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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198003557
Report Date: 11/21/2022
Date Signed: 11/21/2022 11:26:01 AM

Document Has Been Signed on 11/21/2022 11:26 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:RODRIGUEZ FAMILY CHILD CAREFACILITY NUMBER:
198003557
ADMINISTRATOR:RODRIGUEZ, INGRIDFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(818) 802-6015
CITY:GLENDALESTATE: CAZIP CODE:
91202
CAPACITY: 14TOTAL ENROLLED CHILDREN: 9CENSUS: 7DATE:
11/21/2022
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
10:55 AM
MET WITH:Ingrid Rodriguez, LicenseeTIME COMPLETED:
11:50 AM
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Licensing Program Analyst (LPA) Anomeh Eivazian conducted a plan of correction inspection to the above facility on 11/21/2022 to ensure Type A citation that was issued on 11/15/22 was cleared. LPA arrived at the facility at 10:55 AM and met with Ingrid Rodriguez, Licensee who guided analyst on a tour of the facility.

Upon LPA's arrival to the facility, LPA observed 7 children, 3 being infants with licensee and her assistant in the detached activity room. LPA observed children toys and a sofa in the detached activity room. Next LPA toured the home and observed children napping cots in the living room and two pack n' plays in the bedroom. Per licensee, children eat either outside or inside the home in the living room and sleep inside the main home in the living room and one bedroom. Per licensee, children use the detached activity room for limited activity only effective 11/16/22 from 9:00 a.m. to 11:30 a.m. and 3:00 p.m. to 5:30 p.m.. A written declaration obtained from licensee regarding her plans to use the detached activity room for limited activities only.

Acknowledgement forms were observed for all children in care.

LPA cleared Type A deficiency on this date and issued Plan of Correction clearance letter.



The Notice of Site Visit (LIC 9213) was given and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.


Exit interview conducted and report was reviewed with the Licensee, Ingrid Rodriguez at 11:50 a.m..
SUPERVISORS NAME: Christina Gabelman
LICENSING EVALUATOR NAME: Anomeh Eivazian
LICENSING EVALUATOR SIGNATURE: DATE: 11/21/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/21/2022
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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