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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197413992
Report Date: 02/18/2025
Date Signed: 02/18/2025 04:06:04 PM

Document Has Been Signed on 02/18/2025 04:06 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
EL SEGUNDO CC NORTH, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME:JARAMILLO FAMILY CHILD CAREFACILITY NUMBER:
197413992
ADMINISTRATOR/
DIRECTOR:		JARAMILLO, CARLA & EDUARDOFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(818) 982-2271
CITY:NORTH HOLLYWOODSTATE: CAZIP CODE:
91605
CAPACITY: 14TOTAL ENROLLED CHILDREN: 8CENSUS: 6DATE:
02/18/2025
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
03:30 PM
MET WITH:Carla Jaramillo, LicenseeTIME VISIT/
INSPECTION COMPLETED:
04:15 PM
NARRATIVE
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Licensing Program Analyst (LPA) Silva Garibyan conducted an unannounced case management inspection on 02/18/2025. LPA arrived at the facility at 12:10 PM and met with Carla Jaramillo, Licensee, who guided LPA on a tour of the facility. There were six children and two staff present upon arrival.

LPA Garibyan conducted record review and observed that evidence of a current tuberculosis (TB) clearance is missing for the adults that live in Licensee's home. The adults moved into licensee's home in November of 2024.

California Code of Regulations, Title 22, Division 12, Chapter 3, Article 03. Application Procedures, 102369 (b) (9) is being cited on the attached LIC809-D.



The Notice of Site Visit was given and must remain posted for 30 days during the hours of operation after each site visit by a licensing representative.

Exit interview was conducted and report was reviewed with Carla Jaramillo, Licensee .
SUPERVISORS NAME: Betty Bell
LICENSING EVALUATOR NAME: Silva Garibyan
LICENSING EVALUATOR SIGNATURE: DATE: 02/18/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/18/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 2
Document Has Been Signed on 02/18/2025 04:06 PM - It Cannot Be Edited


Created By: Silva Garibyan On 02/18/2025 at 03:09 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245

FACILITY NAME: JARAMILLO FAMILY CHILD CARE
FACILITY NUMBER: 197413992

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/18/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
03/04/2025
Section Cited
CCR
102369(b)(9)

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Evidence of a current tuberculosis clearance, not more than one year prior to or seven days after initial presence in the home, for any adult in the home during the time that children are under care.
This requirement is not met as evidenced by:
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Licensee will obtain TB clearances for the adults in the home and submit copies to CCL by the POC due date.
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Evidence of a current tuberculosis (TB) clearance is missing for the adults in the home. The adults moved into licensee's home in Novemeber of 2024.
This poses a potential health, safety or personal rights risk to persons in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Betty Bell
LICENSING EVALUATOR NAME:Silva Garibyan
LICENSING EVALUATOR SIGNATURE:
DATE: 02/18/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/18/2025


LIC809 (FAS) - (06/04)
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