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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 304371489
Report Date: 05/24/2022
Date Signed: 05/24/2022 12:31:15 PM

Document Has Been Signed on 05/24/2022 12:31 PM - 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, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME:OUR TRIBE OUR VILLAGE CHILDCARE CENTERFACILITY NUMBER:
304371489
ADMINISTRATOR:MARIN, QUASHANIKAFACILITY TYPE:
850
ADDRESS:6441 LINCOLN AVENUETELEPHONE:
(562) 999-6783
CITY:BUENA PARKSTATE: CAZIP CODE:
90620
CAPACITY: 30TOTAL ENROLLED CHILDREN: 30CENSUS: 14DATE:
05/24/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
10:23 AM
MET WITH:Quashanika Marin, DirectorTIME COMPLETED:
11:15 AM
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On May 24, 2022, Licensing program analysts (LPAs) Mila Quinto and Dianna Valdez Santana conducted a case management visit to issue a civil penalty for the case management inspection dated April 27, 2022. This report is generated to issue the civil penalty. Director was provided another copy of the report issued on April 27, 2022.

LPAs met with Director, Quashanika Marin and toured the facility. LPAs observed 5 staff members providing care for 14 preschool children. A review of staff records on this date indicates that all facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions.

On the inspection dated 04/27/2022, Licensing Program Analysts (LPAs) Tina Nguyen and Dianna Valdez-Santana cited the facility type A violation under the California Code of Regulations, Title 22, Division 12, Chapter 1, Article 02 Licensing 101161 (a) Limitations on Capacity. This is a repeated violation from the 04/05/2022 and within the 12 months period, for the same section and subsection. Civil penalty was not assessed on 4/27/2022, due to director yelling at Licensing Staff.

During today inspection, LPAs Quinto and Valdez-Santana issued $250 civil penalty for the repeated violation within the 12 months period.

Exit interview was conducted. The notice of site visit was posted. Licensee was informed the notice of site visit must be posted for 30 consecutive days. Failure to post will result in civil penalty of $100. Appeal Rights was explained. A copy of appeal rights (LIC 9058 1/16) was provided and their signatures on this form acknowledges receipt of these rights. First level appeal is to Regional Manager, address is above on the report.

SUPERVISORS NAME: Patricia Magana
LICENSING EVALUATOR NAME: Mila Quinto
LICENSING EVALUATOR SIGNATURE: DATE: 05/24/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/24/2022
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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