were verbally explained to Licensee. A copy of this report has been signed by LPA Vasquez. This report, along with the Appeal Rights, will be scanned via e-mail to Licensee Bernandita Moreno, 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.
SUPERVISOR'S NAME: Claudia GuangorenaTELEPHONE: (323) 981-3417
LICENSING EVALUATOR NAME: Fabiola VasquezTELEPHONE: (626) 361-1267
LICENSING EVALUATOR SIGNATURE:

DATE: 04/27/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/27/2020
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 1