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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 304312914
Report Date: 06/21/2019
Date Signed: 06/21/2019 03:18:02 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:MAGALLON, BLANCA & HORMAZA, JOSEFACILITY NUMBER:
304312914
ADMINISTRATOR:MAGA, BLANCA & HOR, JOSEFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(714) 356-7188
CITY:ANAHEIMSTATE: CAZIP CODE:
92804
CAPACITY:14CENSUS: 9DATE:
06/21/2019
TYPE OF VISIT:Case Management - Legal/Non-complianceUNANNOUNCEDTIME BEGAN:
02:24 PM
MET WITH:Blanca Magallon and Jose Hormaza, LicenseesTIME COMPLETED:
03:45 PM
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An unannounced Case Management inspection was conducted on this date by Orange County Child Care Regional Manager (RM) Bertha Manzanares and Licensing Program Analyst (LPA) Yesenia Villa for the purpose of serving the following notices:

· Order to Licensee/Facility of Immediate Exclusion from Facility
· Order to Individual of Immediate Exclusion from all Facilities:

During today’s inspection LPA observed 9 children in care, two of them are infants. Also present during today's inspection were Leslie Hurtado and assistant Rosa Gladys Amaya. There were no other adults observed and licensee stated there were no other adults present during today’s inspection. At the time of arrival Giomaira Gonzalez Hormaz was not present during the inspection. Licensees stated Giomaira Gonzalez Hormaz has been their assistant on or about mid April of 2019.
Per Licensees her assistant does not reside in their home. Licensee stated Giomaira Gonzalez Hormaz has been employed on or about April 30, 2019 and works at the facility.Licensees accepted the Immediate Exclusion Order provided to them. The licensees where issued the Immediate Exclusion Letter dated 06/21/19 indicating Giomaira Gonzalez Hormaz not have contact with clients in, any child care facility or any other community care facility licensed by the California Department of Social Services. Licensees were advised to provided the enevople with the Immedaite Exclusion Letter to Giomaira Gonzalez Hormaz and inform her of the Immediate Exclusion Order. The licensees were further instructed to have Giomaira Gonzalez Hormaz contact the Regional Manager Bertha Manzanarez to confirm receipt of the Immediate Exclusion Order.

Licensees were informed they must provide parents with Family Child Care Home Addendum To Notification Of Parents' Rights (Regarding Removal/Exclusion), LIC 995B, obtain parent’s signature, retain a signed copy in the children’s files and send a copy of the signed acknowledgment to the licensing office. Licensees were issued LIC995B forms during todays visit in English and Spanish. (Continued on Page 2)
SUPERVISOR'S NAME: Judy HansonTELEPHONE: (714) 703-2807
LICENSING EVALUATOR NAME: Yesenia VillaTELEPHONE: (714) 703-2818
LICENSING EVALUATOR SIGNATURE:

DATE: 06/21/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/21/2019
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, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME: MAGALLON, BLANCA & HORMAZA, JOSE
FACILITY NUMBER: 304312914
VISIT DATE: 06/21/2019
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Exit interview was conducted with Licensees Blanca Maganon and Jose Hormaza. Notice of Site Visit was posted during the visit. Facility representative was informed that the notice of site visit must be posted for 30 consecutive days. Failure to post will result in civil penalties of $100. Appeal rights provided and explained. RM Manzanares explained the difference in appeal process for the Immediate Exclusion Order. The licensee was provided a copy of their appeal rights (LIC 9058 01/16) and her signature on this form acknowledges receipt of these rights. First level appeals should be sent to the regional manager to the address listed above. Licensee was informed of how/where to access regulations and forms from CCLD website: www.ccld.ca.gov.

End of Report.

SUPERVISOR'S NAME: Judy HansonTELEPHONE: (714) 703-2807
LICENSING EVALUATOR NAME: Yesenia VillaTELEPHONE: (714) 703-2818
LICENSING EVALUATOR SIGNATURE:

DATE: 06/21/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/21/2019
LIC809 (FAS) - (06/04)
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