Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 191501110
Report Date: 03/13/2019
Date Signed 03/13/2019 11:16:23 AM

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:RIOS & GUTIERREZ FAMILY DAY CAREFACILITY NUMBER:
191501110
ADMINISTRATOR:RIOS,S & GUTIERREZ, EFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(909) 593-0308
CITY:LA VERNESTATE: CAZIP CODE:
91750
CAPACITY:14CENSUS: 3DATE:
03/13/2019
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
10:35 AM
MET WITH:Licensee Stella Rios TIME COMPLETED:
11:30 AM
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Licensing Program Analyst Ketki Desai conducted an unannounced Plan of correction inspection following an Annual Random inspection conducted on 3-5-19.
The purpose of the inspection was to clear several deficiencies issued on the day of inspection.
Following citations were cleared

(1) Children's files
(2) Emergency Disaster form posted
(3) Fire and Emergency drills conducted
(4) Hazardous items removed and area has been cleared in the backyard.
(5) Bathroom cabinets have the child proof locks installed
(6) Roster updated

Licensee shall submit the completion certificates (Pediatric CPR/First Aid and Mandated Reporter training and Immunization records by the due date.

No deficiency issued on today's inspection.

Notice of Site Visit shall be posted for 30 consecutive days. Failure to maintain posting as required, will result in an immediate $100 civil penalty.

Exit interview held with Licensee Stella Rios.


SUPERVISOR'S NAME: Adriana HernandezTELEPHONE: (323) 981-3362
LICENSING EVALUATOR NAME: Ketki DesaiTELEPHONE: (323) 981-3351
LICENSING EVALUATOR SIGNATURE:

DATE: 03/13/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/13/2019
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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