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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198020026
Report Date: 07/22/2022
Date Signed: 07/22/2022 11:55:38 AM


Document Has Been Signed on 07/22/2022 11:55 AM - It Cannot Be Edited

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:PEREYRA FAMILY CHILD CAREFACILITY NUMBER:
198020026
ADMINISTRATOR:GABRIELA PEREYRAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(323) 738-1634
CITY:MONTEBELLOSTATE: CAZIP CODE:
90640
CAPACITY:14CENSUS: 10DATE:
07/22/2022
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
10:45 AM
MET WITH:Licensee, Gabriela PereyraTIME COMPLETED:
12:15 PM
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**********************************This inspection was conducted in Spanish*********************
An Unannounced Case Management Inspection was conducted by Licensing Program Analyst (LPA) Mireya Garcia. LPA met with licensee Gabriela Pereyra who guided LPA on a tour of the entire facility indoors and outdoors. The licensee's assistant Jazmin Islas was also present during this inspection. The purpose of today's inspection is to Inspect the new day care room and bathroom that the licensee added to her home. Licensee sent the department a new facility sketch showing all the areas she is requesting for the day care children to use. Licensee also sent the department a Declaration regarding the construction that took place in the addition of the day care main room and restroom #2. Fire clearance STD 850 was granted on May 23, 2022, LPA has approved on this date for the new day care room with bathroom to be used. LPA observed that there are no hazards in the new area and there is a smoke detector with carbon monoxide in the new day care room which was tested at 10:57 am and it is in operable condition. Licensee stated she is also adding a camera in the day care room. Windows in these areas have locks on them. There is a sliding back door in the day care room that can be used as an additional exit that will lead down to the back yard. In addition, there is a sliding door in the day care room that can also be used as an additional exit that will lead to bedroom #1. Licensee stated that the sliding doors will be locked at all times.
A notice of site visit was given and must remain posted for 30 days.

Exit interview conducted and report was reviewed with facility representative, Gabriela Pereyra.

Report ends here page 1 of 1.

SUPERVISOR'S NAME: Brandi VanOostenTELEPHONE: (323) 981-3365
LICENSING EVALUATOR NAME: Mireya GarciaTELEPHONE: (323) 981-3390
LICENSING EVALUATOR SIGNATURE:
DATE: 07/22/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/22/2022
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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