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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198011796
Report Date: 08/18/2023
Date Signed: 08/18/2023 12:12:31 PM

Document Has Been Signed on 08/18/2023 12:12 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 S WEST, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME:ANDRADE FAMILY CHILD CAREFACILITY NUMBER:
198011796
ADMINISTRATOR:ANDRADE, MARIAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(562) 618-0981
CITY:DOWNEYSTATE: CAZIP CODE:
90242
CAPACITY: 14TOTAL ENROLLED CHILDREN: 12CENSUS: 7DATE:
08/18/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
11:17 AM
MET WITH:Licensee - Maria AndradeTIME COMPLETED:
12:30 PM
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Licensing Program Analyst (LPA) R. Derraco conducted an unannounced case management visit to the above mentioned facility on 08/18/23. LPA began visit at 11:17 AM and was met by licensee, Maria Andrade, who guided analyst on a tour of the facility. LPA observed 7 children in care and 2 additional adults upon arrival. The home was observed to be clean and free of defects.

The purpose of this visit is to issue a technical violation under California Code of Regulation (CCR) section 102416(d)(1) with regards to resident S3. LPA observed that S3 has had their fingerprints taken on 05/08/23 via Guardian website. Licensee also provided a fingerprint response letter showing that fingerprints had been taken on 05/08/23 as well as the Livescan form (LIC 9163) dated 05/08/23. Per review of Guardian website, Records of Arrest and Prosecutions (RAP) sheet for Federal, State of California and Child Abuse Central Index have been received and show a clear status.

LPA advised licensee and S3 to follow up with Care Provider Management Bureau with regards to S3's pending association status indicated on the Guardian website.

A notice of site visit 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 Maria Andrade.
SUPERVISORS NAME: Karen Chambers
LICENSING EVALUATOR NAME: Randy Derraco
LICENSING EVALUATOR SIGNATURE: DATE: 08/18/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/18/2023
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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