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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198019425
Report Date: 11/21/2024
Date Signed: 11/21/2024 12:15:38 PM

Document Has Been Signed on 11/21/2024 12:15 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 CC RO, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME:RIVERA GUERRA FAMILY CHILD CAREFACILITY NUMBER:
198019425
ADMINISTRATOR/
DIRECTOR:		ANA MARGARITA RIVERAGUERRAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(323) 738-9706
CITY:LOS ANGELESSTATE: CAZIP CODE:
90063
CAPACITY: 14TOTAL ENROLLED CHILDREN: 8CENSUS: 4DATE:
11/21/2024
TYPE OF VISIT:POCUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
11:30 AM
MET WITH:Ana Rivera GuerraTIME VISIT/
INSPECTION COMPLETED:
12:30 PM
NARRATIVE
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At 11:30am Licensing Program Analyst (LPA) Veronica Martinez Garza conducted an unannounced POC (Plan of correction) inspection to ensure the Type B deficiencies cited on 07/03/24 have been cleared. LPA met with licensee Ana Rivera Guerra. Also present was the licensee's daughter/assistant Destiny Guerra. Census was taken. The following was observed:

-Licensee and assistance do not have proof of the Tdap vaccine. According to the licensee, she does not have an immunization record; however, she stated that she recently received the Tdap vaccine. Licensee will contact the medical office to request proof of immunizations. Per licensee's assistant, she is having issues with the health insurance and therefore she has not been able to schedule an appointment.

The following deficiencies were cited in accordance with Title 22 of the California Code of Regulations and Health & Safety Codes. Please see 809D for documentation of deficiencies.


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 licensee, Ana Rivera Guerra.

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SUPERVISORS NAME: Ana Chico
LICENSING EVALUATOR NAME: Veronica Martinez-Garza
LICENSING EVALUATOR SIGNATURE: DATE: 11/21/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/21/2024
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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Document Has Been Signed on 11/21/2024 12:15 PM - It Cannot Be Edited


Created By: Veronica Martinez-Garza On 11/21/2024 at 11:21 AM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME: RIVERA GUERRA FAMILY CHILD CARE
FACILITY NUMBER: 198019425

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/21/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
12/20/2024
Section Cited
HSC
1597.622(a)(1)

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(1) Commencing September 1, 2016, a person shall not be employed or volunteer at a family day care home if he or she has not been immunized against influenza, pertussis, and measles. Each employee and volunteer shall receive an influenza vaccination between August 1 and December 1 of each year.

This requirement is not met as evidenced by:
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Per licensee, she will contact the medical office to request proof of the Tdap vaccine. According to the assistant, she will contact the health insurance to follow up on the status of her appointment. Once licensee and assistant obtain proof oft the Tdap vaccine it will be sent to LPA by POC date.
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Licensee and assistant do not have proof of the Tdap vaccine.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Ana Chico
LICENSING EVALUATOR NAME:Veronica Martinez-Garza
LICENSING EVALUATOR SIGNATURE:
DATE: 11/21/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/21/2024


LIC809 (FAS) - (06/04)
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