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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198015836
Report Date: 02/09/2022
Date Signed: 02/09/2022 12:32:14 PM

Document Has Been Signed on 02/09/2022 12:32 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 CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME:UMANA FAMILY CHILD CAREFACILITY NUMBER:
198015836
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 3DATE:
02/09/2022
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
11:30 AM
MET WITH:Steven UmanaTIME COMPLETED:
12:35 PM
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Licensing Program Analyst (LPA) Seung Lee conducted an unannounced case management inspection. Upon arrival LPA Lee met with Licensee Steven Umana.

The purpose of the inspection was to complete the pending application to update the family child care home license. The application was to update the license by adding a co-licensee. During the inspection LPA Lee was provided a tour of the home including the off limits area where the co-licensee applicant Erica Sabillon resides. All documents required for the co-licensee has been provided. The application will be processed and the new updated license will provided to the facility as soon as possible.

The notice of site inspection must remain posted for a period of 30 days during hours of operation. Failure to maintain to documents during business hours will result in a civil penalty of $100.00 dollars.

Exit interview conducted with Licensee Steven Umana. Appeal rights discussed and explained.
SUPERVISORS NAME: Guangorena Claudia
LICENSING EVALUATOR NAME: Seung Lee
LICENSING EVALUATOR SIGNATURE: DATE: 02/09/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/09/2022
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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