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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198012194
Report Date: 09/12/2022
Date Signed: 09/12/2022 03:02:18 PM

Document Has Been Signed on 09/12/2022 03:02 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
CCLD Regional Office, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME:GALLEGOS FAMILY CHILD CAREFACILITY NUMBER:
198012194
ADMINISTRATOR:GALLEGOS, IRMAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(562) 673-5979
CITY:LONG BEACHSTATE: CAZIP CODE:
90810
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: DATE:
09/12/2022
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
02:40 PM
MET WITH:Irma Gallegos, LicenseeTIME COMPLETED:
03:25 PM
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 THIS INSPECTION WAS CONDUCTED IN SPANISH

Licensing Program Analyst (LPA) Susann Sanchez conducted a Plan of Correction (POC) inspection on this date. LPA met with Licensee, Irma Gallegos, who guided analyst on a tour of the facility. Also present at the facility was 2 assistants (fingerprinted). LPA observed 4 children, 3 school aged children, and 3 infants.


The purpose of this inspection was determine if Licensee has corrected the deficiency cited on 7/15/22 and 08/10/22. LPA determined the following POC to be cleared:
  • Bedroom #2 was open
  • Licensee was in ratio
  • LPA observed 4 play pins
  • Licensee has all children's & staff files in order.
  • The fire extinguisher meets the 2A10BC standards required by the State Fire Marshall
  • All parents have sign the LIC 9224, The Acknowledgement form.



Therefore, based on LPA records review and observations, POC has been cleared.

The Notice of Site Visit (LIC 9213) – must remain posted for 30 days during the hours of operation after each site visit made by a licensing representative. Failure to maintain posting as required will result in a civil penalty of $100.00.

Exit interview was conducted Irma Gallegos, Licensee, but not limited to Provider Rights, Appeal Procedures and Agencies Consultative Role.
SUPERVISORS NAME: Valarie Cook
LICENSING EVALUATOR NAME: Susann Sanchez
LICENSING EVALUATOR SIGNATURE: DATE: 09/12/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/12/2022
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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