Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 192002652
Report Date: 06/10/2016
Date Signed 06/10/2016 04:24:21 PM

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: 10DATE:
06/10/2016
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
11:34 AM
MET WITH:Claudia Salazar & Rosa TorresTIME COMPLETED:
01:00 PM
NARRATIVE
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Upon the initial arrival of this LPA, the Licensee was not present and her assistant was observed to be supervising seven children, of which three were under the age of two. At 11:49 the 8th child arrived. The Licensee was out of ratio by one infant. The Licensee arrived at 12:03 with two additional children.

The Licensee was not able to provide paperwork for a child that has been in care for the last week. According to the Licensee, the parent has not turned in any of the paperwork, including the identification and emergency form

The following is being cited in accordance with Title 22, California Code of Regulations:

1. There was only one adult/assistant present to initially care for seven children then eight children, of which three were under the age of two, making the Licensee out of ratio by one infant.

2. Licensee did not have the identification and emergency form for child #4 as required.

Upon receipt the Licensee shall post this report where the parent/guardian of children enter and exit the facility. The notice of site was posted where the parent/guardian of children enter and exit the facility. The notice of site visit and licensing report shall be posted for 30 consecutive days. Failure to maintain posting as required will result in a $100.00 civil penalty. A copy of this report shall be provided to the parent/guardian of children in care by the next business day or immediately upon return. A copy of this report shall be provided to the parent/guardian of any newly enrolled child for the next 12 months.

Exit interview conducted with the Licensee, during which appeal rights were explained. A copy of the appeal rights (LIC9058 1/16) 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: 06/02/2016
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/10/2016
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC809 (FAS) - (06/04)
Page: 1 of 3


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: 06/10/2016
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
06/14/2016
Section Cited
102417(g)7
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Operation of a Family Child Care: An emergency information card shall be maintained for each child. The Licensee did not have any paperwork for child #4 as required including the identification and emergency form.
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Per Licensee: I will give another set to the parent and have them complete tonight. I will have the parent fill out the paperwork before they start. Licensee will submit a written plan.

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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: 06/10/2016
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/10/2016
LIC809 (FAS) - (06/04)
Page: 2 of 3


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: 06/10/2016
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
06/13/2016
Section Cited
102416.5(e)
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Staffing Ratio & Capacity: If no assistant provider is present at a Large Family Child Care Home, then the licensee shall comply with the capacity requirements for a Small Family Child Care Home as specified in subsections (b) and (c). There were initially seven children then the 8th child arrived,
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Per Licensee: I will count the children and take some with me when I leave if I need to.

Licensee will submit a written plan.
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left in the care of the assistant, while the Licensee was out. Of the initial seven then the 8th child, three of them were infants, making the Licensee out of ratio by one infant.
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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: 06/10/2016
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/10/2016
LIC809 (FAS) - (06/04)
Page: 3 of 3