Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198012910
Report Date: 11/26/2018
Date Signed 11/26/2018 10:54:25 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:JIMENEZ FAMILY CHILD CAREFACILITY NUMBER:
198012910
ADMINISTRATOR:JIMENEZ, VERONICAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(626) 633-2083
CITY:DUARTESTATE: CAZIP CODE:
91010
CAPACITY:14CENSUS: 12DATE:
11/26/2018
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
10:10 AM
MET WITH:Veronica Jimenez, LicenseeTIME COMPLETED:
11:00 AM
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An unannounced Case Management inspection was conducted on this date by Licensing Program Analyst (LPA), Carlos Gonzalez. LPA met with Veronica Jimenez, Licensee, who guided Analyst on a tour of the facility. Also present at the facility were Licensee's Assistant's, Lindsey McGaffey and Elizabeth Maldonado. LPA observed twelve (12) children in care at the time of inspection, three (3) of whom were infants. The purpose for the inspection is to determine if Licensee is operating in accordance with California Code of Regulations Title 22. Per Licensee, twenty (20) children are currently enrolled in care at this time. A facility roster was available and is current.

Based on LPAs observations and records review, there are no deficiencies being cited at this time. Licensee is in compliance with California Code of Regulations Title 22.

The Notice of Site Visit (LIC 9213)must remain posted for 30 days during the hours of operation after each site visit made by a licensing representative. Failure to maintain posting as required will result in a civil penalty of $100.00.

Exit interview was conducted with Veronica Jimenez, Licensee, including, but not limited to Provider Rights, Appeal Procedures and Agencies Consultative Role.
Report ends page 1 of 1
SUPERVISOR'S NAME: Brandi VanOostenTELEPHONE: (323) 981-3439
LICENSING EVALUATOR NAME: Carlos GonzalezTELEPHONE: (323) 981-3381
LICENSING EVALUATOR SIGNATURE:

DATE: 11/26/2018
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/26/2018
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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