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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 304310419
Report Date: 01/25/2021
Date Signed: 01/25/2021 03:14:27 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME:PACHON-VALENZUELA, CAROLINAFACILITY NUMBER:
304310419
ADMINISTRATOR:PACHON-VALENZUELA, CAROLINFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(213) 305-9829
CITY:ANAHEIMSTATE: CAZIP CODE:
92804
CAPACITY:14CENSUS: 0DATE:
01/25/2021
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Carolina Pachon ValenzuelaTIME COMPLETED:
10:30 AM
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Licensing Program Analyst, (LPA) Villa conducted a case management visit on this day. The call was conducted via tele-visit due to preventative measures related to COVID-19. There were no children present during the tele-inspection. A review of the Facility Personnel Report Summary on this date indicates all facility residents, staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearance of exemptions.

LPA Villa conducted a walk through of the home via face-time and provided resources related to COVID-19 in preparation of re-opening the daycare. The facility was inactive since 05/15/2016 until present. The licensee contacted LPA Villa via phone and indicated that she was ready to re-open the daycare. LPA Villa provided COVID-19 Technical assistance to the provider along with all forms and resources related to COVID-19 via email prior to the case management visit. This case management visit provided guidance and support for the reopening of the daycare effective 01/25/2021. This case management visit also satisfies the RAST technical assistance visit for this facility. Flyers and self-assessment guides were provided to the licensee. LPA Villa also discussed the new safe sleep regulations and informed the licensee where she can obtain updated policy and regulation information.

A new license will be mailed to the licensee with the effective date of 01/25/2021. Her license will go from inactive to active. An exit interview was conducted with the licensee Carolina Pachon Valenzuela. A copy of this report was emailed to the Licensee and a receipt of acknowledgement serves as the electronic signature. The notice of site visit was not posted as this was a virtual visit.

SUPERVISOR'S NAME: Judy HansonTELEPHONE: (714) 703-2807
LICENSING EVALUATOR NAME: Yesenia VillaTELEPHONE: (714) 293-9465
LICENSING EVALUATOR SIGNATURE:

DATE: 01/25/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/25/2021
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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