Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197409882
Report Date: 07/13/2018
Date Signed: 07/13/2018 03:09:23 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
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: 8DATE:
07/13/2018
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
02:00 PM
MET WITH:Isabel GuzmanTIME COMPLETED:
03:05 PM
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Licensing Program Analyst (LPA) Silva Garibyan visited the facility for the purpose of a Plan of Correction (POC) visit. On the initial visit of 07/05/2018, LPA observed the licensee's assistant caring for a total of 9 children including 3 infants and 6 preschoolers. Licensee was over by 3 children (no school age children were present). Licensee was cited for the following deficiency:

1) Staffing Ratio and Capacity

Upon LPA’s arrival Licensee and her assistant were present with 8 children (including two infants). LPA observed the LIC 9224 ( Acknowledgement of Receipt of Licensing Reports) in the children's files.

At the time of the Plan Of Correction visit the facility was found to be in substantial compliance.

Exit interview was conducted and copy of report was provided.
SUPERVISOR'S NAME: Mary RuizTELEPHONE: (424) 301-3061
LICENSING EVALUATOR NAME: Silva GaribyanTELEPHONE: (424) 301-3062
LICENSING EVALUATOR SIGNATURE:

DATE: 07/13/2018
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/13/2018
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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