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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198010798
Report Date: 06/06/2024
Date Signed: 06/06/2024 01:37:00 PM

Document Has Been Signed on 06/06/2024 01:37 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
MONTEREY PARK SW RO, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME:CARDONA FAMILY CHILD CAREFACILITY NUMBER:
198010798
ADMINISTRATOR/
DIRECTOR:		CARDONA, VIRGINIAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(323) 316-3804
CITY:LOS ANGELESSTATE: CAZIP CODE:
90037
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 1DATE:
06/06/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
11:30 AM
MET WITH:Virginia CardonaTIME VISIT/
INSPECTION COMPLETED:
12:30 PM
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On 6/6/2024 at 11:30 am, Licensing Progam Analyst (LPA) Claudia Kam conducted an unannounced case management visit to the above mentioned facility on 06/06/2024. LPA arrived at the facility and was met by licensee, Virginia Cardona who guided analysts on a tour of the facility. LPA observed the licensee and one cleared adult in the home and 1 child in care at time of visit. The facility was observed to be clean and free of defects.

The purpose of this visit is to provide the licensee with the decision order for uncleared adult and consult with licensee regarding the decision of non-exempted. LPA provided licensee with a copy of the decision order. LPA observed that the licensee had in her possession the decision order mailed to her by CDSS and her verification that she has been responding with required statements and documents requested by the court. Per licensee 3 adults live in the home her daughter, renter and herself. All adults were confirmed via Guardian to be cleared. LPA discussed the decision order to ensure she understands that the individual’s exemption was denied and he cannot reside in the home or visit while children are in care.

No citations will be issued today 6/6/24.

An exit interview was conducted and report was reviewed with Licensee Virginia Cardona.
SUPERVISORS NAME: Denise Gibbs
LICENSING EVALUATOR NAME: Claudia Kam
LICENSING EVALUATOR SIGNATURE: DATE: 06/06/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/06/2024
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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