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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198013810
Report Date: 07/18/2022
Date Signed: 07/18/2022 02:51:41 PM

Document Has Been Signed on 07/18/2022 02:51 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:JAUREQUI FAMILY CHILD CAREFACILITY NUMBER:
198013810
ADMINISTRATOR:JAUREQUI, MIRNAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(562) 964-3957
CITY:BELLFLOWERSTATE: CAZIP CODE:
90706
CAPACITY: 14TOTAL ENROLLED CHILDREN: 0CENSUS: 13DATE:
07/18/2022
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
02:10 PM
MET WITH:Mirna Jaurqui, LicenseeTIME COMPLETED:
03:13 PM
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Licensing Program Analyst (LPA) Susann Sanchez conducted a Plan of Correction (POC) inspection on this date July 18,2022 at 2:10pm. LPA met with Licensee, Mirna Jaurqui who guided analyst on a tour of the facility. Also present at the facility was Licensee's assistant. LPA observed 12 children (4 children, 1 infant, and 6 school aged) at the time of inspection. The purpose of the POC inspection was determine if Licensee has corrected the deficiency cited on 04/05/2022. LPA determined the following:
  • LPA did not observed any swings at the facility.


However, LPA reviewed children's files and did not observed LIC 9224 (Acknowledgment of Receipt) in children's files. Per Licensee parents have a copy of the report but did not ask parents to sign the Acknowledgement form. Per Licensee she did not understand the process. LPA reviewed the process again at 2:35pm.

Therefore, based on LPAs records review and observations, POC has been not been cleared. LPA will return at a later date, if acknowledgement is not signed when LPA returns, a civil penalty will be issued.

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 Mirna Jaurqui 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: 07/18/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/18/2022
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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