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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 192001526
Report Date: 04/04/2023
Date Signed: 04/04/2023 09:09:29 AM

Document Has Been Signed on 04/04/2023 09:09 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:CERVANTES FAMILY CHILD CAREFACILITY NUMBER:
192001526
ADMINISTRATOR:CERVANTES, SILVIAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(323) 266-7233
CITY:LOS ANGELESSTATE: CAZIP CODE:
90022
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 0DATE:
04/04/2023
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
08:00 AM
MET WITH:Silvia Cervantes, LicenseeTIME COMPLETED:
09:20 AM
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Inspection conducted in Spanish

On April 4, 2023, Licensing Program Analyst (LPA) Monique Ayala conducted an unannounced Plan of Correction (POC) visit at the above facility. A COVID-19 risk assessment was conducted prior to entering the facility. LPA met with licensee, Silvia Cervantes who guided LPA on a tour of the facility. Per licensee there are no children present and LPA did not observe any children in care.

The purpose of the visit is to ensure that the licensee has corrected the deficiencies that were cited to her on 03/23/2023.

1. 102418(a): Immunization's
2. 102419(d)(1): Admission Procedures and Parental
3. 102417(g)(7): Operations of a Family Child Care Home
4. 102417(m)(3): Operations of a Family Child Care Home
5. 102417(g)(4): Operations of a Family Child Care Home
6. 102425(j)(1): Infant Safe Sleep

LPA observed the corrections of the above deficiencies and found that the licensee have become incompliance with Title 22 Regulations.

An exit interview was conducted and a copy of this report was provided to the licensee along with Notice of Site Visit.
SUPERVISORS NAME: Ana Chico
LICENSING EVALUATOR NAME: Monique Jessica Ayala
LICENSING EVALUATOR SIGNATURE: DATE: 04/04/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/04/2023
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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