Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197409882
Report Date: 03/16/2017
Date Signed: 03/30/2017 09:33:13 AM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 6167 BRISTOL PARKWAY #400
CULVER CITY, CA 90230
FACILITY NAME:GUZMAN FAMILY CHILD CAREFACILITY NUMBER:
197409882
ADMINISTRATOR:GUZMAN, ISABELFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(818) 763-7849
CITY:NORTH HOLLYWOODSTATE: CAZIP CODE:
91601
CAPACITY:14CENSUS: 6DATE:
03/16/2017
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Isabel Guzman, LicenseeTIME COMPLETED:
10:45 AM
NARRATIVE
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This is an amended report. Facility Evaluation deficiency report has been amended. Mariela Ramon, Licensing Program Analyst/Complaint Specialist (CS) conducted a visit to the facility for the purpose to issue deficiencies observed at the facility on 03/08/17. Upon arrival, CS observed 1 infant and 5 preschool age children in care with the licensee, licensee's husband and licensee's assistant. During today's visit, the facility capacity/ratio were in compliance.

During a visit conducted on 03/08/17, licensee disclosed to CS that on 03/06/17, licensee was providing care to 4 infants and 10 preschool age children. There were no school age children in care. Licensee's husband and licensee's assistant were assisting licensee to provide care to the children. The facility did not meet Title 22 Regulations for the license ratio. A large family day care home may provide care for more than 12 children and up to and including 14 children, if all the following conditions are met:
  • At least one child is enrolled in and attending kindergarten or elementary school and a second child is at least six years of age.

  • No more than three infants are cared for during any time when more than 12 children are being cared for


On 03/08/17, licensee provided CS with an incomplete facility roster. Licensee shall maintain a current roster of children who are provided care in the facility. The roster shall include the name, address, and daytime telephone number of the child's parent or guardian.

The facility was cited a type A and B deficiencies. Please see Facility Evaluation Report LIC 809D for deficiencies cited.
SUPERVISOR'S NAME: Mary RuizTELEPHONE: (310) 337-4826
LICENSING EVALUATOR NAME: Mariela RamonTELEPHONE: (310) 337-4809
LICENSING EVALUATOR SIGNATURE:

DATE: 03/16/2017
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/16/2017
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 4


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 6167 BRISTOL PARKWAY #400
CULVER CITY, CA 90230
FACILITY NAME: GUZMAN FAMILY CHILD CARE
FACILITY NUMBER: 197409882
VISIT DATE: 03/16/2017
NARRATIVE
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Licensee was advised upon receipt of this report, the report must be posted along with the notice of site visit for 30 days for parents to view. Licensee must inform the parents/guardians of children in care at the facility and to parents/guardians of children newly enrolled at the facility during the next 12 months via form LIC 9224 Acknowledgement of Receipt of Licensing Reports.

An exit interview was conducted and a copy of this report was provided to licensee.
SUPERVISOR'S NAME: Mary RuizTELEPHONE: (310) 337-4826
LICENSING EVALUATOR NAME: Mariela RamonTELEPHONE: (310) 337-4809
LICENSING EVALUATOR SIGNATURE:

DATE: 03/16/2017
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/16/2017
LIC809 (FAS) - (06/04)
Page: 4 of 4


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 6167 BRISTOL PARKWAY #400
CULVER CITY, CA 90230
FACILITY NAME: GUZMAN FAMILY CHILD CARE
FACILITY NUMBER: 197409882
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/16/2017
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
03/16/2017
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. On 03/08/17, licensee provided CS with an incomplete facility roster. This is a type B deficiency that if not corrected, it could become a risk to the Health, Safety or the personal rights of children in care.
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On 03/08/17, licensee provided CS with an up to date facility roster. POC cleared during the visit.
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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: Mary RuizTELEPHONE: (310) 337-4826
LICENSING EVALUATOR NAME: Mariela RamonTELEPHONE: (310) 337-4809
LICENSING EVALUATOR SIGNATURE:

DATE: 03/16/2017
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/16/2017
LIC809 (FAS) - (06/04)
Page: 3 of 4


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 6167 BRISTOL PARKWAY #400
CULVER CITY, CA 90230
FACILITY NAME: GUZMAN FAMILY CHILD CARE
FACILITY NUMBER: 197409882
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/16/2017
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
03/16/2017
Section Cited
102416.5 (a)(d)
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Staffing Ratio and Capacity. The capacity specified on the license shall be the maximum number of children for whom care can be provided. On 03/06/17, licensee provided care to 4 infants and 10 preschool age children. This is a Type A violation and it poses an immediate risk to the health and safety of children in care.

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Licensee stated that effective immediately she will follow the license capacity and ratio regulation. Licensee provided CS with a written statement indicating the above information. POC cleared during the visit.
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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: Mary RuizTELEPHONE: (310) 337-4826
LICENSING EVALUATOR NAME: Mariela RamonTELEPHONE: (310) 337-4809
LICENSING EVALUATOR SIGNATURE:

DATE: 03/16/2017
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/16/2017
LIC809 (FAS) - (06/04)
Page: 2 of 4