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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198014215
Report Date: 12/20/2024
Date Signed: 12/20/2024 09:06:51 AM

Document Has Been Signed on 12/20/2024 09:06 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
MONTEREY PARK CC RO, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME:RUBALCABA FAMILY CHILD CAREFACILITY NUMBER:
198014215
ADMINISTRATOR/
DIRECTOR:		RUBALCABA, GRACIELAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(323) 604-9050
CITY:LOS ANGELESSTATE: CAZIP CODE:
90063
CAPACITY: 12TOTAL ENROLLED CHILDREN: 12CENSUS: 7DATE:
12/20/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:30 AM
MET WITH:Graciela Rubalcaba - LicenseeTIME VISIT/
INSPECTION COMPLETED:
09:20 AM
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Licensing Program Analyst (LPA) Nolan Tcheng conducted an unannounced Case Management inspection for the purpose of delivering an Amended Report. Upon arrival at 8:30am, LPA met with Licensee Graciela Rubalcaba, to whom the purpose of the inspection was explained. A tour of the facility was provided. There were children present during the time of inspection.

Census was taken. There were 7 children with 1 staff member.

During today’s inspection, LPA provided an Amended report for the inspection conducted on 12/18/2024. Amended report obtained LPA and licensee signatures that were missed on the original inspection date.

There were no deficiencies observed during today’s inspection.

A notice of site visit was given and must remain posted for 30 days.

Exit interview conducted and report was reviewed with Licensee Graciela Rubalcaba, at 9:10am. Copy of Report provided.

END OF REPORT

SUPERVISORS NAME: Ana Chico
LICENSING EVALUATOR NAME: Nolan Tcheng
LICENSING EVALUATOR SIGNATURE: DATE: 12/20/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/20/2024
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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