364845376-4-23-2021-09-CC-EJOS-C2CVNR-20210423163533

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 364845376
Report Date: 04/23/2021
Date Signed: 04/23/2021 04:36:12 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501

FACILITY NAME:	BURGOS FAMILY CHILD CARE		FACILITY NUMBER:	364845376
ADMINISTRATOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY:	8	CENSUS:	DATE:	04/23/2021
TYPE OF VISIT:	Office	UNANNOUNCED	TIME BEGAN:	11:00 AM
MET WITH:	Yolanda Burgos		TIME COMPLETED:	12:13 PM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	Due to COVID-19, Licensing Program Analysts (LPA) Elyse Jones, Taadhimeka Haynes-Zeigler and Licensing Program Manager, Aaron Ross conducted a Tele-inspection with Yolanda Burgos, Licensee via Face Time for the purpose of a Case Management-Licensee Initiated for an increase of capacity. During the tele-inspection an Informal Meeting was conducted. During the tele conference, the compliance history of the facility including Criminal Record Clearances, Capacity and Ratio, and Operation of Family Child Care Home. Licensee agreed to contact (Child Care Resource Center 909-384-8000) to obtain training regarding the above topics discussed as it pertains to a Family Child Care Home. Licensee also agreed to review the Child Care career videos pertaining to the above topics. The licensee will submit a written statement by 05/07/21 ensuring the Department that she has reviewed and understands the seriousness of these topics. Licensee agrees to submit proof of enrollment to the Department on or by 5-7-2021 and classes must be completed by 6-30-2021. Complete proof of correction for deficiencies cited for failure to remain in compliance must be submitted to the Department on or before the due dates on the LIC 809-D.

SUPERVISOR'S NAME: Aaron Ross	TELEPHONE: (951) 320-2023
LICENSING EVALUATOR NAME: Elyse Jones	TELEPHONE: (951) 897-2468
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501

FACILITY NAME: BURGOS FAMILY CHILD CARE	FACILITY NUMBER: 364845376
	VISIT DATE: 04/23/2021

NARRATIVE

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Licensee was advised to subscribed to received important updates during the tele conference. The updates will be sent directly to the e-mail provided. This website can also be accessed through www.ccld.ca.gov.

Exit interview was conducted with licensee Yolanda Burgos. A copy of this report was provided to the director. This report must be made available to the public upon request for the next 3 years.

SUPERVISOR'S NAME: Aaron Ross	TELEPHONE: (951) 320-2023
LICENSING EVALUATOR NAME: Elyse Jones	TELEPHONE: (951) 897-2468
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

LIC809 (FAS) - (06/04)

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