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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198019679
Report Date: 01/26/2024
Date Signed: 01/26/2024 10:56:27 AM

Document Has Been Signed on 01/26/2024 10:56 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
CCLD Regional Office, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME:ANDRADE FAMILY CHILD CAREFACILITY NUMBER:
198019679
ADMINISTRATOR:ESTELA ANDRADEFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(626) 421-1662
CITY:EL MONTESTATE: CAZIP CODE:
91732
CAPACITY: 14TOTAL ENROLLED CHILDREN: 6CENSUS: 1DATE:
01/26/2024
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
09:50 AM
MET WITH:Licensee, Estela Andrade TIME COMPLETED:
11:10 AM
NARRATIVE
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Licensing Program Analyst (LPAs) Roxana Lopez and Saul Valenzuela conducted a Case Management-Deficiencies visit on this date to address deficiencies revealed during a POC inspection on this date. There was one child present.

LPAs initially arrived to the facility at 9:00 am- upon entry Licensee, informed LPA Lopez that they were going to be honest and that their un-fingerprinted adult son Joe Andrade stayed the night and was currently asleep in the room. Per Licensee, son does not live in the home and was getting picked up soon. LPAs did observed Joe Andrade leave the facility at 9:45 am. This poses an immediate health and safety risk for children in care. Civil Penalty of $100 was assessed on this date.

Based on LPA observations and records review, the following deficiencies listed on the attached LIC 809D (deficiency page) are being cited in accordance with California Code of Regulations Title 22. Deficiencies that are being cited need to be cleared to protect the children’s health and safety.

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SUPERVISORS NAME: Brandi VanOosten
LICENSING EVALUATOR NAME: Roxana Lopez
LICENSING EVALUATOR SIGNATURE: DATE: 01/26/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/26/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 3
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME: ANDRADE FAMILY CHILD CARE
FACILITY NUMBER: 198019679
VISIT DATE: 01/26/2024
NARRATIVE
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 LPA Roxana Lopez informed Licensee Estela Andrade that this report dated 1/26/2024 document(s) 1 Type A citation(s) which shall be posted for 30 consecutive days as there is/are immediate risk(s) to the health, safety, or personal rights of children in care. Also, LPA Roxana Lopez informed the Licensee to provide a copy of this licensing report dated 1/26/204 that documents any Type A citation(s) to parents/guardians of all children currently enrolled by the next business day or the next day the children are in care, and to any newly enrolled parents/guardians for 12 months from the date of this report. A signed Acknowledgement of Receipt of Licensing Report (LIC 9224), or other written statement, must be placed in the child's file for verification.

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 the Licensee, Estela Andrade.

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SUPERVISORS NAME: Brandi VanOosten
LICENSING EVALUATOR NAME: Roxana Lopez
LICENSING EVALUATOR SIGNATURE:

DATE: 01/26/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/26/2024
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 01/26/2024 10:56 AM - It Cannot Be Edited


Created By: Roxana Lopez On 01/26/2024 at 10:09 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: ANDRADE FAMILY CHILD CARE
FACILITY NUMBER: 198019679

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/26/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
01/26/2024
Section Cited
CCR
102370(a)

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102370 Criminal Record Clearance
(a) Prior to the Department issuing a license, the applicant(s) and all adults residing in the home shall obtain a California criminal record clearance or exemption.This requirement was not met as evidenced by:
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Per Licensee, son was speniding the night and is not fingerprinted because he lives in San Bernadino. Per Licensee, she will have son fingerprinted and associated to the home. Joe Andrade left facility at 9:45 am
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Based on observation, interview, Licensee's adult son Joe Andrade is not fingerprinted cleared which poses an immediate health and safety risk to children in care.
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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:Brandi VanOosten
LICENSING EVALUATOR NAME:Roxana Lopez
LICENSING EVALUATOR SIGNATURE:
DATE: 01/26/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/26/2024


LIC809 (FAS) - (06/04)
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