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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198400129
Report Date: 06/21/2023
Date Signed: 06/21/2023 03:44:34 PM

Document Has Been Signed on 06/21/2023 03:44 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 CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME:SANDOVAL FAMILY CHILD CAREFACILITY NUMBER:
198400129
ADMINISTRATOR:SUSANNA SANDOVALFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(424) 215-6263
CITY:CARSONSTATE: CAZIP CODE:
90745
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 10DATE:
06/21/2023
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
02:27 PM
MET WITH:Susanna SandovalTIME COMPLETED:
03:55 PM
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Licensing Program Analyst (LPA) Warren Birks conducted an unannounced Case Management Inspection. The purpose of today's inspection is to discuss an incident that took place in the neighborhood of the Licensee's facility on Saturday June 17, 2023 (early morning around midnight). LPA met with Licensee Susanna Sandoval and Cleared Assistant spouse who were caring for ten (10) children (six preschool and four school age).

Between approximately 2:30pm and 3:15pm LPA conducted observed premises and conducted interviews with Licensee and cleared Assistant spouse. LPA received corroborated disclosure indicating that the June 17, 2023 incident took place away from the facility (about eight houses down on or near the corner). Both also informed LPA that they were not interviewed by law enforcement and law enforcement never visited the facility at all. In addition, both indicated that they received no police reports regarding the incident. LPA observed the facility appear to be in safe and sanitary condition. During the inspection, LPA observed nothing indicating concern related to the June 17, 2023 incident. LPA informed Licensee that she may be contacted at a later date by LPA Navarro if necessary.

Note: Licensee Sandoval indicated that she called and emailed LPA Navarro on June 20, 2023 to discuss the incident. She informed LPA Birks that she thought the Licensing Department was closed on Monday for the Holiday. Licensee informed LPA Navarro that the June 17, 2023 incident did not affect any children or facility operations.

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. This report along with a copy of the appeal rights was provided. Exit interview was conducted with Licensee Susanna Sandoval.
SUPERVISORS NAME: Karen Chambers
LICENSING EVALUATOR NAME: Warren Birks
LICENSING EVALUATOR SIGNATURE: DATE: 06/21/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/21/2023
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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