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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198019836
Report Date: 04/23/2021
Date Signed: 05/19/2021 01:50:33 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 CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME:GARCIA FAMILY DAY CAREFACILITY NUMBER:
198019836
ADMINISTRATOR:JASMIN GARCIAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(562) 607-7969
CITY:LONG BEACHSTATE: CAZIP CODE:
90805
CAPACITY:14CENSUS: 8DATE:
04/23/2021
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Licesnee - Jasmin GarciaTIME COMPLETED:
10:45 AM
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Due to COVID – 19 and the Department of Public Health (DPH) guidelines of social distancing, an unannounced follow-up tele-inspection was conducted on 04/23/21 at 10:00 AM regarding an Unusual Incident Report (UIR) dated 04/14/21. Licensing Program Analyst (LPA) Randy Derraco met with licensee Jasmin Garcia via Facetime. LPA observed eight children in care and one adult assistant. Licensee took LPA on a guided tour of home. LPA observed the home to be clean and in good repair.

Based on the available information that was gathered through interviews, C1 stepped on and held a metal gate located in the backyard that resulted in an injury. The licensee comforted C1, tended to the injury, and contacted C1’s mother for immediate pick up. Licensee states the metal gate was repaired the same evening as the incident and a sensor was installed to the sliding glass door leading to the backyard. LPA observed weld marks on the top and bottom of the metal gate and a working sensor above the sliding glass door.
Based on the available information gathered through inspection and interviews, it does not appear that the incident was the result of a Title 22 violation for Operation of a Family Child Care Home

An exit interview was conducted with the licensee, and a copy of this report was signed by LPA Randy Derraco. This report will be sent via email to licensee who agrees to sign and date the report. This report was sent via email and an electronic read receipt confirms receiving the report.
SUPERVISOR'S NAME: Trevino CochranTELEPHONE: (323) 981-3385
LICENSING EVALUATOR NAME: Randy DerracoTELEPHONE: (323) 981-3431
LICENSING EVALUATOR SIGNATURE:

DATE: 04/23/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/23/2021
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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