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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198400129
Report Date: 11/19/2024
Date Signed: 11/19/2024 01:00:20 PM

Document Has Been Signed on 11/19/2024 01:00 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 SW RO, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME:SANDOVAL FAMILY CHILD CAREFACILITY NUMBER:
198400129
ADMINISTRATOR/
DIRECTOR:		SUSANNA SANDOVALFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(424) 215-6263
CITY:CARSONSTATE: CAZIP CODE:
90745
CAPACITY: 14TOTAL ENROLLED CHILDREN: 10CENSUS: 4DATE:
11/19/2024
TYPE OF VISIT:Case Management - Legal/Non-complianceUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:00 PM
MET WITH:Licensee, Susanna SandovalTIME VISIT/
INSPECTION COMPLETED:
01:10 PM
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On 11/19/2024, Licensing Program Analysts (LPAs) Jonnisha Culbert and Jeanette Estrada, conducted an unannounced Case Management Inspection. LPA met with Licensee Susanna Sandoval. The purpose for today's inspection is to ensure that the licensee is operating in full compliance following the Decision & Ordered- CDSS No. 7924116001 that became effective on date 11/04/2024 and to provide Licensee with a copy of LIC 995B Family Child Care Home Addendum to Notitfication of Parents' Rights (regarding removal/exclusion).

There was 4 children, 1 assistant, 2 adults (that lives in the home), present with Licensee when LPAs arrived. LPAs toured facility.
Decision & Order - CDSS No. 7924116001, the following was reviewed and observed:
  • Licensee Susanna Sandoval stated that she understands that the respondent Victoria Meza Cruz is excluded from all facilities licensed by the Department, certified or approved by a licensed foster family agency, or any resource family home, and from holding the position of member of board of directors, executive director, or officer of licensee of any facility licensed by the department for the rest of respondent, Victoria Meza Cruz's, life.
  • LPAs provided a copy of Decision & Order to Licensee, Susanna Sandoval.
  • LPAs reviewed all individuals residing or working in the home have been discussed.
  • All adults present during today's inspection in the home have obtained a criminal record clearance.
LPAs provided a copy of the LIC 995B- "Family Child Care Home Addendum to Notification of Parents' Rights (regarding removal/exclusion). The Licensee was advised that a copy of the Family Child Care Home Addendum to Notification of Parents’ Rights (Regarding Removal/Exclusion) LIC 995B must be provided to the parents of current and newly enrolled children and a copy of signed LIC995B is required to be maintained in each the children’s file. Failure to have a signed LIC995B receipt for each child will result in a civil penalty of $100.00 per family.
The Notice of Site Visit (LIC 9213) – was given and must remain posted for 30 days. Exit interview was conducted with Licensee Susanna Sandoval.
SUPERVISORS NAME: Karen Chambers
LICENSING EVALUATOR NAME: Jonnisha Culbert
LICENSING EVALUATOR SIGNATURE: DATE: 11/19/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/19/2024
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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