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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 192001526
Report Date: 04/18/2024
Date Signed: 04/18/2024 11:35:50 AM

Document Has Been Signed on 04/18/2024 11:35 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:
04/18/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Silvia Cervnates, LicenseeTIME COMPLETED:
11:00 AM
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On April 18, 2024, Licensing Program Analyst (LPA), Monique Ayala conducted an unannounced case management inspection. The purpose of the inspection is to follow up on an incident report that reported on 03/06/2024 and was reported to the department in a timely manner. The incident occurred on 03/01/2024 and is a possible personal rights violation. 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. LPA did not observe any children in care. Inspection was conducted in Spanish.

During this inspection LPA a current facility roster and LPA interviewed Staff #1 (S1).

At this time the incident report requires further investigation. There will be no deficiencies cited today, 04/18/2024.

An exit interview was conducted and a copy of this report was provided to the licensee, along with Notice of Site Visit. Notice of Site Visit must be posted for 30 days.
SUPERVISORS NAME: Ana Chico
LICENSING EVALUATOR NAME: Monique Jessica Ayala
LICENSING EVALUATOR SIGNATURE: DATE: 04/18/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/18/2024
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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