Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 192002652
Report Date: 03/04/2016
Date Signed 03/10/2016 11:49:07 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:TORRES FAMILY CHILD CAREFACILITY NUMBER:
192002652
ADMINISTRATOR:ROSA TORRESFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(562) 404-5219
CITY:NORWALKSTATE: CAZIP CODE:
90650
CAPACITY:14CENSUS: 5DATE:
03/04/2016
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
11:13 AM
MET WITH:Rosa TorresTIME COMPLETED:
12:40 PM
NARRATIVE
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A case management visit was conducted this date by Complaint Specialist, Karen Chambers. During this visit the following was observed and cited in accordance with, California Code of Regulations, Title 22, Division 12, Chapter 3


The Licensee was unable to provide the roster upon request as required, resulting in a confidential names list with 17 names being created. According to the Licensee she has one, but could not locate it.

Exit interview conducted with the Licensee, during which appeal rights were explained. A copy of the appeal rights (LIC9058 12/15) were provided. The Licensee’s signature on this reports acknowledges receipt of her rights.
SUPERVISOR'S NAME: Bertha ManzanaresTELEPHONE: (323) 981-3365
LICENSING EVALUATOR NAME: Karen ChambersTELEPHONE: (323)854-7636
LICENSING EVALUATOR SIGNATURE:

DATE: 03/04/2016
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/04/2016
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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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: TORRES FAMILY CHILD CARE
FACILITY NUMBER: 192002652
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/04/2016
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
03/07/2016
Section Cited
102417(g)(8)
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Operation of a Family Child Care Home. All homes shall have a current roster of the children.
This roster shall be available to the licensing agency upon request. The Licensee stated that she does have a roster, but was unable to locate and provide when requested, resulting in a confidential names list being created.
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Per Licensee: I will do it again, even though I know I have it.
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This is a potential risk to the health and safety of children if not corrected.
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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: Bertha ManzanaresTELEPHONE: (323) 981-3365
LICENSING EVALUATOR NAME: Karen ChambersTELEPHONE: (323)854-7636
LICENSING EVALUATOR SIGNATURE:

DATE: 03/04/2016
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/04/2016
LIC809 (FAS) - (06/04)
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