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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198019966
Report Date: 09/03/2024
Date Signed: 09/03/2024 12:49:13 PM

Document Has Been Signed on 09/03/2024 12:49 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:VILLALOBOS FAMILY CHILD CAREFACILITY NUMBER:
198019966
ADMINISTRATOR/
DIRECTOR:		GLORIA VILLALOBOSFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(213) 909-3613
CITY:LOS ANGELESSTATE: CAZIP CODE:
90004
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 6DATE:
09/03/2024
TYPE OF VISIT:POCUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
11:30 AM
MET WITH:Norma Gonzalez, Assistant TIME VISIT/
INSPECTION COMPLETED:
01:00 PM
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On September 3, 2024, Licensing Program Analysts (LPAs) Monique Ayala and Priscilla Ochoa conducted an unannounced Case Management Inspection – Plan of Correction at the above facility. A COVID-19 risk assessment was conducted prior to entering the facility. LPAs met with licensee's assistant Norma Gonzalez, who guided LPAs on a tour of the facility. LPAs observed 6 children in care. Per assistant, the licensee stepped out for a family emergency. The purpose of this inspection is to ensure that the facility is in compliance with Title 22 Regulations and the deficiencies cited on 08/13/2024 were corrected.

Licensing staff observed and reviewed the following:

· Criminal Record Clearance for licensee's adult daughter

· Sleeping Log for infants

· Mandated Reporter Training

· LIC700

· Facility Roster

· LIC995A

· LIC282

Letters of Deficiencies Citations Cleared were provided for deficiencies corrected.

The Notice of Site Visit (LIC 9213) – must remain posted for 30 days during the hours of operation after each site visit by a licensing representative. Failure to maintain posting as required will result in a civil penalty of $100.00

An exit interview was conducted, and a copy of this report was provided to licensee's assistant Norma Gonzalez.

SUPERVISORS NAME: Ana Chico
LICENSING EVALUATOR NAME: Monique Jessica Ayala
LICENSING EVALUATOR SIGNATURE: DATE: 09/03/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/03/2024
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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